Diagnostic significance of endotoxin and antitoxic opsonin – fibronectin in the blood flow in purulent-necrotic inflammatory of the lower limb in patients with diabetes mellitus

Abstract

Introduction. In the cascade of pathogenetic mechanisms of diabetes mellitus, one of the central positions is occupied by systemic vascular lesions, including the lower extremities with the formation of diabetic foot syndrome. Aim. To investigate and evaluate the diagnostic significance of endotoxin concentration and plasma fibronectin parameters in indicating the severity of purulent-necrotic inflammation of the feet in patients with diabetes mellitus. Materials and methods. The study included 112 patients with purulent-necrotic inflammation of the feet aged 61.4 ± 12.5 years. By types of surgical intervention, patients were divided into groups: the main group (21 patients with transmetadarsal ammutation of the foot and 27 with amputation at the level of the lower leg), the comparison group – 64 patients with necrectomy and plastic closure of wounds on the foot. The concentration of endotoxin in the bloodstream was determined by the micro-LAL test (EU/ml), the content of plasma fibronectin was assessed by enzyme immunoassay (µg/ml). Results. With the progressive development of purulent inflammation of the feet in patients of the main group, the concentration of endotoxin reached 9.32 (0.91) EU/ml, in the comparison group – 5.73 (0.36) EU/ml, in which purulent-necrotic the process was limited. In the main group of examined patients, hypofibronectinemia also had a more significant character. At the same time, the lowest fibronectin in patients was observed with an extensive purulent-necrotic process, in whom an amputation was performed at the level of the lower leg – 124.7 (6.2) µg/ml, the concentration of endotoxin in them reached the maximum figures – 10.51 (0.5) EU/ml. Discussion.The main factor determining the depth of endotoxin aggression and destructive lesions of the extremities can be the enhanced utilization of fibronectin. Conclusion. The progression of endotoxin aggression is a predictor of an increase in the severity of destructive tissue damage in patients with diabetes mellitus.