Vol.6, No 1, 1999 pp. 97 - 102
UC 618.2;612.65 
CHRONIC DISEASES IN CHILDHOOD AS A CONSEQUENCE
OF IMMUNE SYSTEM DISFUNCTION OF MOTHER DURING PREGNANCY
Borislav Kamenov, Hristina Dimitrijević, Gordana Tasić, Svetlana Pljaskić
Clinic of Pediatrics and Department of Microbiology University School of Medicine Niš, Yugoslavia
Health Center Niš, Yugoslavia
Summary: Growth and development of the embryo and fetus in the antigen "privileged" environment and Th2 response predominance of mother's immune system are necessary for appropriate development of the immune system (prevention of clonal abortion anergy, apoptosis) as well as for the development of other organs and tissues. Cytokines of Th1 response, oxygen free radicals and nitrites with their potential to influence gene expression may seriously interfere with cell proliferation, differentiation, apoptosis and migration. Many acute viral infections are known to cause death of the embryo or serious anomalies. Prenatal development of Th1 microenvironment is analyzed as a possible factor for the immune system dysfunction and its possible influence on chronic diseases in childhood. 250 children, having in common chronic disease, were analyzed in relation to Th1 response predominance of mother's immune system during pregnancy in a paralell with 100 Chlidren and they mothers treated because of acute infactions and without sighns of chronic diseases. Beside the specific examinations for appropriate organ or system the following parameters were analyzed: red and white blood cell counts, hemoglobin level serum immunoglobulin level ELISA : HSV, CMV, EBV, HIV; NBT, phenotyping of peripheral blood mononuclear cells: CD2 CD3, CD4, CD8, DR, CD25, CD56; electrophoresis of the serum proteins immune complexes, autoantibodies, enzymes: CPK, LDH, AST and ALT. Chronic disease with Th1 type response was present in 231 mothers: iron resistant anemia 163, viral infections 114 (HSV and CMV the most often), bacterial infections 6, autoimmune diseases 15, acute viral infections in 21 mothers. 75 mothers were treated during pregnancy with hormones or tocolitics. Problems with previous pregnancies had 28 because of sterility 163-spontaneous abortions, 5-dead born newboms. The most of the children had problems after birth manifested as hypo or hypertrophy, inappropriate respiratory, cardiovascular and termoregulatory adaptation. Clinical manifestations in examined children were: anemia-197, lymphadenopathy-155, higher incidence of infections-87, vasculitis-72, nervous system dysfunction-54, asthma-36, angioedema- 32, stomatitis-21, hepatitis-19, polyarthritis-15, leucopenia-14, anomalies-13 rachitis-8 non epidemic parotitis-7, malapsorption-6, malignant diseases in the later follow up-4, and chromosomal aberrations-3. 82 % of the patients had higher activity in most of the examined enzymes (CPK, LDH, AST and ALT).
Key words: Immune system dysfunction, Th1 cytokines in pregnancy, chronic diseases in childhood
HRONIČNE BOLESTI U DETINJSTVU KAO POSLEDICA
DISFUNKCIJE IMUNSKOG SISTEMA MAJKE ZA VREME TRUDNOĆE

Kratak sadržaj: Rast i razvoj embriona i fetusa u antigeno ptivilegovanoj sredini i dominacija Th2 odgovora majke su neophodni za adekvatni razvoj imunskog sistema (prevencija abortusa klona, anergije i apoptoze) kao i za razvoj drugih organa i tkiva. Citokini Th1 odgovora, slobodni radikali kiseonika i nitriti sa svojim potencijalom da utiču na ekspresiju gena mogu ozbiljno da interferiraju sa ćelijskom proliferacijom, diferencijacijom apoptozom i migracijom. Mnoge akutne virusne infekcije su poznate po svom potencijalu da izazovu smrt ploda ili dovedu do ozbiljnih anomalija. Prenatalno uspostavljanje Th1 odgovora se analizira kao mogući faktor disfunkcije imunskog sistema i njegovog uticaja na pojavu hroničnih bolesti u detinjstvu. Analizirano je 250 dece koja su bolovala od hroničnih bolesti u odnosu na postojanje Th1 odgovora majke u toku trudnoće u poređenju sa 100 dece i njihovih majki lečenih zbog akutne infekcije, a bez znakova hronične bolesti. Pored ispitivanja specifičnih za organ ili sistem, analizirani su sledeći parametri: broj eritrocita i leukocita, LGL, nivo hemoglobina, ELISA test na HSV, CMV, EBV, HIV; NBT, fenotipizacija mononuklearnih leukocita periferne krvi: CD2, CD3, CD4, CD8, DR, CD25, CD56; elektroforeza serumskih proteina, imunske komplekse, autoantitela, anzime: CPK, LDH, AST i ALT. Hronična bolest majke sa Th1 odgovorom je postojala kod 231 majke: gvožđe rezistentna anemija kod 163, virusna infekcija kod 114 (najčešće HSV i CMV), bakterijska infekcija 6, autoimunskih bolesti 15, akutnih virusnih infekcija 21. Kod 75 majki primenjeno je lečenje hormonima i tokoliticima u toku trudnoće, 28 majki je lečeno zbog steriliteta, 63 je imalo spontani abortus, a 5 je rađalo mrtvu decu. Većina dece je pokazivalo hipo ili hipertrofiju i neadekvatnu respiratornu, kardiovaskularnu i termoragulacionu adaptaciju posle rođenja. Kliničke manifestacoije kod ispitivane dece su bile: anemija 197, limfadenopatija 155, česte infekcije 87, vaskulitis 72, disfunkcije CNS-a 54, astma 36, angioedema 32, stomatitis 21, hepatitis 19, poliartritis 15, leukopenija 14, anomalije 13, rahitis 8, neepidemijski parotitis 7, malapsorpcioni sindrom 6, maligne bolesti u kasnijem periodu 4, hromozomske aberacije 3. 82% ispitanika pokazivala je povišene vrednosti bar jednog od ispitivanih enzima (CPK, LDH, ALT, AST).
Ključne reči: Disfunkcija imunskog sistema, Th1 citokini u trudnoći, hronične bolesti u detinjstvu