BLOOD FLOW CONDITION IN LOWER EXTREMITY VESSELS AND ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS DEPENDING ON DISEASE DURATION
Abstract
The purpose of the study. Study arterial blood flow and blebbing of the plasma membrane of lymphocytes in the neuroischemic form of diabetic foot syndrome (SDS) depending on the age of the disease.
Material and methods. In a prospective study, 150 patients of type 2 DM were examined, of which 50 people with a neuroischemic form of SDS. Blood flow condition on vessels of lower extremities and plasma membrane of lymphocytes was examined. There were 30 women (60%), 20 men (40%). Vascular channel condition was evaluated by ultrasound dopplerography of lower extremity arteries, degree of diabetes mellitus compensation was determined by glycated hemoglobin level, lymphocyte membrane condition was evaluated by phase contrast microscope imaging results.
Results of the study. 72% of patients had complete occlusion of the tibia-foot segment of the arteries of the lower extremity, 28% had stenosis. The glycated hemoglobin level averaged 10.3 [8.5; 14.3]%, i.e. all observed patients had insufficient compensation for carbohydrate metabolism disorders. The total and terminal lymphocyte blebbing was 30.1 [25.4; 33.2]% and 15.8 [11.8; 18.4]%, which was 3 and 5 times higher than the control group, respectively. A high positive correlation between the duration of DM disease and the total (rS=0,72; p = 0.001) and terminal (rS=0,78; p = 0.001) blebbing of lymphocyte membrane.
Conclusion. The high correlation between the timing of DM disease and the blebbing of the lymphocyte plasma membrane allows these indicators to be used as markers of endothelial dysfunction in neuroischemic and ischemic forms of SDS. The level of summary and terminal blebbing can be considered as a prognostic marker of the development of macroangiopathy in patients with type 2 DM.
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Dedov I.I., SHestakova M.V., Vikulova O.K. et al. Saharnyj diabet v Rossijskoj Federacii: rasprostranennost’, zabolevaemost’, smertnost’, parametry uglevodnogo obmena i struktura saharosnizhayushchej terapii po dannym Federal’nogo registra saharnogo diabeta, status 2017 g. [Diabetes mellitus in the Russian Federation: prevalence, morbidity, mortality, carbohydrate metabolism parameters and structure of diabetes reduction therapy according to the Federal Register of Diabetes Mellitus, status 2017]. Saharnyj diabet [Diabetes mellitus], 2018, vol. 21, no. 3, pp. 144-159. https://doi.org/10.14341/DM9686
Dedov I.I., SHestakova M.V., Majorov A.YU. et al. Algoritmy specializirovannoj medicinskoj pomoshchi bol’nym saharnym diabetom: Klinicheskie rekomendacii (Vyp. 9) [Algorithms of specialized medical care for patients with diabetes mellitus: Clinical recommendations (Vol. 9)]. Saharnyj diabet [Diabetes mellitus], 2019, vol. 22, no. S1, pp.1-144. https://doi.org/10.14341/DM221S1.
Simanenkova A.V., Makarova M.N., Vasina L.V. et al. Dopplerografiya mikrocirkulyatornogo rusla kak sposob ocenki endotelijprotektivnyh svojstv lekarstvennyh preparatov u bol’nyh saharnym diabetom [Dopplerography of the microcirculatory bed as a method of assessing endothelium projective properties of drugs in patients with diabetes mellitus]. Regionarnoe krovoobrashchenie i mikrocirkulyaciya, 2018, vol. 17, no. 3, pp.120-128. https://doi.org/10.24884/1682-6655-2018-17-3-120-128
American Diabetes Association. Introduction: Standards of Medical Care in Diabetes – 2018. Diabetes Care, 2018, vol. 41, no. 1, pp. S1-S2. https://doi.org/10.2337/dc18-Sint01
Binns-Hall O, Selvarajah D, Sanger D, et al. One-stop microvascular screening service: an effective model for the early detection of diabetic peripheral neuropathy and the high-risk foot. Diabetic Medicine, 2018, vol. 35, no.7, pp. 887-894. https://doi.org/10.1111/dme.13630
Chao CYL, Cheing GLY. Microvascular dysfunction in diabetic foot disease and ulceration. Diabetes Metabolism Research and Reviews, 2009, vol. 25, no.7, pp. 604-614. https://doi.org/10.1002/dmrr.1004
Charkoudian N. Mechanisms and modifiers of reflex induced cutaneous vasodilation and vasoconstriction in humans. Journal of Applied Physiology, 2010, vol. 109, no. 4, pp. 1221-1228. https://doi.org/10.1152/japplphysiol.00298.2010
Eleftheriadou I., Tentolouris A., Grigoropoulou P. et al. The association of diabetic microvascular and macrovascular disease with cutaneous circulation in patients with type 2 diabetes mellitus. Journal of Diabetes and its Complications, 2019, vol. 33, no.2, pp. 165-170. https://doi.org/10.1016/j.jdiacomp.2018.10.008
Ewing D.J., Clarke B.F. Diagnosis and management of diabetic autonomic neuropathy. British Medical Journal, 1982, vol. 285, no. 6346, pp. 916-918. https://doi.org/10.1136/bmj.285.6346.916
Ewing D.J., Martyn C.N., Young R.J. et al. The Value of Cardiovascular Autonomic Function Tests: 10 Years Experience in Diabetes. Diabetes Care, 1985, vol. 8, no. 5, pp. 491-498. https://doi.org/10.2337/diacare.8.5.491
He T., Wang C., Zuo A. et al. Electrochemical Skin Conductance May Be Used to Screen for Diabetic Cardiac Autonomic Neuropathy in a Chinese Population with Diabetes. Journal of Diabetes Research, vol. 2017, Article ID 8289740, 6 pages. https://doi.org/10.1155/2017/8289740
Kempler P., Tesfaye S., Chaturvedi N. et al. Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study. Diabetic Medicine, 2002, vol. 19, no. 11, pp. 900-909. https://doi.org/10.1046/j.1464-5491.2002.00821.x
Lee C-H., Kim E., Kim D. Detection of atrial fibrillation during pulpal blood flow assessment using Doppler ultrasound: a case report. Dentomaxillofacial Radiology, 2018, vol. 47, no. 5, pp. 20170354. https://doi.org/10.1259/dmfr.20170354
Lenasi H., Potočnik N., Petrishchev N. et al. The measurement of cutaneous blood flow in healthy volunteers subjected to physical exercise with ultrasound Doppler imaging and laser Doppler flowmetry. Clinical Hemorheology and Microcirculation, 2017, vol. 65, no. 4, pp. 373-381. https://doi.org/10.3233/CH-16204
Lin K., Wei L., Huang Z. et. al. Combination of Ewing test, heart rate variability, and heart rate turbulence analysis for early diagnosis of diabetic cardiac autonomic neuropathy. Medicine (Baltimore), 2017, vol. 96, no. 45, pp. e8296. https://doi.org/10.1097/MD.0000000000008296
Mamontov O.V., Babayan L., Amelin A.V. et al. Autonomous control of cardiovascular reactivity in patients with episodic and chronic forms of migraine. The Journal of Headache and Pain, 2016, vol. 17, no. 1, pp. 52. https://doi.org/10.1186/s10194-016-0645-6
Rawshani A., Rawshani A., Franzén S. et al. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes. The New England Journal Of Medicine, 2017, vol. 376, no. 15, pp. 1407-1418. https://doi.org/10.1056/NEJMoa1608664
Spallone V., Ziegler D., Freeman R. et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metabolism Research and Reviews, 2011, vol. 27, no. 7, pp. 639-653. https://doi.org/10.1002/dmrr.1239
Stirban A. Microvascular Dysfunction in the Context of Diabetic Neuropathy. Current Diabetes Reports, 2014, vol. 14, no. 11, pp. 541. https://doi.org/10.1007/s11892-014-0541-x
Tesfaye S., Boulton AJ.M., Dyck P.J. et al. Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments. Diabetes Care, 2010, vol. 33, no. 10, pp. 2285-2293. https://doi.org/10.2337/dc10-1303
Vinik A.I., Maser R.E., Mitchell B.D. et al. Diabetic Autonomic Neuropathy. Diabetes Care, 2003, vol. 26, no. 5, pp. 1553-1579. https://doi.org/10.2337/diacare.26.5.1553
Zelenina T., Salukhov V., Volkova E. et al. High-Frequency Ultrasonic Dopplerography May be used to Screen for Diabetic Cardiac Autonomic Neuropathy. International Journal of Endocrinology and Metabolic Disorders, 2019, vol. 5, no. 2. https://doi.org/10.16966/2380-548X.160
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