Nonspecific Immune Response Peculiarities to Influenza Vaccination in Patients with Diabetes Mellitus

The purpose of the study is to examine the indices of cellular immunity, interleukin-4 (IL-4), interferon-γ (IFN-γ) before and 3 weeks after vaccination against influenza in patients with type 2 diabetes. 67 patients with type 2 diabetes who made up the group "1" were examined. The control group "2" included 30 healthy persons. Among the patients with diabetes there were 31 (46%) women and 36 (54%) men aged 43 to 79 years, whose mean age was (M ± SD) (63.1 ± 15.8) years. In the control group, there were 14 (47%) women and 16 (53%) men aged 42 to 77 years, whose mean age was (M ± SD) (60.7 ± 17.8) years. Thus, the groups were comparable by sex and age. The diagnosis of diabetes was established based on the diagnostic criteria of the International Diabetes Federation (International Diabetes Federation, 2011). Insulin resistance was determined using the HOMA (The Homeostasis Model Assessment) index. Determination of the number of lymphocytes in peripheral blood with CD antigenic determinants was performed using monoclonal antibodies "Anti-CD4", "Anti-CD8" (Granum, Ukraine). The level of insulin in the blood serum was determined by the enzyme immunoassay using sets of ready-made reagents produced by DRG, Germany. IL-4 and IFN-γ were determined in the blood serum by a solid-phase enzyme immunoassay using sets of ready-made reagents "Interleukin-4-IFA-BEST", "Interferon-γ-IFA-BEST", (Vector-Best CJSC, Russia) respectively. The statistical analysis was carried out using the Microsoft Office 2007 Excel statistical software package. The threshold for the statistical error of different tests was set at 5%. The nature of the descriptive statistics depended on the type of variables. To compare the data, the t-test (Student), Wilcoxon and the chi square test were used. The NOMA-index before vaccination in groups "1" and "2" was (4.5 ± 1.8) vs (2.3 ± 0.6), p = 0.00. Also significantly higher NOMA-index was in group "1" 3 weeks after vaccination (5.2 ± 1.7) against (2.0 ± 0.6), p = 0.00. Unlike the indices of group "2", p = 0.06, in group "1" there was a significant increase in this index, p = 0.01. The level of CD4 + at the initial stage was significantly lower in the group "1" (24.4 ± 6.9)% vs (29.1 ± 7.4)% in the group "2", p = 0.03. After 3 weeks, this index in group "1" did not change, and in group "2" there was a significant increase in it: (26.5 ± 8.6)%, p = 0.12, against (33.5 ± 8.6)%, p = 0.04, in the group "2". Relative differences were also obtained between the groups after 3 weeks. A similar picture was observed when determining the CD8 + level: the primary indices in the group "1" were lower than those in the group "2": (19.6 ± 6.8)% against (23.0 ± 6.1)%, p = 0.02. After 3 weeks, the level of this indicator significantly increased in the group "2" (28.3 ± 8.7), p = 0.01. In the group "1", the CD8 + level was (21.8 ± 6.9)%, p = 0.07 compared to the baseline data and p = 0.00 compared with the group "2" data. The level of IL-4 in patients with diabetes did not significantly differ from that in healthy subjects before vaccination and increased 2.5 times after vaccination. At the same time, the content of IL-4 in SD patients after vaccination became significantly lower than in healthy individuals. This may serve as evidence of a smaller increase in Th2 cell activity. At the same time, the level of INF-γ, which was significantly lower before vaccination in diabetic patients compared with healthy individuals, increased more significantly after vaccination (by 2.9 times). Accordingly, the ratio of INF-γ / IL-4 after vaccination significantly increased, both within the group and in comparison with healthy individuals. As a result, we can assume the initial decrease in immunological activity in patients with diabetes and the imbalance of the immune system, which is manifested by greater activation of Th1 cells.