mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical University10.21886/2219-8075-2026-17-1-87-96mvjr-2173Research ArticleАЛЛЕРГОЛОГИЯ И ИММУНОЛОГИЯALLERGOLOGY AND IMMUNOLOGYКлинико-иммунологические аспекты первой атаки рассеянного склероза (клинически изолированный синдром)Clinical and immunological aspects of the first attack of multiple sclerosis (clinically isolated syndrome)https://orcid.org/0000-0001-5716-4397СизякинаЛ. П.SizyakinaL. P.

Сизякина Людмила Петровна, д.м.н., профессор, заведующая кафедрой клинической иммунологии и аллергологии ФПК и ППС 

г. Ростов-на-Дону 

Ludmila P. Sizyakina, MD, Professor, Head of the Department of Clinical Immunology and Allergology, Faculty of Advanced Training and Professional Development 

Rostov-on-Don 

msiziakina@mail.ruhttps://orcid.org/0000-0001-7093-9548ГончароваЗ. А.GoncharovaZ. A.

Гончарова Зоя Александровна, д.м.н., профессор, заведующая кафедрой нервных болезней и нейрохирургии 

г. Ростов-на-Дону 

Zoya A. Goncharova, MD, PhD, Professor, Head of the Department of Nervous System Diseases and Neurosurgery 

Rostov-on-Don 

centrms@mail.ruhttps://orcid.org/0000-0002-4616-0750ЯрошН. М.YaroshN. M.

Ярош Наталья Михайловна, врач-невролог неврологического отделения РостГМУ 

г. Ростов-на-Дону 

Natalya M. Yarosh, neurologist, Department of Neurology 

Rostov-on-Don 

yarosh-nats@mail.ruhttps://orcid.org/0009-0007-1871-6372МарковаЕ. А.MarkovaE. A.

Маркова Елена Алексадровна, врач-невролог неврологического отделения РостГМУ 

г. Ростов-на-Дону 

Elena A. Markova, neurologist, Department of Neurology 

Rostov-on-Don 

markova.rostgmu@gmail.comРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian Federation2026260320261718796Copyright © Сизякина Л.П., Гончарова З.А., Ярош Н.М., Маркова Е.А., 20262026Сизякина Л.П., Гончарова З.А., Ярош Н.М., Маркова Е.А.Sizyakina L.P., Goncharova Z.A., Yarosh N.M., Markova E.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medicalherald.ru/jour/article/view/2173

Цель: выявление клинических и иммунологических предикторов ранней конверсии у пациентов с клинически изолированным синдромом (КИС). Материалы и методы: анализ медицинской документации и лабораторных данных 320 пациентов, обработка данных одно- и двухфакторный дисперсионный анализ (ANOVA), непараметрический критерий c2 (хи-квадрат), параметрический и непараметрический (Спирмена) корреляционный анализ, ранговый критерий Манна — Уитни. Результаты: возраста дебюта — 13–71 год, средний — 36,4±8 лет; Me=36 лет. У 60 пациентов (18,7 %) дебют в возрасте 50 лет и старше. Полифокальный дебют выявлен у 84,4%, у большинства пациентов конверсия наступала через 12 месяцев и более. Во врождённом иммунитете увеличение CD16+Gr+, % 7,8 [5,2;9,1], CD14+289+ 12 [4;20], инверсия НСТ-теста 155 [139;171] (р < 0,05). В адаптивном иммунитете — повышение CD3+HLA DR+,% 3 [2;5,4], CD8+Gr+20 [15;27], CD19+, %9 [7;12], увеличение ЦИК, у. е. 60 [47;84] (р < 0,05) снижение CD4+CD25+, % 1,3 [1,0;2,2], CD19+CD5+, %0,6 [0,3;0,9] (р < 0,05). Выявлены широкие граница возраста дебюта, с тенденцией к повышению среднего возраста, с преобладанием полифокального варианта. Во врождённом иммунитете повышение моноцитов, экспрессирующих CD14+289+, с уменьшением способности к антибактериальной защите, снижение активационной способности моноцитов, повышение цитотоксических функций натуральных киллеров, снижение адаптационных резервов нейтрофильного звена с инверсией коэффициента НСТ-теста. Изменения адаптивного иммунитета приводят к инверсии иммуно-регуляторного индекса (увеличения клеток с цитотоксическим эффектом, нарушению соотношения В1/В2 лимфоцитов и их дискоординации). В гуморальном звене дискоординация процессов антителогенеза. Выводы: выявлены клинические и иммунологические маркеры ранней конверсии КИС в рассеянный склероз.

Objective: to identify clinical and immunological predictors of early conversion in patients with CIS. Materials and methods: analysis of medical records and laboratory data of 320 patients, data processing - one- and two-way analysis of variance (ANOVA), nonparametric chi-square test, parametric and nonparametric (Spearman) correlation analysis, Mann-Whitney rank test. Results: age of onset: 13–71 years, mean — 36.4±8 years; Me=36 years. In 60 patients (18.7%) the onset was at the age of 50 years and older. Polyfocal onset was detected in 84.4%, in most patients conversion occurred after 12 months or more. In innate immunity: an increase in CD16+Gr+, % 7.8 [5.2; 9.1], CD14+289+ 12 [4; 20], inversion of the HBT test 155 [139; 171] (p < 0.05). In adaptive immunity: an increase in CD3+HLA DR+, % 3 [2; 5.4], CD8+Gr+ 20 [15; 27], CD19+, % 9 [7; 12], an increase in the CIC, AU. 60 [47;84] (p < 0.05), decrease in CD4+CD25+, % 1.3 [1.0;2.2], CD19+CD5+, % 0.6 [0.3;0.9] (p < 0.05). a wide range of the age of onset was revealed, with a tendency towards an increase in the average age, and prevalence of polyfocal debut. In innate immunity, an increase in monocytes expressing CD14+289+ with a decrease in the ability of antibacterial protection, a decrease in the activation capacity of monocytes, an increase in the cytotoxic functions of natural killers, a decrease in the adaptive reserves of the neutrophil link with inversion of the NBT test. Changes in adaptive immunity lead to inversion of IRI (an increase in cells with a cytotoxic effect, a violation of the B1/B2 lymphocyte ratio and their discoordination). Discoordination of antibody production processes in the humoral immunity. Conclusion: clinical and immunological markers of early conversion of CIS to MS have been identified.

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The authors declare that there are no conflicts of interest present.