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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">mimmun</journal-id><journal-title-group><journal-title xml:lang="ru">Медицинская иммунология</journal-title><trans-title-group xml:lang="en"><trans-title>Medical Immunology (Russia)</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1563-0625</issn><issn pub-type="epub">2313-741X</issn><publisher><publisher-name>SPb RAACI</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.15789/1563-0625-EOP-3177</article-id><article-id custom-type="elpub" pub-id-type="custom">mimmun-3177</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group></article-categories><title-group><article-title>Ферменты пуринового метаболизма и субпопуляции лимфоцитов у больных лекарственно-чувствительным и лекарственно-устойчивым инфильтративным туберкулезом легких</article-title><trans-title-group xml:lang="en"><trans-title>Enzymes of purine metabolism and lymphocyte subpopulations in patients with drug-sensitive and drug-resistant infiltrative pulmonary tuberculosis</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7810-880X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дьякова</surname><given-names>М. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Dyakova</surname><given-names>M. Ye.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Дьякова Марина Евгеньевна - д.б.н., старший научный сотрудник отдела фундаментальной медицины.</p><p>191036, Санкт-Петербург, Лиговский пр., 2-4. Teл.: 8 (921) 375-54-32</p></bio><bio xml:lang="en"><p>Marina Ye. Dyakova - PhD, MD (Biology), Senior Researcher, Department of Fundamental Medicine.</p><p>2-4 Ligovsky Ave St. Petersburg 191036 Phone: +7 (921) 375-54-32</p></bio><email xlink:type="simple">marinadyakova@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2418-9368</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Серебряная</surname><given-names>Н. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Serebryanaya</surname><given-names>N. B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д.м.н., профессор кафедры цитологии и гистологии биологического ГУ»; профессор кафедры клинической микологии, аллергологии и иммунологии ФГБОУ ВО «Северо-Западный ГМУ имени И.И. Мечникова» Министерства здравоохранения РФ; заведующая лабораторией общей иммунологии ФГБНУ «Институт экспериментальной медицины».</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>PhD, MD (Medicine), Professor, Department of Cytology and Histology, Faculty of Biology, St. Petersburg State University; Professor, Department of Clinical Mycology, Allergology and Immunology, I. Mechnikov North-Western State Medical University; Head, Laboratory of General Immunology, Institute of Experimental Medicine.</p><p>St. Petersburg</p></bio><email xlink:type="simple">nbvma@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9841-0061</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Эсмедляева</surname><given-names>Д. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Esmedlyaeva</surname><given-names>D. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>к.б.н., старший научный сотрудник отдела фундаментальной медицины.</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>PhD (Biology), Senior Researcher, Department of Fundamental Medicine.</p><p>St. Petersburg</p></bio><email xlink:type="simple">diljara-e@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4385-9643</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Яблонский</surname><given-names>П. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Yablonskiy</surname><given-names>P. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>.м.н., профессор, директор ФГБУ «Санкт-Петербургский Научно-исследовательский институт фтизиопульмонологии» Министерства здравоохранения РФ; проректор по медицинской деятельности ФГБОУ ВО «Санкт-Петербургский ГУ».</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>PhD, MD (Medicine), Professor, Director, St. Petersburg State Research Institute of Phthisiopulmonology; Deputy Rector for Medicine, St. Petersburg State University, St. Petersburg, RFMU (Sechenov University).</p><p>Moscow</p></bio><email xlink:type="simple">piotr_yablonskii@mail.ru</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБУ «Санкт-Петербургский Научно-исследовательский институт фтизиопульмонологии» Министерства здравоохранения РФ</institution><country>Россия</country></aff><aff xml:lang="en"><institution>St. Petersburg State Research Institute of Phthisiopulmonology</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБОУ ВО «Санкт-Петербургский государственный университет»; ФГБОУ ВО «Северо-Западный государственный медицинский университет имени И.И. Мечникова» Министерства здравоохранения РФ; ФГБНУ «Институт экспериментальной медицины»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>St. Petersburg State University; I. Mechnikov North-Western State Medical University; Institute of Experimental Medicine</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФГБУ «Санкт-Петербургский Научно-исследовательский институт фтизиопульмонологии» Министерства здравоохранения РФ; ФГБОУ ВО «Санкт-Петербургский государственный университет»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>St. Petersburg State Research Institute of Phthisiopulmonology; St. Petersburg State University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>14</day><month>02</month><year>2026</year></pub-date><volume>28</volume><issue>1</issue><fpage>87</fpage><lpage>98</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Дьякова М.Е., Серебряная Н.Б., Эсмедляева Д.С., Яблонский П.К., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Дьякова М.Е., Серебряная Н.Б., Эсмедляева Д.С., Яблонский П.К.</copyright-holder><copyright-holder xml:lang="en">Dyakova M.Y., Serebryanaya N.B., Esmedlyaeva D.S., Yablonskiy P.K.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.mimmun.ru/mimmun/article/view/3177">https://www.mimmun.ru/mimmun/article/view/3177</self-uri><abstract><p>Клиническое течение туберкулеза и в конечном итоге его клинический исход обусловлены сложным взаимодействием между Mycobacterium tuberculosis (Mtb) и иммунными клетками хозяина. Цель настоящего исследования – оценить состояние ферментов пуринергической системы и субпопуляционный состав лимфоцитов у больных с впервые выявленным инфильтративным туберкулезом легких в зависимости от лекарственной устойчивости Mtb к противотуберкулезным препаратам. У 109 больных инфильтративным туберкулезом легких (ИТЛ), вызванным лекарственно-устойчивыми и лекарственно-чувствительными штаммами Mtb, которые достигли значительного или менее выраженного улучшения после проведения интенсивной фазы химиотерапии, до начала лечения оценивали активность аденозиндезаминазы в сыворотке крови (eADA-1, 2), мононуклеарах и нейтрофилах, концентрацию экто-5’-нуклеотидазы (eNT5E) в сыворотке крови, CD26 (DPPIV) в сыворотке (s, растворимая форма) и мононуклеарах (m, мембраносвязанная форма), субпопуляционный состав лимфоцитов. У больных ИТЛ, выделяющих лекарственно-чувствительные штаммы Mtb, достигших «менее выраженного улучшения», статистически значимыми были увеличение концентрации и активности эктоферментов, ответственных за образование внеклеточного аденозина (eNT5E) и его трансформацию (eADA-1 и eADA-2), а также увеличением доли цитотоксических Т-клеток по сравнению с больными, достигшими значительного улучшения. При этом у больных, выделяющих лекарственно-устойчивые штаммы Mtb, достигших «менее выраженного улучшения», отметили более низкие показатели абсолютного числа Т-лимфоцитов, Т-хелперов при увеличении доли цитотоксических Т-клеток, а также усилении активности eADA-2, по сравнению с лицами, достигшими значительного улучшения. До начала противотуберкулезной химиотерапии активность ферментов пуринового метаболизма и субпопуляционный состав лимфоцитов не были связаны с характеристиками лекарственной устойчивости Mtb. Хотя существенное число взаимосвязей между показателями ферментов пуринергической регуляции и количеством/долей лимфоцитов определено у больных, достигших значительного улучшения, при менее выраженном улучшении, независимо от лекарственной устойчивости Mtb, таких взаимосвязей не выявлено. Это свидетельствует о несбалансированности факторов воспаления (представленного ферментами пуринового метаболизма) и иммунного ответа на Mtb у лиц, показавших худшие результаты исходов интенсивной фазы химиотерапии. Учитывание вклада каждого компонента защитных реакций необходимо как для оценки их значимости при различных исходах лечения, так и для назначения адекватной химиотерапии, патогенетической терапии и иммунокоррекции, направленной на прекращение прогрессирования заболевания.</p></abstract><trans-abstract xml:lang="en"><p>The purpose of our study was to evaluate the enzyme profile of purinergic system and lymphocyte subsets in patients with newly diagnosed infiltrative pulmonary tuberculosis (IPT), depending on the drug resistance of Mycobacterium tuberculosis (Mtb) to anti-tuberculosis drugs. In 109 patients with drug-sensitive Mtb (significant or less pronounced improvement after intensive phase of chemotherapy), or in drug-resistant cases, the activity of adenosine deaminase (eADA-1, 2), concentration of ecto-5’-nucleotidase (eNT5E), CD26 (DPPIV), and the composition of lymphocyte subsets were evaluated before treatment. The IPT patients with drug-sensitive Mtb strains who achieved a “less pronounced improvement” exhibited higher concentrations and activity of ectoenzymes responsible for production of extracellular adenosine (eNT5E) and its transformation (eADA-1 and eADA-2). The proportion of cytotoxic T cells was also higher compared with patients who achieved significant improvement. Patients isolating drug-resistant Mtb strains who achieved a “less pronounced improvement” had lower absolute counts of T lymphocytes and helper T cells with an increased proportion of cytotoxic T cells and elevated eADA-2 activity compared with individuals who achieved significant improvement. Thus, prior to initiation of tuberculosis chemotherapy, the activity of purine metabolism enzymes and the subpopulation profile of lymphocytes were not associated with the characteristics of Mtb drug resistance. A relationship between the parameters of purinergic regulation enzymes and numbers/ ratio of lymphocytes was revealed in patients who achieved significant improvement. Such relationships were not revealed in the group with less pronounced improvement, regardless of the drug resistance of Mtb. These findings suggest an imbalance of inflammatory factors and immune response to Mtb in the patients who showed worse clinical outcomes after intensive chemotherapy. Taking into consideration each component of protective reactions is required for administration of adequate chemotherapy, pathogenetic treatment, and immunocorrective treatment in order to prevent progression of the disease.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>ферменты пуринового метаболизма</kwd><kwd>популяции лимфоцитов</kwd><kwd>лекарственная чувствительность</kwd><kwd>туберкулез</kwd><kwd>воспаление</kwd><kwd>исходы терапии</kwd></kwd-group><kwd-group xml:lang="en"><kwd>purine metabolism enzymes</kwd><kwd>lymphocyte population</kwd><kwd>drug sensitivity</kwd><kwd>tuberculosis</kwd><kwd>inflammation</kwd><kwd>therapy outcomes</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Вишневский Б.И., Яблонский П.К. Персистенция Mycobacterium tuberculosis — основа латентного туберкулеза (обзор литературы) // Медицинский альянс, 2020. Т. 8, № 2. 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