NEUROVEGETATIVE MECHANISMS OF ADAPTATION IN CHILDREN WITH CH. TRACHOMATIS FETAL INFECTION ASSOCIATED WITH UREOPLASMIC INFECTION

The risk of fetal and new-born infection, when a pregnant woman has Chlamydia infection, varies from 40 to 80%.  A fetus is infected in the result of Chlamydia transmission during pregnancy via antenatal (ascending, trans decidual, hematogenic, lymphogenic) and intra-natal way while passing through genitals of the woman (contact, aspirational). A baby becomes three times vulnerable under  the influence of trans-placental, intra-natal and postnatal external infectious impact   [1, c.8, 2,c. 163, 8, c. 93, 10, c. 33, 14, c. 4]. Sometimes pregnancy has favorable outcome, and carrying of the infection does not effect a fetus. Though, in some cases a baby is born with congenital infection.  Monitoring of a baby, born from infected mother, as a rule, is limited by maternity hospital. Not all of the children, born by mothers with fetal infection, undergo examination for the most spread infections transmitted by sexual way, such as Сh. trachomatis, not to mention the necessity of dynamic observation with application of polymerase chain reaction (PCR) and immune enzyme analysis (IEA) for diagnostics. The relation of a possible carrying of Сh. trachomatis and pathologic states observed in babies [3, c.31, 4, c. 28, 7, c. 96, 9, c. 331, 12, c. 37, 17, c. 63]. Systemic and multi-component processes of  Ch.trachomatis fetal infection associated with persisting ureaplasmic infection impact on the formation of neuro-vegetative mechanisms of adaptation among young children is not studied well yet and have fragment character [11, c.15, 13, c. 131]. The aim of the research is to study spectral characteristics of cardiac rhythm variability (CRV) with its correlation interrelations in young children with fetal Сh. trachomatis infection associated with ureaplasmic infection.  Materials and methods of the research. In our work we used the complex examination results of 35 children born from mothers with chronic TORCH infections. The main group included children (n=10), fetally infected Сh. trachomatis and associated with ureaplasmic infection. The control group involved non-infected children (n=25). In SRI of Obstetrics and gynecology we checked healthy mature new-born babies and their mothers at the 1-2^nd days after birth.  Fetal infection was proved by PCR positive results of urine and nasopharyngeal scrape for Сh. trachomatis and Ur. Urealyticum genome. All children had nor clinical symptoms of fetal infection at the birth neither pathologic progress of early adaptation period. That’s why the new-born babies were duly vaccinated and discharged from maternity hospitals. There were no clinical manifestations of fetal infection during further weeks of neonatal period too.  Later, for 3 years we performed prospective monitoring of the children’s health in the municipal pediatric consultation-diagnostic center in Tashkent. The cardiac rhythm graphic analyses were performed when there were no clinical manifestations of associate infection or severe somatic pathology. All results of the analysis were registered in special prepared formal cards using markers for the introduction of these materials to electronic tables (Microsoft Excel 6.0). The absolute values of spectral density were achieved with the help of Furie’s method (complete conversion of singular series on “Hamming” variant) [6, c. 348]. The spectrum was divided to the following zones: High Frequency (HF) –  high frequency fluctuations, combined with breathing and reflecting the impact of parasympathetic system on cardiac muscle with 0,4–0,15 Hz (2,5–6,5 sec) frequency; Low Frequency (LF) – power of low frequency part of the spectrum (slow waves 1^st line or vasomotor waves) – 0,15–0,04 Hz (6,5–25 sec), characterizing the status of sympathetic part of VNS, and particularly, the system of vascular tension regulation; Very Low Frequency (VHF) – “very” low frequency fluctuations (slow waves 2^nd line) – 0,04 –0,003 Hz (25 – 333 sec), reflecting cerebral ergotropic impacts on the lower levels and it provides estimation of the brain functional status; Ultra Low Frequency (ULF) – area of ultra low frequency above 0,003 Hz, characterizing energetic balance and cortical regulation mechanisms, and coordinating the functional activity of all system of organism [5, c. 148, 6, c. 229]. The following limits of frequency range were set: HF = >0.150 Hz: sub-range HF-1-30 = 0.150 — 0.300 Hz; LF (21 sub-ranges) =  0.150-0.040 Hz; VLF (5 sub-ranges) = 0.040- 0.015 Hz; ULF (3 sub-ranges) = <0.015Hz. We considered time parameters: Mo-mode, the most often met values of cardiac intervals RR; AMo – amplitude of modal value of RR interval massive; NN50 – the number of sequent NN interval pairs, different more than to 50miliseconds for the whole period of the record; SDNN- average square deviation of the analyzed RR intervals; RMSSD – square root of the mean of square differences of sequent RR intervals’ lengths; VBI – vegetative balance index; VRV – vegetative rhythm value; RPAV – regulation processes adequacy value; VI – voltage index. The statistic processing of the data was performed with the help of non-parametric methods. Correlation analysis was performed according to Kendul’s method (r) [13, c. 135, 15, c.156]. Results of the research and discussion. Average time and spectral parameters of CRV in the children of the main and control groups are represented in the table 1. In the presented results of the children of the main group we detect differently directed alterations of time parameters of CRV, and particularly, rise of Mo value to 44.9% (p<0.05) and decrease of average values of AMo to  12.1%, voltage index (VI) to  32.7% reference units against the control, indicating the prevalence of autonomous regulation counter activity. The provement of autonomous cardiac rhythm regulation counter intensification was diminished values VRV (p<0.001), VBI, RPAV and reliable rise of NN50 (p<0.01), PNN50 (p<0.01), SDNN  (p<0.05), RMSSD  (1.5 times) against the control ones. Statistically reliable differences were identified in spectral parameters also, in the ranges and subranges: more explicit differences among the often detected high values were registered in subranges LF-18, 20; in the range HF and sub-ranges HF-1-1, 1-4, 1-5, 1-7, 1-13, 1-14, 1-16, 1-17, 1-26, 1-30, 2-12, 2-13, 2-14, 2-18, 2-27, 3-7. Regular decreases of CRV powers were noted in the ranges ULF and VLF  (p<0.001); in sub-ranges VLF-1, 2, 3, 5; LF-1, 3, 4, 7, 16; HF (p<0.01), HF- 1-22, 1-23, 2-2, 2-3, 2-5, 2-6, 2-8, 2-10, 2-11 with high level of reliability in comparison to the control.

Table  1

Average values of time and spectral parameters of cardiac rhythm variability in children

Note: reliability of value differences with *- p<0.05; ** — p<0.01; ***- p<0.001. in relation to the control one.

Statistically reliable differences in relation to the control and the values between the groups of comparison provided the possibility to detect spectral symptoms for the children of the main group. So we detected 27 reliable symptoms of spectral parameters of Ch. trachomatis fetal infection – VLF-1, 3; LF-18, 20; HF; HF-1-1, 1-2, 1-4, 1-5, 1-7, 1-13, 1-14, 1-16, 1-17, 1-23, 1-26, 1-30, 2-2, 2-3, 2-5, 2-6, 2-8, 2-10, 2-12, 2-13, 2-18, 2-27. We detected one direction dynamics of vago-sympathetic interrelation indexes decrease – LF/HF (р<0.01), activity of neuro-humoral and metabolic levels of regulation — VLF/HF and ULF/HF (р<0.01, р<0.01, correspondingly) in comparison to the control values. The given comparative analysis testifies the degree of Ch. trachomatis fetal infection impact on the parameters of CRV. In relation to that, it seemed perspective to study the degree of interrelations between the CRV parameters and the positive results of PCR of the children for Ch. trachomatis. We detected the reliable correlations at the level of time parameters (AMo: r=+0.064, p<0.029; Mo: r=-0.067, p<0.020; NN50: r=-0.061, p<0.035) with various vectors. A positive close link was noted with ULF-2 (r=+0.071, p<0.014) and with VLF (r=+0.077, p<0.008). The opposite negative ratios were detected in sub-ranges LF-3, 18, 20 (r=-0.067, p<0.020, r=-0.058, p<0.048, r=-0.068, p<0.019, correspondingly) and high frequency sub-ranges HF-1-17, 1-26,  2-12  (r=-0.068, p<0.019, r=-0.057, p<0.050, r=-0.075, p<0.008, correspondingly). That phenomenon, seemingly, was conditioned by pro-gradient character of antigenemia in case of Chlamydia infection with unclear clinical progress. The next stage of the research included the search of diagnostically valuable differences according to the frequency of range estimations of CRV in the main ranges of spectrograms. In the ULF spectral range the prevailing number of the children of the main group had  2 and 4 points. For the VLF range the symptoms of Сh.trachomatis fetal infection was point 7. Besides, that group was characterized by zero frequency of 1 point. According to the frequency of range points in LF range as a symptom of fetal infection there were notable “continuous” differences in 6 and 7 ranges. The most valuable differences were noted in the 1, 6 and 7 ranks for HF range. Thus, the differential characteristics of Сh.trachomatis fetal infection were observed in the following ranges: ULF –2 and 4; VLF- 1 and 7; LF- 6 and 7; HF- 1, 6 and 7. Conclusion.  The results of the relative and rank values spread, characterizing the spectral density of cardiac rhythm in certain ranges and sub-ranges, provided the isolation of reliable symptoms of Ch. trachomatis fetal infection. The presence of close correlation links between CRV parameters and etiologic agents of the infection, as well as the destruction of the structure of inner interrelations between certain mechanisms of vegetative regulation in an organism dependently on the infectious factor, prove the cause-effect relation between pathophysiologic phenomena at the level of vegetative nerve system and long-term infectious stress. The detected regular correlation and rank links of Сh. trachomatis marker and CRV parameters in children provided the possibility of that method application for stratification and non-invasive screening of fetal infection.

References:

1. Abdullayeva M.A. Chlamydia and mixed infection as a cause of obstetric and perinatal pathology: scientific edition // News of dermatovenerology and reproductive health. — Т., 2005. — №2. — P. 8-10.
2. Alimova B.D. Clinical characteristics of new-born babies born from mothers with Chlamydia and Mycoplasma infection // 5^th conference of Uzbekistan dermatovenerologists, dedicated to the 75^th anniversary of scientific research institute of dermatology and venereology (21-22 May 2008): collection of scientific works. Tashkent, 2008. – P. 163-164.
3. Adolescence and other risk factors for Chlamydia trachomatis genitourinary infection in women in Melbourne, Australia /H. Williams, S. N. Tabrizi, W. Lee et al. //Sex. Transm. Infect. – 2003. – Vol.79, №1. – Р. 31-34.
4. Analysis of cardiac rhythm variability in case of using of various electric cardiographic systems/ Edid. R.M. Bayevski. – М.: KNMT MHC RF, 2000.– 50 p.
5. Bayevski R.M., Berseneva A.P. Estimation of adaptation capabilities of organism and risk of disease development. M. Medicine. 1997. 235 p.
6. Borovikov V.P., Borovikov I.P Statistica: Statistic analysis and Windows data processing. – М.: DII «Philin», 1997. – 608 p.
7. de Barbeyrac B, Benali L, Clerc M, Garapon S, Bébéar C, Gromb S. Chlamydia trachomatis infection in children: do not forget perinatal acquisition: a case report of a 7-year old girl, C. trachomatis infected, presumed sexually assaulted //J Forensic Leg Med. 2010 Feb;17(2):96-8.
8. Drujinin Y.B., Maranyan A., Protopopova N.V. Urogenital infections during pregnancy // Bulletin of CUSSSO RAMS, 2006 — №1(47). – P.93-94. 9. Golalipour MJ, Khodabakhshi B, Ghaemi E. Possible role of TORCH agents in congenital malformations in Gorgan, northern Islamic Republic of Iran //East Mediterr Health J. 2009 Mar-Apr; 15(2):330-6.
9. Gorbunov Y.F., Cinzerling V.A., Semenov N.V. Characteristics of perinatal damages of inner organs caused by Chlamydia trachomatis //Pathology Archives. – 2007. – №3. – P.33-36.
10. Khaspekova N.B. Diagnostic self-descriptiveness of cardiac rhythm variability monitoring. // Arythmology bulletin. – 2003. — № 32. – P. 15 – 22.
11. Kokolina V.F. Urogenital Chlamydia in children. Diagnostics and therapy // Doctor in charge. — М., 2007. — №3. — P. 37-39.
12. Kotelnikov S.A., Nozdrachev A.D., Odinak M.M. and others // Cardiac rhythm variability: notions about mechanisms. Human physiology. St.Petersburg, 2002, Vol.-28, №1, P-130-143.
13. Kurbanov D.D., Porsokhonova D.F., Vaisov I.A. Morphologic aspects of reproductive complications in case of ITSW (Chlamydia and ureaplasma) and methodology of couples check-up in sterility cases.–Т.-2004. –15 p.
14. Maleta Y.S. Non-parametric methods of statistic analysis in biology and medicine. – М.: MSU, 1982. – 203p.

15. Wang Y, Yang WB, Yuan HY, Zhang QX, Zhu XY. Analysis of the infection status and the drug resistance of mycoplasma and chlamydiae in genitourinary tracts of children with suspected nongonococcal urethritis //Zhonghua Er Ke Za Zhi. 2009 Jan; 47(1):62-4.[schema type=»book» name=»NEUROVEGETATIVE MECHANISMS OF ADAPTATION IN CHILDREN WITH CH. TRACHOMATIS FETAL INFECTION ASSOCIATED WITH UREOPLASMIC INFECTION» description=»The aim of the research is to study spectral characteristics of cardiac rhythm variability (CRV) with its correlation interrelations in young children with fetal Сh. trachomatis infection associated with ureaplasmic infection. Methods of the research. In our work we used the complex examination results of 35 children born from mothers with chronic TORCH infections. The main group included children (n=10), fetally infected Сh. trachomatis and associated with ureaplasmic infection. The control group involved non-infected children (n=25). Results and сonclusion of the research. There are defined regular neuro-vegetative and reliable spectral values of Сh. trachomatis fetal infection. The detected regular correlation and rank links of Сh. trachomatis marker and CRV parameters in children provided the possibility of that method application for stratification and non-invasive screening of fetal infection.» author=»Shoira Agzamova» publisher=»БАСАРАНОВИЧ ЕКАТЕРИНА» pubdate=»2017-03-15″ edition=»ЕВРАЗИЙСКИЙ СОЮЗ УЧЕНЫХ_30.05.2015_05(14)» ebook=»yes» ]