Humoral and cellular factors of the mucosaal system of the respiratory tract in assessing the effectiveness of treatment of patients with chronic tonsillitis

   Objective. To assess the efficacy of various types of comprehensive treatment for patients with chronic tonsillitis, using the dynamics of lysozyme, lactoferrin, secretory immunoglobulin A (sIgA), and NETosis products in smears from the surface of the palatine tonsil lacunae as criteria.

   Materials and methods. The study enrolled 120 patients aged 18–65 years diagnosed with chronic tonsillitis. All patients were divided into three groups of 40 individuals each. Group 1 patients underwent a two-stage vacuum and manual lavage of the palatine tonsils, followed by intralacunar administration of an oil solution of chlorophyllipt. In Group 2, the procedures were supplemented with exposure to low-intensity laser radiation. In Group 3, intralacunar administration of exogenous nitric oxide was additionally applied. The levels of humoral factors (lactoferrin, lysozyme, and serum immunoglobulin A [sIgA]) and cellular factors (products of neutrophil extracellular trap transformation) of the mucosal system of the respiratory tract were evaluated before treatment, and 1, 6, and 12 months after therapy. Statistical analysis was conducted using Statistica 12 software. The median, first and third quartiles of Me [LQ; UQ], mean value and standard deviation (M ± σ) were calculated. Statistical differences between groups were assessed using the Mann-Whitney U test and Fisher's exact test. A significance level of p < 0.05 was accepted for all analyses.

   Results. Statistically significant improvement in humoral factors (lactoferrin, lysozyme, sIgA) of the mucosal system was observed in the combined treatment groups utilizing physiotherapeutic methods. The proportion of patients with no NETosis products at 1 month after the course of therapy accounted for 27.5 %, 37.5 % and 40 %, at 12 months – 22.5 %, 40 % (p < 0.05) and 35 % (p < 0.05) against the initial 17.5 %, 20 % and 17.5 % in Groups 1, 2 and 3, respectively. In Group 1, the number of patients with moderate and high levels of NETosis products decreased by 10 %, 5 %, and 10 % (p < 0.05) in one, six, and twelve months after therapy, respectively; in Group 2, it reduced by 19 % (p < 0.05), 14.3 % (p < 0.05), and 33.3 % (p < 0.05); in Group 3, this number declined by 33.3 % (p < 0.05), 23.8 % (p < 0.05), and 47.4 % (p < 0.05), correspondingly.

   Conclusion. When selecting a conservative treatment algorithm, the advantages lie with a combined approach that includes a comprehensive irrigation-elimination regimen alongside physiotherapeutic methods, particularly laser therapy and nitric oxide therapy, the efficacy of which can be objectively confirmed by the dynamics of humoral and cellular factors of the mucosal system of the respiratory tract.

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