Молодежный инновационный вестник

2415-7805

Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации

8288

Unclassified

ASSESSMENT OF THE PREVALENCE OF AUTOIMMUNE DISEASES AMONG STUDENTS

Aralova

Victoria S.

vikaaralova2014@mail.ruhttps://orcid.org/0000-0002-7290-9390Alvane

Kamilla H.

alvanekamilla@yandex.ruhttps://orcid.org/0000-0003-1140-1160

Voronezh State Medical University named after N.N. Burdenko

20042023

12S2272275

13022023

14042023

2023

Every year in the world by 12.5% there is an increase in the number of cases of autoimmune diseases (AD), which are based on the development of a cascade of immune responses to antigens of the body's own tissues. These diseases are one of the main causes of disability in the population. ADs include: diabetes mellitus, rheumatoid arthritis, autoimmune thyroiditis (AIT), celiac disease, and others. Purpose. To analyze the prevalence of autoimmune diseases among university students and evaluate the role of the hereditary factor. Materials and methods. We analyzed data on the presence of autoimmune diseases in 243 students enrolled in higher education programs from 1 to 6 courses. The research method was an online questionnaire, which contained a list of questions aimed at identifying autoimmune diseases and hereditary predisposition. Results. According to the data obtained during the study, it was found that 3.7% of respondents have autoimmune diseases (diabetes mellitus, AIT, celiac disease, rheumatoid arthritis). 6.3% have a hereditary predisposition - relatives suffer. It has been established that the female population is at higher risk than the male population. Conclusion. It should be said that autoimmune diseases are considered difficult to treat at the moment and require a more detailed study of the features of pathogenesis, diagnosis and treatment. It is also worth noting that great importance is given to heredity in the development of autoimmune diseases.

autoimmune diseasesrheumatoid arthritisceliac diseaseautoimmune thyroiditis

аутоиммунные заболеванияревматоидный артритцелиакияаутоиммунный тиреоидит

Autoimmune diseases (AD) are an urgent public health problem, as their number is steadily growing from year to year. It is important that they often lead to social exclusion and disability of patients. In order to prevent negative consequences, one of the most important tasks is to detect these diseases at an early stage. Autoallergy is a state of altered reactivity of the body, a typical pathological process, which is based on the development of a cascade of immune reactions to antigens of the body's own tissues. It leads to the development of AD, in the pathogenesis of which an allergic reaction to an autoallergen plays a fundamental role. Autoallergy occurs as a result of sensitization of the body by components of normal tissues, or tissues that have become alien to the body. Autoallergy is a mixed allergy, since DTH and HNT reactions are involved in its mechanisms. Among autoallergies, autoimmune diseases of the blood (anemia, thrombocytopenia, leukopenia), eyes (endophthalmitis, uveitis), nervous system (encephalomyelitis, myasthenia gravis, multiple sclerosis), thyroid gland (myxedema, thyroiditis) occupy a leading place in the structure of morbidity. By their nature, both autoimmune and allergic diseases are immunopathological reactions of the body to certain antigens. The main difference is that the basis of the pathogenesis of allergic manifestations is the hypertrophied response of the body's immune system to exogenous antigens (allergens), while autoimmune diseases are nothing more than a response to endogenous antigens (autoantigens). It can be argued that autoimmune and allergic diseases are different variants of hypersensitivity reactions, the development paths of which are most likely close. Purpose. To analyze the prevalence among students of higher educational institutions of autoimmune diseases, such as diabetes mellitus, rheumatoid arthritis, autoimmune thyroiditis (AIT), celiac disease, and also to assess the role of heredity in the pathogenesis of the above diseases. Material and research methods The object of the study were 243 students (including: 86% - female, 14% - male), students in higher education programs from 1 to 6 courses (VSMU named after N.N. Burdenko, VSU, VSPU, VSTU, RANEPA, MGMSU, NUST MISIS, PSPbGMU, USMU, BSMU, BFU. Kant, TSU named after G.R. Derzhavin). The research method was an online survey on the Google platform, which contained a list of questions aimed at identifying autoimmune diseases and hereditary predisposition. The processing of statistical data was carried out using the Excel package and included the calculation of relative indicators (%). The reliability of the obtained results was assessed using Student's t-test. Results. Based on the data obtained, it was found that 3.7% (9) of the respondents suffer from autoimmune diseases. The number of patients with type I diabetes mellitus was 4, AIT - 3, celiac disease - 1, rheumatoid arthritis - 1. 6.3% (15) of respondents have a hereditary predisposition relatives suffer from autoimmune diseases. Genetic burden was distributed as follows: predisposition to diabetes mellitus was 8 people, AIT-3, Sjgren's syndrome-2, psoriasis-1, rheumatoid arthritis-1. It should be emphasized that ADs are not genetic, but the combination of certain genes in combination with some factors can lead to the development of these pathologies. Thus, it can be argued that if someone in your family has an autoimmune disease, then there is a possibility of inheriting AD in the future, and not necessarily the same diagnosis. Discussion. The development of autoallergy is associated with two main processes: 1. The appearance of autoallergens in the body; 2. Dysfunction of the immune system, leading to damage to healthy tissues of the body. Mechanisms of development of autoallergy. 1. Proteins of the nervous tissue, lens, testicles, mammary gland, thyroid gland are barrier antigens. If the proteins of the lens of the eye, nervous tissue, testicles, thyroid gland enter the bloodstream, which becomes possible with injuries and surgical interventions, then the body's immune system perceives them as foreign structures of the body and begins to form allergic antibodies and sensitized T-lymphocytes against them, which penetrate into the corresponding organ and cause its destruction. For example, autoimmune thyroiditis develops in this way. 2. Burnet's theory. The second mechanism for the development of the formation of autoaggression against one's own healthy tissues is associated with the occurrence of mutations in the lymphatic system, functional and structural changes in histocompatibility receptors, which leads to the appearance of atypical pathological lymphocytes that lose immune tolerance to their own tissues. With the participation of this mechanism, rheumatoid arthritis, systemic lupus erythematosus and myasthenia gravis develop.3. Theory of the forbidden clone. A certain role in the development of autoallergy is played by the activation of the forbidden clone of lymphocytes for a number of reasons. A forbidden clone of lymphocytes can form antibodies and sensitized T-lymphocytes to healthy body tissues. 4. Theory of Rem-Petrov. The next mechanism of autoallergy is an immune deficiency, accompanied by a deficiency in the body of Ts. With a deficiency of Ts, B-lymphocytes begin to react to the tissue proteins of their own organs and produce antibodies against them. 5. Generality theory of AG-determinants. There are common AH determinants in streptococcus A, cardiomyocytes, and the basement membrane of the renal glomeruli. In this case, autoallergic damage to the heart or kidneys occurs according to the following scheme: streptococcus invades the body and allergic antibodies are formed against it, but since the determinant groups in the tissues of these organs are the same as in streptococcus, the resulting antibodies also damage the structural components of the heart and kidneys (rheumatic heart disease, glomerulonephritis). Since diabetes mellitus of types I and II occupies the first place in prevalence among both students and their relatives, it is necessary to consider the features of the pathogenesis of these diseases in more detail. Type I diabetes mellitus is an autoimmune disease associated with the destruction of insulin-producing pancreatic -cells, the origin of which is determined by genetic and immunological factors. Type 1 diabetes accounts for up to 10% of all cases of diabetes. It should be noted that in insulin-dependent diabetes mellitus, autoimmune thyroid diseases (AIT) can be detected in 15-30% of cases, celiac disease in 4-9% [1]. DM 1 is a polygenic multifactorial disease, in the pathogenesis of which both hereditary predisposition and environmental factors play an important role. A decrease in insulin secretion leads to its absolute deficiency in the blood, since the secretory activity of pancreatic -cells is impaired. After the manifestation of DM 1, some patients may experience a period in the first months, which is characterized by a reduced need for exogenous insulin up to its complete withdrawal, since there is a temporary improvement in the function of the remaining intact -cells. This period is called clinical remission or "honeymoon". Non-insulin-dependent diabetes mellitus is one of the most frequently encountered organ-specific autoimmune diseases today. The following forms of the disease are distinguished: autoimmune, virus-induced, slowly progressive. Diabetes was responsible for 1.5 million deaths in 2019, with 48% dying before the age of 70[2]. Autoantigen in the case of non-insulin-dependent diabetes mellitus are insulin receptors - blocking antibodies (insulin antagonists). It is known that the insulin-dependent form of diabetes mellitus is a self-limiting autoimmune disease due to the organ-specificity of the pathological process - with the complete destruction of -cells, autoimmune reactions stop. It is known that virus-induced type 2 diabetes mellitus is most often diagnosed among males at a young age. The autoimmune form is currently little studied, but it is known that it has no relationship with acute viral pancreatitis. Violation of tolerance in this form of diabetes is more significant, and in connection with this, lesions of other organs are quite often established (Hashimoto's thyroiditis, Addison's disease). This disease is most common among middle-aged women. The main clinical manifestations of diabetes mellitus include: polyuria, polydipsia, polyphagia, pollakiuria and weight loss, the development of coma (ketoacidotic, lactic acidemia) is also possible. Treatment of type 2 diabetes involves lifelong use of insulin preparations. Complications of diabetes include mainly damage to the cardiovascular system, eyes, kidneys and nervous tissue. The risk of developing strokes and heart attacks in people with diabetes is 2-3 times higher than in healthy people [3]. Vascular complications of DM also include diabetic retinopathy, which in the long term can lead to complete loss of vision [4]. Rheumatoid arthritis is an autoimmune rheumatic disease characterized by chronic erosive arthritis and systemic involvement of internal organs. The number of patients in the overall structure of morbidity is 1% of the population. Most often, women aged 40-55 suffer from this disease. One of the most serious complications of rheumatoid arthritis are atherosclerosis and vasculitis. In turn, atherosclerosis in about half of the cases can lead to myocardial infarction and stroke. As for the manifestations of vasculitis, they include the development of ulcers on the fingers and toes. At the onset of the disease, symptoms such as stiffness in the joints, their swelling and pain may appear.It is very important to slow the progression of the disease and achieve remission. AIT is an autoimmune thyroid disease characterized by slow progression and nonspecific early signs. This pathology is based on changes in thyroid status (in the direction of hypo- or hyperthyroidism). It has been established that autoimmune thyroid diseases occupy one of the leading places in the structure of thyroid diseases [5]. Currently, up to 20% of the world's population suffer from this pathology. It is known that the triggering factor for the development of AIT is mainly environmental factors, and the role of genetic predisposition is no less important [6]. Features of pathogenesis are due to the close relationship between the functioning of the immune and endocrine systems. Inflammation develops in the tissues of the thyroid gland, leading to dystrophy and further fibrosis, as the disease progresses, the production of thyroid hormones is likely to decrease and TSH increases, which leads to the growth of the thyroid epithelium, as a result, hypertrophic AIT develops, and in the opposite case, atrophic AIT. In the synthesis of antibodies that stimulate or block TSH, a large role is played by thyrocyte apoptosis. Celiac disease (gluten enteropathy) is a ubiquitous AD in the small intestine, characterized by intolerance to gluten proteins (gluten) from wheat and other cereals. Celiac disease is characterized by the development of hyperregenerative atrophy of the mucous membrane, which is clinically manifested by the syndrome of malabsorption. Celiac disease is now recognized as one of the most common genetic pathologies worldwide. Symptoms of celiac disease include diarrhea, steatorrhea, weight loss due to malabsorption, and extraintestinal manifestations occur in 50% of patients, such as anemia, osteoporosis, tooth enamel hypoplasia, and neurological disorders [7]. Both hereditary predisposition and neurological disorders play a significant role in pathogenesis and environmental factors. We can also note that autoimmune diseases occur predominantly among the female population, and every year there is a tendency to reduce the age of the diseased. Most likely, this is directly related to hormonal surges in women's lives (puberty, pregnancy, menopause). According to numerous studies, androgens play a protective role, and estrogens are direct stimulators of AD development. As for students, against the background of increased emotional and physical tension, there is a possibility of developing diabetes mellitus. Conclusion. Autoimmune diseases are currently an important problem of modern medicine, affecting, among other things, young people and requiring a more detailed study of the etiology and pathogenesis, the development of generally accepted diagnostic features and classifications in relation to diseases such as type I and II diabetes mellitus, rheumatoid arthritis, AIT, celiac disease. The role of hereditary predisposition in the development of autoimmune diseases is great.

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