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The glycoprotein (15-18 kDa) antigen of Mycobacterium tuberculosis H37Rv was affinity isolated on the immunosorbent with monoclonal antibodies S4C1G4 (specific to M. tuberculosis H37Rv; Avdiyenko V. G., Kondrashov S.Yu, Lyashenko S.M.@Probl. Tuberk. 1996, v. 1, p. 6-8 (in Russian). This antigen and PPD (Batch RT 45, Stattens Seruminstitute, Denmark) that was a standard antigen were used for enzyme-linked immunosorbent assay (ELISA), by detecting serum IgG antibodies in patients with pulmonary tuberculosis, and control groups of patients with lung diseases other than tuberculosis (bronchitis and/or asthma, pneumonia) as well as healthy volunteers. The diagnostic parameters of specificity and sensitivity for titers and the same parameters for optic density (OD) (in serum dilution with maximum differences for groups of patients and donors) were compared. The new monoantigen method provided 86.11% specificity and 87.87% sensitivity, which were higher those obtained for optic density (63.89 and 80%, respectively). With PPD, the specificity and sensitivity were 58.04 and 78.78 (for the new titer method) versus 50 and 78.78% (OD data). The method error for titer determination was 10% and for standard OD determination was 27%. The new approach offers additional possibilities of enhancing the quality of ELISA for diagnosis of tuberculosis.

A hundred and seventy one patients with revealed rounded lung formations of tuberculous and non-tuberculous origins were examined. Mycobacterial antigens, cellular antituberculosis immunity, and antituberculosis antigens were determined. Cellular sensitization to mycobacterial antigens was found to develop in about 50% of patients with round lung formations of tuberculous origin. This sensitization to PPD was more revealed by BTR rather than by TMR. At the same time, the latter is positive in healthy donors and in patients with non-tuberculous abnormality. Finally it can be concluded that cell tests are little suitable for immunodiagnosis of tuberculosis. It was also ascertained that determination of antituberculosis antigens and antigenemia might be a important component of examinations of patients with rounded lung formations in order to make a differential diagnosis of tuberculosis and non-tuberculous abnormality as with their determination, high sensitivity and specificity of appropriate tests can be achieved. These tests are more informative for the immunodiagnosis of tuberculosis than that of infiltrative tuberculosis.

272 patients with pulmonary tuberculosis, 101 patients with pneumonia and 76 patients with cancer varying in severity have undergone a comprehensive immunological examination. Irrespective of the disease etiology, extension of the lesion in all the patients correlated with suppression of cellular immunity and activated IgA production. Increasing production of antituberculous antibodies in patients with disseminated tuberculosis and pulmonary cancer suggests unfavorable outcome of the disease. Genetic markers seem to relate with characteristics of pathological process in the lungs.

Enzyme immunoassay performed in patients with malignant and benign affections of the lungs determined antibodies (Abs) to glycoprotein isolated from saprophyte microorganism Bacilus megaterium H. In pulmonary tuberculosis and nonspecific pulmonary inflammation the above Abs occurred in patients with fibrous-proliferative changes and associated neoplastic conditions. In lung cancer the Abs were detected in well and moderately differentiated tumors. Nondifferentiated and poorly differentiated variants did not exhibit any rise in Abs to glycoprotein.

The immunological survey of 1,688 patients with tuberculosis and 486 with non-specific pulmonary diseases was made. Criteria were identified for immunodiagnosis. The use of current mathematical methods of analysis allowed the development of high performance immunodiagnostic systems for pulmonary abnormalities, which included diagnostic tables and discriminant analysis by employing a computer. The major immunological disorders were determined, which in agreement with the definite direction of a tuberculous process with the subsequent use of data for monitoring the patient's status and correcting the treatment. The most potent immunocorrective drugs were studied, indications for their use were specified, proceeding from the immunological characterization of a specific patient. It was shown that the comprehensive assessment of various links of the immune system is of undoubtful value for the diagnosis and prediction of diseases, and prescription of immunocorrective therapy for pulmonary tuberculosis.

A test group of 40 patients and a control group of 20 matched controls with pulmonary cancer and suppuration were exposed to preoperative and postoperative electromyostimulation (EMS) with adjuvant intravascular laser radiation of the blood (ILRB) to prevent thromboembolism versus conventional chemotherapy, respectively. At the preoperative examination all the patients exhibited secondary immunodeficiency. It was found that introduction of EMS and ILRB corrects immunity and activates fibrinolysis. A positive trend in coagulation is also attributed to immunomodulating effects of EMS and ILRB.

Some parameters of peripheral blood cellular and humoral immunity were studied in 80 patients with different stages of pulmonary sarcoidosis, which were compared with the results obtained in 30 healthy subjects of the control group. An increase in the total count of lymphocytes, and primarily that of B-lymphocytes, was found, as compared with those in healthy subjects. T-lymphocyte changes were statistically insignificant. The IgM level was found decreased with the values of IgG and IgA being constant, as compared with those in subjects of the control group. In the group of patients there was a statistically significant decrease in the values of total complement with the values of phagocytosis in sarcoidosis patients and healthy subjects being statistically indistinguishable.

The results of a computer analysis of immunograms for the differential diagnosis of tuberculosis, cancer, pneumonia and sarcoidosis are presented. The findings indicate that computer immunodiagnosis may be used as a supplementary tool that increases the effectiveness of diagnosis in difficult cases. The advantage of the elaborated system is to rapidly apply a systemic approach to the assessment of the patient's immune status and to objective diagnosis by using computer algorithms.

Stemming from the results of a complex immunologic examination of 653 patients with lung diseases, 4 immunologic reactions of highly diagnostic value were identified, i. e. specific antibody formation, blast transformation with PPD and PHA and spontaneous rosette formation. The most valuable combinations of these reactions were defined for each type of the pathology. For tuberculosis, 16 such combinations were found, including 5 without specific antibody formation; 5 in cancer; 3 in nonspecific inflammation; and 1 in sarcoidosis. Diagnostically important combinations of the above immunologic reactions are summarized in the Table whose use in differential diagnosis of doubtful cases of tuberculosis, cancer, nonspecific pneumonia and sarcoidosis can increase their diagnostic probability up to 0.95-0.99 in 30 per cent of the patients without employing invasive methods.

Diagnostic enzyme immunoassay kits were used for the examination of parallel tests of venous and capillary blood in 43 patients with nonspecific pulmonary diseases for the presence of antibodies to tuberculosis pathogen. The method of parallel tests has revealed that disregarding the site of blood collection (vein, finger) the EIA results are identical. Analysis sensitivity in tuberculosis patients varies within 30 and 86% in relation to the clinical activity of a tuberculosis process. Analysis specificity in tuberculosis patients is 3.4%.

Examination which included 21 patients with tuberculosis, 6 with sarcoidosis and 9 healthy volunteers was aimed at determining the amount and intensity of surface fluorescence of CD+3, CD+4, CD+8 lymphocytes and CD14+, KIM+I monocytes. The findings demonstrate that determination of the fluorescence intensity of lymphocytes and monocytes provides a more exact characterization of the morphofunctional state of cells involved in the immune response. It is shown in particular that tuberculosis and sarcoidosis patients exhibit a varying density of the expressed antigenic markers of lymphocytes, which increases only in sarcoidosis, except a suppressor subpopulation (cytotoxic lymphocytes). Patients with tuberculosis had decreased density of CD9+, CD14+ and KIMI markers on the particular subpopulations.

The results of examination of 224 patients with newly detected disseminated processes in the lungs who were admitted for differential diagnosis are presented. Immunologic studies which include determination of the natural killer activity, neutrophil phagocytosis, a total number of T- and B-lymphocytes and synthesis of antituberculosis antibodies in the indirect hemagglutination reaction with three basic M. tuberculosis antigens (phosphatide, polysaccharide and tuberculin) proved to be of high diagnostic value. Immunologic tests used along with clinical studies allowed timely diagnosis of disseminated pulmonary tuberculosis in 62 patients, the disseminated forms of lung sarcoidosis in 115 and nonspecific diseases (microfocal pneumonias of a protracted character, pneumoconioses carcinomatoses, etc.) in 57 patients.

Different models of algorithms for the immunologic diagnosis of pulmonary tuberculosis, cancer, nonspecific inflammation and sarcoidosis were developed. A comparative assessment of the effectiveness of 3 versions of Diagnostic Tables was made. A significant advantage of these Diagnostic Tables based on the analysis of immunologic indices characterizing groups of patients with different forms of the process was defined, as they are seen in the X-ray pictures (3d version). A differential diagnosis of tuberculosis and nonspecific lung diseases made by the 3d version of the tables showed that correct and incorrect answers made up 87.6 and 6.8%, respectively. The developed method of immunodiagnosis can be of great help in the differential diagnosis of lung diseases.

In sarcoidosis patients, comparison of the outcomes of treatment with corticosteroids alone (n = 142) or in combination with T-activin (n = 20) showed a marked positive effect of T-activin on the improvement of the patients' immunologic status and pronounced regression of changes in the lungs and intrathoracic lymph nodes. Indications for T-activin administration were defined and its treatment regimen was suggested.

The level and antigenic composition of immune complexes (ICs) in 49 patients with nonspecific inflammatory diseases of the respiratory organs (NIDRO) and tuberculosis were studied in relation to separate indices of systemic and local immunity. Involvement of the ICs in the pathogenesis of tuberculosis and NIDRO was shown and the role of the level and composition of the ICs in the prognosis and differential diagnosis of the indicated pathological processes was revealed. It was noted that in patients with active tuberculosis and in patients with chronic bronchitis and residual lesions after cured tuberculosis of the respiratory organs the ICs mainly formed by antigenic substances of tubercle bacilli. In the patients with chronic bronchitis and suppurative affections of the lungs the ICs formed due to antigenic substances of bacterial infections. The use of a technique for simultaneous cleavage of the ICs in blood and bronchoalveolar secretion provided determination of etiology of the inflammatory processes in the lungs and bronchi. The technique proved to be highly efficient for early differential diagnosis of tuberculosis and NIDRO.

It was shown that the functional state of neutrophils and monocytes in the peripheral blood of patients with sarcoidosis lowered which was evident from their lower absorbing capacity, lower numbers of the EAC-rosette-forming cells and higher metabolic activity. Prior prednisolone therapy influenced the functional state of neutrophils: the cell ability to reduce NBT and the activity of acid phosphatase decreased while the lysozyme levels and absorption capacity increased. The functional state of monocytes was in general the same in the patients treated and untreated with the glucocorticoid.