The state of cellular and humoral immunity in patients with purulent complications of the diabetic foot and the development of sepsis in them

Abstract

Annotation. The purpose of the study was to find out the disorders of the specific immune system of the body in patients with DFS and in the case of complications of the disease with sepsis. Materials and methods. 1627 patients were examined for complicated DFS, in which in 4.1% of cases (67 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 CNPE “City Hospital № 3” in Zaporizhzhia for the period 2007-2022. The criteria for inclusion in the study were: purulent-necrotic processes of a diabetic's foot and cases when the disease was complicated by the development of sepsis. Exclusion criteria: type I diabetes and patients undergoing hemodialysis. Statistical analysis was performed using the “Statgraphics Plus for Windows 7.0” software package. 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 7th to 8th day of treatment of patients with DFS, 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, and on the 12th to 16th day - CD3+1 - CD4+1- CD8+1- CD25+1+, which indicated the transition of the immune system disorder from II degree to I. In CDS patients whose disease was complicated by sepsis, the content of CD3+, CD4+, CD8+ at hospitalization was reliable (P < 0,05) was lower than in patients without sepsis. The 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 7th - 8th and 12th - 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 as follows: Ig A1- Ig M1- Ig G1- CD221-, which indicated the first degree of immunological disorders, while in patients with sepsis - Ig A-1 Ig M3+ Ig G3+ CD22+1+. Similar changes in the latter corresponded to the II degree of immune disorders. On the 7th - 8th and 12th - 16th days, the formula of immune disorders was as follows: Ig A2- Ig M1- Ig G1- CD222-, which corresponded to the II degree of immune disorders. In patients with sepsis, during the same period of the study, an immune disorder of the II degree was observed, but the formula was as follows: Ig A1- Ig M1- Ig G1+ CD22+2-. Thus, the state of the cellular and humoral links of the immune system in patients with both purulent-necrotic processes of DFS and with the development of sepsis is qualified as general immune depression.