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Tatyana V. Pavlova Anton N. Kaplin Irina I. Povalyaeva Lyudmila O. Zemlianskaia Lyubov A. Pavlova Igor Yu. Goncharov

Abstract

Introduction: Diabetes mellitus (DM) is one of the most common diseases. According to the WHO, at present, the total number of patients with diabetes in the world has exceeded 100 million people. Endothelial dysfunction is an integrated syndrome of insulin resistance deepens it, increases vascular reactivity, and provokes cardiovascular disorders. In connection with this search for modern methods of detecting and identifying the presence of endothelial dysfunction in patients with diabetes is extremely important. Taking into account the above, the purpose of our study was to study the possibilities of using innovative pathomorphological approaches (scanning raster and atomic force microscopy) in the study of endothelial cell dysfunction in women with type I diabetes.


Materials and Methods: The research materials consisted of two groups. The first group included pregnant women with type I diabetes, the second group consisted of patients of various age groups. The study and morphometric processing were carried out in a scanning electron microscope and an atomic force microscope. The geometric parameters of erythrocytes were calculated as area, volume, max Z, perimeter.


Results and discussion: When studying erythrocytes, it was shown that the sizes of different groups of cells did not differ significantly. Pathological forms of erythrocytes were represented by: transitional forms (capable of reverse transformation): ellipses, discocytes with a crest, flat disks, discocytes with outgrowth, discocytes with multiple outgrowths, erythrocytes in the form of a "mulberry berry"; prehemolytic forms (with changes that are irreversible): domed, spherical, in the form of a "deflated ball"; degenerative. There was a clear tendency to an increase in their content with increasing age of the patients, which, apparently, is associated with the duration of the course of the disease. In the older age groups of patients with diabetes mellitus I, the erythrocyte cavity depth indicators varied significantly, therefore, there was no significant increase in this indicator compared to the biological norm group for this age; on the contrary, it was decreased. In the samples of the uterus of pregnant women with type I DM, obtained during the caesarean section, the vessels had a greater tortuosity than in the control group. Moreover, their diameter varied significantly. Foci of destruction were identified in the endothelium. The distance between the folds of endothelial cells increased


In the lumen of a part of the vessels, fibrin was determined in the form of separate filaments and layers, platelets, erythrocytes with stasis and sludge. The structure and shape of erythrocytes was often disrupted.


Conclusions: Even with a short duration of the disease, deviations of the main hemorheological properties and indicators are observed, including such as changes in the basic geometric parameters of erythrocytes, their ability to aggregate and deform. Diagnosis of hemorheological disorders in diabetes can serve as an early marker of target organ damage. The study proved that changes in carbohydrate metabolism in diabetes mellitus significantly affect the properties of the endothelial-erythrocytic system, and they can be diagnosed using various modern microscopy methods at an early stage.

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Keywords

diabetes mellitus, pregnant, erythrocytes, electron, atomic force microscope

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