Резюме. Показано, что у больных бронхиальной астмой теломеры лимфоцитов и CD4 + клеток периферической крови короче, чем у доноров, и такое укорочение происходит в разных субпопуляциях в зависимости от клинико-патогенетической формы астмы. В подгруппе с инфекционно-зависимой астмой выявлено укорочение теломер в CD4 + и в CD8 + Т-лимфоцитах, у больных с астмой атопического генеза-только в CD4 + клетках. У больных астмой смешанного генеза изменения длины теломер не обнаружено, однако выявлена достоверная прямая зависимость между длиной теломер CD4 + и CD8 + Т-лимфоцитов и концентрацией сывороточного IgE. Оказалось, что чем выше уровень IgE в сыворотке крове пациента, тем более длинные теломеры в обеих субпопуляциях лимфоцитов. Полученные данные говорят о том, что сокращение теломер в лимфоцитах может происходить не только при истощении Т-клеточного пула и индуцируемой лимфопенией гомеостатической пролиферации, но и при экспансии антиген-реактивных клеток. Все эти данные говорят в пользу серьезных патогенетических различий разных форм бронхиальной астмы, важной основой которых может быть разный вклад атопического и инфекционного воспаления в развитие заболевания.

Circadian variations in the immune status and serum melatonin were studied in asthmatics during exacerbation stage before and after treatment. Deviations from the normal (donor) immunogram values at 9.00 and 21.00 and decreased correlations between immune values and blood melatonin level were detected. The correlations of immune values between each other and with melatonin over the circadian cycle increased after treatment.

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Aim. To assess the impact of autologous activated T-lymphocyte immunotherapy on clinical parameters and quality of life in patients with allergic bronchial asthma (BA) in comparison with patients with allergic BA who received standard therapy.Materials and methods. A non-randomized, pilot study included 19 patients with allergic BA of moderate severity (7 men and 12 women aged 23–61 years, average age – 38.5 ± 4.3 years) who received the T-cell vaccine (n = 12) and standard therapy with inhaled glucocorticoids, short- and long-acting β2-adrenergic agonists (n = 7). After signing an informed consent, the patients were subcutaneously injected with autologous activated T-lymphocytes with a frequency of 4 injections 1 time / week, and then 6 injections 1 time / month. The research methods included asthma control measurement according to the ACQ-5 questionnaire and quality of life assessment according to the AQLQ(S) questionnaire. Clinical data were collected during lung function tests and by measuring the total immunoglobulin E (IgE) level.Results. In the course of the study, the immunotherapy was well tolerated, no systemic adverse reactions were noted. The treatment approach in the patients who received the T-cell vaccine resulted in significant improvement of asthma control parameters (according to the ACQ-5 questionnaire) and parameters of the patients’ quality of life (according to the AQLQ(S) questionnaire) within all 4 categories. Besides, their lung function improved by the end of treatment, and the total IgE level decreased. No significant changes in these parameters were observed during the follow-up in patients who received standard therapy. The study was conducted before immunotherapy, after 2 months (after 5 injections), and after 7 months (after 10 injections).Conclusion. Evaluation of the impact of immunotherapy with autologous activated T-lymphocytes on the clinical parameters and quality of life in patients with BA indicates effectiveness of treatment in patients with allergic BA.