COMPLEX ASSESSMENT OF PROTEIN INDICATORS OF ACUTE PHASE INFECTION IN DIAGNOSTICS AND PROMOTION OF MUTUAL-NECROTIC COMPLICATIONS OF DIABETES MELLITUS

Abstract

Diabetes mellitus (DM ) represents a serious medical and social problem. 415 million people (every 11th) suffers from it, with a tendency to increase in size in 2040 up to 642 million (almost 10 % of the total population). In Ukraine, the prevalence of diabetes at the beginning of 2015 was 2.8 %. One of the complications of diabetes is the diabetic foot syndrome (DFS), which today is considered as one of the most serious complications, and is the result of the development of polyneuropathy, osteoarthropathy, angiopathy.

The aim of the study – increasing effectiveness of treatment of patients with purulent-necrottic form of diabetic foot.

Materials and Methods. We observed 116 patients with DFS aged 63.3±7.1 years old. Inclusion criteria’s was absence of adequate for revascularization peripheral arterial flow (based on contrast computed tomography angiograms), presence of purulent – necrotic process on foot and signed informed consent.

Results and Discussion. Destruction stage on foot was 3–4 by P. M. Wagner (1979) classification in 74 % cases. At the moment of hospitalization 78 % of patients have long term decompensation of DM (HbA1c-9.43±0.32 %). Duration of illness in 69 (59.4 %) cases was longer than 10 years. In algorithm of treatment for all patients included small amputation and complex medication treatment – 48 (I group). In 68 cases (II group) catheterization of a.epigastrica and osteoperforation of tibia was added. At the moment of hospitalization: usage of transcutaneous oximetry shows average TcpO2 15.1±6.3 mm.hg. Concentration of С-reactive protein was increased in 98.9 % cases and in average was 12.1±1.9 mg/l (0/24.0 mg/l) (p<0.1). In 64.3 % patients increasing of fibrinogen range was found – 5.8 g/l (4.7/7.0 g/l), (p<0.01). On 10 day after operation in group II we saw the increasing of average ranges of TcpO2 up to 28.3±9.3 mm.hg., swallow decreasing and tendency to wound healing. Results of fibrinogen range in blood plasma were equate to normal and was 5.1±1.7 g/l (2.8/9.0 g/l) on the third day and 3.9±0.7 (2.4/3.1) on a 10th day (p <0.1). Ranges of C-reactive protein on third and tenth day was 0±1.1 mg/l (0/12 mg/l).

Conclusions. In case of possibility absence to perform the reconstructive operation with renovation of arterial flow – alternative is to perform the catheterization of a.epigastirica inferior an osteoperforation of tibia. The greatest sensitivity and specificity is characterized the range of C-reactive protein and fibrinogen that shows their diagnostic significance in patients with purulent – necrotic DFS. Concentration of C-reactive protein increases proportionally to severity of illness and response to wound healing.