A szervezeti önvédelem módja: a gyulladás | The way of self-defence of the organism: inflammation

A szerző kritikusan attekinti az organizmust fenyegető korokok altal kivaltott akut es kronikus szervezeti gyulladasos valaszreakcio megjelenesi formait. Megallapithato, hogy a kivalto okok, tenyezők jellegetől fuggően kulonboző, nagyon valtozatos megjelenesi formaju gyulladas lehetseges. Van akut es kronikus, steril vagy nem steril es tobbes okkal biro gyulladasos reakcio. A koroki tenyezők sokasaga alapjan klinikailag es patologiailag rendkivuli modon kulonboző patobiokemiai sajatossaggal biro folyamatokrol van szo. Olykor megkerdőjeleződik a gyulladas hasznos vagy karos volta. Gyakorta előfordul, hogy valojaban a gyulladas maga a „betegseg”, noha az a szervezet vedekező, elharito, reparacios eszkoze. A nem steril akut gyulladast patogen mikroorganizmusok valtjak ki hasonlokeppen a klinikai megjelenesi formak valtozataival. A kulonbsegek magyarazata a mikrobak nagyon elterő tulajdonsagai, a vedekező organizmus tulajdonsagai, a naturalis es adaptiv immunitas epsege vagy defektusos volta. Ebben a formaban vilaglik ki leginkabb, hogy a gyulladas maga a „betegseg”, noha az csak a szervezet vedekező, elharito valasza, amit a cortico-hypothalamo-adrenalis tengely iranyit. A gyulladas a vedekezes modja, a naturalis, veleszuletett immunvalasz resze, attol nem elkulonithető, es ami az adaptiv, specifikus immunvalasszal egyuttműkodve, kolcsonos egymasra hatasban zajlik. A szervezeti akutfazis-reakcio a gyulladas akut szakaszanak foghato fel, az egesz szervezet bevonasaval. Kemokinek, citokinek, adhezios molekulak kepezik a hirhalozatot, egymas hatasait kolcsonosen befolyasolva, modositva. Sajatos jelenseg a dontően hepatocytak termelte ugynevezett akutfazis-reaktansok szerumbeli gyors es nagymertekű koncentraciovaltozasa. Gyakorlatilag nehany kivetellel az osszes fontos plazma feherje-glikoprotein koncentracioja emelkedik vagy csokken, beleertve a HDL-szintjet is. Az elvaltozasok szeles korű volta alapjan gyakorlatilag erdektelen az akutfazis-reaktans megjeloles. Az atherosclerosis koran kezdődő, valtozo sebesseggel előrehalado, nem megfordithato egyedi kronikus vasculitis szindroma. Kivalto ok nincs, kockazati tenyezők vannak, amelyek kulonboző csoportokba verődve műkodnek a hatterben. A patobiokemiai folyamatokban vannak kulonbsegek es rokonsagok egyarant, a vegeredmeny, a propagacio azonban teljesen mas. A kronikus gyulladas szindroma igy inkabb „betegseg” jelleget olt, haszna a szervezet szamara alig felismerhető, bar a kronikus mivoltanak, a propagacio sebessegenek a megszabasaban lehet – akar fontos – szerepe is. Orv. Hetil., 2013, 154, 1247–1255. | The acute and chronic constitutional reactions of the organism elicited by sterile causes and pathogenic structures threatening the soundness of the organism are surveyed by the author. It is emphasized that depending on causes which can be very different, there are various syndromes occurring in the clinical practice. On the basis of multitudiness of pathogenic factors and individual differences, the infammatory reactions are clinically, pathologically and pathobiochemically can be hugely variable. The acute inflammatory response may be sterile. It is often difficult to recognize in these processes whether the inflammation is harmful or beneficial for the organism as a whole. It is possible that the inflammatory response itself is the defending resource of the individual. The non-sterile acute inflammation is evoked by pathogenic microorganisms. The variety of clinical syndromes are explained by the high diversity of pathogenic microbes, the individualities of the defending organisms, and the natural and adaptive immunity of the organism which may be intact or possibly defective. In the latter case the inflammation itself is the disease, as a consequence of a pathological process conducted by the cortico-hypothalamo-adernal axis. The acute inflammation is a defending, preventing and repairing process, constituting an important part of the natural innate immune response. It is inseparable from the natural innate immune response, which is in close cooperation with the adaptive, specific immune response with mutual effects on each of the other. The conductor and the response reactions of the two immune responses are also the same. There are alterations in serum proteins/glycoproteins synthesized mostly by the hepatocytes. Because the concentration of almost all proteins/glycoproteins may change, the use of the discriminative term “acute phase reactant” is hardly relevant. For example, the HDL molecule is a negative “acute phase reactant”. On the gound of clinical, pathological and biochemical caracteristics, the chronic sterile inflammation is a very different entity. It has been established that atherosclerosis is one of the ab origine chronic inflammatory syndrome. It is a long-lasting pathological entity progressing, rather than resolving with different celerity, namely a unique vasculitis syndrome. We are speaking about risk factors instead of causes, which constitute larger or smaller groups to elicite the preventing reaction of the host. The propagations and final outcomes are quite different from that of the acute process. The disadvantages or benefits for the organism are scarcely predictable, albeit the chronic process may have roles in its prolonged nature. Orv. Hetil., 2013, 154, 1247–1255.