Antiendotoxin immunity and neutrophil activity in purulent-necrotic inflammation of the feet against the background of diabetes

Introduction. As diabetes progresses, systemic vascular damage occurs, followed by the possible formation of diabetic foot syndrome and a high risk of developing ulcers and gangrene.

Aim. To study and evaluate the contribution of monitoring of functional-metabolic activity of neutrophils and antiendotoxin immunity parameters in purulent-necrotic feet inflammation with underlying diabetes.

Materials and methods. The study included 157 patients (67.1 ± 14.2 years) with purulent-necrotic inflammation of the feet, including 72 with transmetadarsal amputation of the foot and amputation at the level of the lower leg (main group) and 85 with necrectomy and plastic closure of wounds on the foot (comparison group). The reactivity of neutrophils was determined by the reaction of spontaneous (sLZHL) and induced (iLZHL) luminol-dependent chemiluminescence reaction. Indicators of antiendotoxin immunity were recorded in all patients using enzyme immunoassay. Glycolipid (GLP), a structural unit of endotoxin (Re-mutant Salmonella Minnesota), was used as an antigen.

Results and discussion. With the progressive course of purulent-necrotic inflammation of the feet, the indicators of sLPHL of neutrophilic granulocytes (NG) increased sharply (1775.5 ± 7.133 imp/min). Depression in the generation of reactive oxygen species was recorded according to the level of iLHL (68.4 ± 9.61 pulses/min), a deficiency in the concentration of antibodies to GLP (5.02 ± 0.29 μg/ml) and significantly differed from the results of patients in the comparison group (1266, respectively, 5 ± 5.897, 87.15 ± 16.2 imp/min and 6.21 ± 0.11 µg/ml). A direct correlation was established between the biocidal parameters of NG and the concentration of high-strength antibodies to GLP (r + 0.62, p < 0.001) in patients with a widespread purulent-necrotic process on the foot.

Conclusions. The results allow to consolidate the severity of the purulent-inflammatory process of the feet in patients with diabetes with markers of neutrophil metabolism and the level of antiendotoxin protection. The nature of destructive changes is closely related to the reactivity of NG, the severity of their endogenous activation and depression of the antimicrobial reserve.

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