Immune status in patients with purulent-necrotic processes of the diabetic foot and sepsis
DOI:
https://doi.org/10.11603/2414-4533.2023.4.14347Keywords:
immune status, purulent-necrotic processes of a diabetic foot, sepsisAbstract
The aim of the work: to find out the disorders of the specific immune system of the body in patients with diabetic foot syndrome and in case of complications of the disease with sepsis.
Materials and Methods. 627 patients were examined for complicated diabetic foot syndrome, in which in 6.7 % of cases (42 patients) the disease was aggravated by sepsis. All patients had type II diabetes and were treated in the city purulent-septic center with beds for the diabetic foot of the City Hospital No. 3 in Zaporizhia for the period 2007–2022. The studied patients were divided into two groups: a comparison group (patients with type II diabetes with purulent-necrotic lesions of the diabetic foot in the number of 585 patients, the main group – patients with diabetic foot syndrome complicated by sepsis – 42 people.
Results and Discussion. The state of the T-cell immune system in patients with complicated diabetic foot syndrome during hospitalization was characterized by a 20 % decrease in CD3+ (Р < 0.05) and a decrease in the number of CD4+ by 18% (Р < 0.05) compared to the donors. At the same time, in patients with sepsis, the change in these indicators was more pronounced (Р<0.05). On the contrary, the level of CD8+ was increased relative to the donors by 17% (Р < 0.05), and the level of CD25+ – by 33 % (Р < 0.05). Such stimulation of CD8+ and CD25+ is associated with a protective mechanism directed against the development of an immune response against own tissue structures. The state of the T-cell system based on the derived formula of immune disorders was as follows: CD3+1- CD4+1- CD8+1+ CD25+1+, which is qualified as the 1st degree of immunological disorders of cellular immunity. On the 7–8th day of treatment, a decrease in the level of both CD3+ and CD4+ was observed by 24 and 30 % (Р<0.05), respectively, according to the indicators of donors, however, compared to the indicators of patients during hospitalization, these changes were unreliable (Р>0.05 ) was lower than in patients without sepsis. The formula of immune disorders was as follows: CD3+2- CD4+2- CD8+1- CD25+1-, which indicated a disorder of the immune system of the II degree. On the 12th – 16th day, the levels of CD3+ and CD4+ were 17 and 14 % (Р<0.05) lower than the donors' indicators, however, a clear tendency to their increase was observed in comparison with similar indicators during hospitalization and on the 7th – 8th day of the postoperative period. The immune formula changed slightly: CD3+1- CD4+1- CD8+1- CD25+1+, which indicated the transition of the immune system disorder from II degree to I. In patients with CDS, whose disease was complicated by sepsis, the content of CD3+, CD4+, CD8+ during hospitalization was significantly (Р < 0.05) lower than in patients without sepsis. They differed by 40 %, 45 % and 23 %, respectively, with the indicators of the donor group. The given data on the number of T-lymphocytes with helper and suppressor function made it possible to calculate the CD4+/CD8+ index and establish its changes relative to healthy individuals – suppression by 34 % (Р<0.05). We did not establish a difference in the content of CD25+ in patients with and without sepsis.
The obtained results of the study of the cellular link in patients with sepsis can be represented by the formula: CD3+2- CD4+2- CD8+1- CD25+2-, which indicates an immune disorder of the II degree. The formula of immune disorders of the cellular link in patients with sepsis on the 7–8th and 12–16th day of the postoperative period indicated that the suppression of the cellular link corresponds to the II degree of immune disorders.
The state of humoral immunity in patients with purulent-necrotic processes of the diabetic foot during hospitalization was characterized by a decrease in Ig A relative to the parameters of donors by 11 % (Р < 0,05), Ig M – by 16 % (Р < 0,05) and Ig G by 6 % (Р > 0,05) against the background of a 13 % (Р<0.05) decrease in CD22+, and the formula of immune disorders was as follows: Ig A1- Ig M1- Ig G1- CD221-, which indicated the 1st degree of immunological disorders, while in patients with sepsis – Ig A-1 Ig M3+ Ig G3+ CD22+1+
Thus, the state of the cellular and humoral links of the immune system in patients with both purulent-necrotic processes of diabetic foot syndrome and with the development of sepsis is qualified as general immune depression.
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