Ischemia and tissue hypoxia observed in diabetes mellitus are the main factors contributing to increased formation of reactive oxidant mu s in various organs and tissues, and involved in the development of pathologically changed structures of tissues and organs, which leads to a violation of their function.
Diabetes mellitus is characterized by chronic hyperglycemia syndrome, which leads to all types of metabolism, directly affecting the development of vascular complications of diabetes. If the equilibrium is in organism shifts towards oxidizer processes, this is called oxide telnym stress. In addition, the accumulation of large quantities of active forms of acid Horn, as well as reduced concentration Thedevelopment of cellular glutathione (the main antioxidant produced by our body) is the cause of the development of such complications as diabetic diabetes foot.
Oxidative stress – a violation of the authority measurable balance between prooxidant and E components of the antioxidant defense system. It is accompanied by varying degrees of insulin deficiency. On andinsulin resistance, which are essential components of the pathogenesis of vascular complications of diabetes. Oxidative stress in diabetes mellitus It may be due to different mechanisms. Increased formation of reactive oxidants resulting from the oxidation of both carbohydrates and carbohydrates forming complexes with various proteins, as well as as a result of auto-oxidation of fatty acids in triglycerides, phospholipids and cholesterol esters;
Ischemia and tissue hypoxia observed in diabetes mellitus are additional - inflammatory factors that contribute to increased formation of reactive oxidant s in various organs and tissues, and involved in the development of pathologically changed structures of tissues and organs, which leads to disruption of their function.
Unlimited free ras dicids and lipid hydroperoxides should have led to the rapid destruction of cellular structures, but under natural conditions this does not happen due to the presence of complex and many bioantiokisliteley component system and natural antioxidants capable of inhibiting a chemical impact of free-radical oxidation of the lipid.
Normally, there is a balance between speed antioxidant activity (vitamins E, C, B, superoxide dismutase, catalase, glutathione transferase , glutathion peroxidase , glutathione reductase , etc.), which is one of the main factors indicators of homeostasis. The final product of the FLOOR is malonic dialdehyde which ing prostacyclin inhibits promoting aggregation of platelets and ii tromboobrazova NIJ. The increased activity of the FLOOR plays su significant role in red blood cell damage comrades and vascular endothelium and in the formation of diabetic angiopathies.
However, the level of RFK, exceeding the protective capabilities of the cell, causes severe cellular disorders (for example, depletion of ATP) and, as a result, destruction cage cells. Depending on the cell stress forces mo gut die from apoptosis toza when internal contents of the cell time to degrade to non-toxic degradation products or due to not Croze, when the power of oxidative stress is too great. Withnecrosis, the cell membrane is broken and the cell contents are released into the environment, which can result in damage to the surrounding cells and tissues.
We have analyzed the indicators of antioxidant system in patients with mixed diabetes syndrome foot therapy, treated in the department of purulent surgery Krasnoyarsk of the regional purulent-septic center for purulent-necrotic complications diabetes mellitus. A total of 31 patients aged from 24 to 83 years old were examined. Wednesday Lower patient age was 59.5 years.
There were 10 men (32.3%), 21 women (67.7%).
On admission, patients had a mixed form of diabetic foot syndrome complicated by osteomyelitis of the foot bones, and 29.2% of patients had diabetes syndrome foot gland complicated by gangrene pal cervical and distal foot, 60.4% had purulent-necrotic ulcers and wounds. According to the Wagner classification, sick races were as follows: Wagner 2 – 60.4%; Wagner 3 – 10.4%; Wagner 4 – 22.9%; Wagner5 – 6.2%. Bse sick Radiated standard therapy.
The intensity of oxidative stress was estimated by the level of malonic acid dialde gide – MDA. which – arises in org During degradation of polyunsaturated fats with reactive forms of oxygen, it serves as a marker of peroxidation of fats and oxidative stress. For evaluation consists AOS in the examined patients the activity of intracellular antioxidant enzyme enzymes was also divided: superoxide dismutase (SOD ), glutathione peroxidase ( GPx ), glutathione transferase, and catalase (CT). Studies were carried out at post. Taking the patient to the clinic on the 3rd, 7th, 14th day ki and at discharge. Results of the study: According to the data, patients at admission have a significant increase in the level of MDA 1.5 times, and in case of high amputations 2.5-3 times. MDA content in patients in all periods of the study above the norm, in 50% of patients high MDA saved and at discharge.
Superoxide dismutase ( SOD ) refers To a group of antioxidant enzymes. In a place with catalase and other antioxidants With this enzyme it protects the organ human base from the constantly formed highly toxic oxygen radicals. Superoxide dismutase catalyzes the strand with mutation of superoxide into oxygen and hydrogen perok seed. Thus, it plays a crucial role in antioxidant protection. Those of almost all cells that are somehow in contact with oxygen. According to a study in 32.3% of patients with SOD 2.5-3 times higher than normal, but the hearth of the total number of patients 67.7% SODcloser to normal, and 30% of them are even lower than the norm. Catalase indices were also ambiguous: in 45.2%, catalase was 1.5–2 times higher than the normal , but in 34.8% of catalase within the normal range, in 20% of cases it was lower than normal . Indicators of glutathione peroxy dase in half of the cases are above the norm by 1.5 times, in the remaining patients it is within the normal range of 40% and below the norm in 60% of cases. Glutathione transferase is 100% higher than normal we, in half the cases above the norm, are 10 or more times. It is worth noting throughout the study that these indicators varied from indicators below the norm to an increase of 2-3 times higher than the norm and vice versa, that ritages about the high sensitivity of antioxidant enzymes.
Based on these results, we can conclude that oxidative stress, which develops as a result of hyperglycemia, is characterized by excessive production of free radicals (or reactive oxygen species – ROS) and, as a result, decreases the activity of the antioxidant system leads to the development of such complications diabetes mellitus like diabetic syndrome foot.