Моrphometric investigations of the blood vessels of skin and muscles in patients, suffering an ischemic form of the diabetic foot syndrome
Objective. To study a quantitative criteria of affection of blood vessels in the skin and muscles in patients, suffering an ischemic form (IF) of diabetic foot syndrome (DFS) and to determine on their base a diabetic microangiopathy degree (DMAP).
Маterials and methods. The probes of paraffin blocks of the skin and muscles were selected in 49 patients, suffering a Type II diabetes mellitus (DM) and IF of DFS on background of stenotic-occlusive affection of the lower extremities arteries, who were treated in the Centre of Vascular Surgery of Clinical Hospital «Feofaniya» in 2014 – 2017 yrs. For comparison the probes of the skin and muscles were selected in 10 patients, who did not have systemic diseases.
There were conducted histological and immunohistochemical investigations for detection of a Type IV collagen – marker of basal membranes, VEGF – vascular endothelial growth factor; CD31 – marker of endothelial cells, and of a smooth muscles аctin. The diameters and density of the blood vessels in the skin and muscles were measured and compared.
Results. Characteristic changes of morphometric indices of the hemomicrocirculatiry bed (HMCB) of vessels in the skin and muscles in DMAP, what permits to detect its degree.
- There were determined a quantitative indices, which have changed, depending on course and compensation of DM: density of the HMCB vessels in a papillary layer of the skin; the thickness of basal membranes of the blood vessels; diameter of the vessel’s lumen in HMCB.
- There are characteristic qualitative changes in tissues: a basal membrane of epidermis smoothing, its modulation in some sites; rising of expression of receptors towards Vegf (Vegfr-1); rising of the actin level expression in the blood vessels, including those in capillaries; uneven expression of CD31 in the blood vessels.
- Basing on the obtained summarized data, concerning qualitative and quantitative changes in HMCB of skin and muscles, criteria were elaborated for determination of the skin and muscles DMAP degree, what may be applied to create the algorithm for complex treatment of patients, suffering IF of DFS.
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