CHEMILUMINESCENT ACTIVITY OF NEUTROPHILIC GRANULOCYTES IN PROGRESSION OF OBSTRUCTIVE JAUNDICE DEPENDING ON ITS ORIGIN AND BILIRUBIN LEVELS

Mechanical jaundice (MJ) is a severe pathological condition, caused by obstruction of the bile ducts, requiring immediate surgical intervention. Etiologically, MJ can be of benign (60-80% of the cases,) or malignant origin. MJ progression depends on the underlying pathology, and, moreover, on bilirubin levels. Focal inflammation in affected area represents a significant mechanism of the MJ progression. Neutrophilic granulocytes, are primarily involved into the immune response, i.e., pathogen elimination. Hence, the MJ progression may depend on their functional activity. In this context, the aim of our study was to investigate chemiluminescent activity of neutrophil granulocytes in progression of MJ, depending on the bilirubin levels and origin of the jaundice. All the MJ patients showed altered chemiluminescent activity of granulocytes. Both spontaneous and induced chemiluminescence (CL) intensity was decreased in the patients with gallstoneassociated MJ. Meanwhile, the CL intensity did not change in MJ caused by benign tumors (BTP). An increased activation index reflected higher induced activity of phagocytes. In patients with MJ of malignant origin, the largest number of changes was found, i.e., an increase in the induced luminescence intensity and higher activation indexes were revealed. The MJ progression depends on blood bilirubin levels. All the patients with gallstone-related MJ exhibited a decrease in spontaneous and induced CL activity of the neutrophils. In cases of BTP-caused MJ, the indexes of spontaneous and induced CL decreased at the bilirubin levels of 60 to 200 mmol/L, with increased activation index suggesting elevated induced activity over its spontaneous levels. In patients with MJ and bilirubin levels >200 mmol/L, distinct unidirectional changes in the granulocyte activation were observed, with increased spontaneous and induced CL intensity. In patients with MJ caused by malignancies with bilirubin levels <60 mmol /L , both spontaneous and induced CL activity were reduced, whereas, at 60 to 200 mmol/L, a recovery of granulocytic activity was observed. In the cases of bilirubin levels of >200 mmol/L, an increased spontaneous and induced activity of granulocytes was registered in these cases, probably, due to development of multi-organ failure and toxic effects of bilirubin. The granulocytes seem to exhibit their maximal activity, until exhaustion of their functional limits.

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