Патогенетическое значение дисфункции эндотелия в формировании гипертонуса периферической сосудистой стенки при местной холодовой травме

Abstract

The relevance of local cold injury remains high. In the structure of general injury prevalence, proportion of freeze burns is great. Identification of new markers of cold injury will help earlier determination of tissue lesion depth, development of new approaches in the surgical treatment of deep freeze burns of extremities, and promote rehabilitation of patients.The aim of this study was to elucidate the dynamics of the serum content of nitric oxide (NO), asymmetric dimethylarginine (ADMA), and circulating endothelial cells (CEC) in patients with local cold injury.Methods. The study included 80 patients with III-IV degree frostbite of the lower extremities in the late reactive period and the period of granulation and epithelization. Multiplex analyses of blood serum were performed with Biomedical (USA) reagent kits, according to methods by Hladovec (1978) and Golikov (2004).Results. In all groups of patients with frostbite, NO level was decreased compared to the control. Patients with local cold trauma displayed significant decreases in blood levels of ADMA on day 5; on day 30 after the cold trauma, the ADMA level did not differ from the control group. In patients with frostbite of the distal foot segments, the blood concentration of ADMA did not change from the control level. In patients with the most severe frostbite of the lower extremities, serum ADMA decreased 3.6 times. Patients with local cold trauma had a 5.2-fold increase in the blood level of CEC on day 5. On day 30 after the freeze burn, the amount of CEC was decreased but still remained above the control value. In patients with frostbite of the distal foot segments, the content of CEC increased 2.7 times compared to the control. In patients with lesions of more proximal segments of the lower extremities, the CEC index was increased 6.7 times compared to healthy volunteers. In patients with the most severe frostbite of the lower extremities, the blood content of CEC was 9 times increased.