THE RELATIONSHIP BETWEEN IMMUNOMETABOLIC MARKERS AND CLINICAL MANIFESTATIONS IN NON-SEGMENTAL VITILIGO: ON THE EXAMPLE OF THE POPULATION OF SAMARKAND REGION

Abstract

Relevance. Non-segmental vitiligo is a chronic polyetiological disease whose prevalence is growing throughout the world, especially in regions with high insolation such as Samarkand region. The disease is characterised by a complex immunometabolic pathogenesis that includes the activation of Th1-mediated inflammation, an increase in the levels of CXCL10 and IFN-γ, pronounced oxidative stress and metabolic disorders. The insufficient study of the relationship between immune, metabolic and antioxidant indicators and the clinical manifestations of vitiligo, as well as the regional features of risk factors, determine the high relevance of further research in this area. Aim of the study. To assess the relationship between immunometabolic markers and the clinical manifestations of non-segmental vitiligo (NV) in patients of Samarkand region and to determine the most informative biomarkers of disease activity. Materials and methods. A single-centre cross-sectional study was carried out, including 112 patients with a diagnosis of NV and 40 healthy volunteers. The clinical indices VASI and VIDA, the Fitzpatrick phototype and the duration of the disease were assessed. The laboratory parameters included the levels of IFN-γ, IL-6, TNF-α and the chemokine CXCL10 (ELISA), the subpopulations of CD4+/CD8+/NK cells (flow cytometry), the indicators of oxidative stress (MDA, SOD, GPO), metabolic indices (lipid profile, HOMA-IR) and vitamin D. Statistical analysis included the t-test, Pearson correlation analysis and ROC analysis (p<0.05). Results. Patients with NV had a pronounced activation of the Th1-mediated immune response: IFN-γ, CXCL10, IL-6 and TNF-α were significantly higher than in the control group (p<0.001). CXCL10 showed the best diagnostic ability for disease activity (AUC = 0.91) and a high correlation with the VASI and VIDA indices. A significant intensification of oxidative stress was established: the MDA level was increased more than 2.3-fold, while the activity of SOD and GPO was reduced by 35–42 %. The MDA and SOD indicators correlated with the clinical indices (r = 0.55 and r = –0.49 respectively). Insulin resistance was detected in 36.7 % of patients and was associated with elevated levels of IL-6 and CXCL10. Hypovitaminosis D was found in 71 % of cases and was combined with a more pronounced inflammatory activity. Conclusion. Non-segmental vitiligo in patients of Samarkand region has a pronounced immunometabolic profile characterised by the activation of Th1 inflammation, impairment of antioxidant defence and metabolic imbalance. CXCL10 is the most informative biomarker of vitiligo activity. A comprehensive assessment of immunometabolic parameters can be used to objectify the degree of disease activity and to personalise treatment tactics.