DIAGNOSIS AND PROGNOSIS OF THE HEALING PROCESS OF TROPHIC ULCERS IN CHRONIC VENOUS INSUFFICIENCY OF THE LOWER LIMBS

Pikaluk V. S., Hryvenko S. H., Izosimov V. V., Umerov E. E.

MORPHOLOGY

Scentific article

The article presents the results of an immunohistochemical study of trophic ulcers skin biopsies in patients with chronic venous insufficiency of the lower extremities in two groups of patients. In both groups, multicomponent antibacterial, water-soluble ointments were used for local treatment, which were supplemented by compression therapy and the prescription of phlebotonic preparations. The first group consisted of 54 patients. The second consisted of 52 patients who were additionally given reparant and enterosorption as part of complex treatment of trophic ulcers (Patents of Ukraine to Utility Models No.89297 and No.112033). Monitoring the morphological data in the process of complex treatment, a decrease in the total number of macrophages in the dermis was noted. At the same time, there was a significant increase in the number of macrophages with weak expression of CD68 on the 7th day from the initiation of complex treatment. The number of macrophages with marked expression of CD68, on the contrary, gradually increased, especially in the second group of patients. Similar trends are observed on the 14th day from the initiation of the complex treatment, which may be a criterion of the effectiveness of the treatment, and the authors proposed method for diagnosing the course of the wound process in trophic ulcers of venous genesis (Patent of Ukraine to utility model No.119601). A steady increase in the macrophage activity index (the ratio of macrophages with pronounced expression relative to weak expression) in the wound contents and its gradual approach to the level of 1.0 testified to the favorable treatment in trophic ulcers. Such regularity in the increase of the macrophage activity index allowed it to be proposed as a way to predict the course of the wound healing process in trophic ulcers in chronic venous insufficiency of the lower extremities (the patent of Ukraine to the utility model No.123242).

trophic ulcers, macrophages, complex treatment

1. Zhadinskij NV, Zhadinskij AN. Pato- i sanogeneticheskie aspekty ranevogo processa (obzor literatury). Ukrains’kij zhurnal hіrurgіi. 2013;2(21):158-62. [in Russian].
2. Petrenko OM, Bezrodnij BG, Tihomirov AO. Monіtoring perebіgu ranovogo procesu u gnіjnyh ranah. Hіrurgіya Ukrainy. 2014;2:65-9. [in Ukrainian].
3. Supil’nikov AA, Devyatkin AA, Pavlova ON, Gulenko ON. Morfologicheskie i fiziologicheskie aspekty techeniya ranevogo processa (literaturnyj obzor). Vestnik medicinskogo instituta «REAVIZ». 2016;3:144-51. [in Russian].
4. Alekseeva NT, Nikityuk DB, Gluhov AA. Osobennosti morfologicheskoj reakcii tuchnyh kletok pri reparativnoj regeneracii v kozhe pod vliyaniem regional’nyh faktorov. Morfologicheskie vedomosti. 2014;3:20-30. [in Russian]
5. Zavgorodnyaya MI, Makeeva LV, Slavcheva OS, Sulaeva ON. Kletochnye i molekulyarnye osnovy zazhivleniya ran. Morfologіya. 2016;10(3):1923. [in Russian].
6. Zarivchackij MF, Lukin PS, Vinogradov AB, Ponomareva TB. Citologicheskoe issledovanie dinamiki ranevogo processa pri sindrome diabeticheskoj stopy. Permskij medicinskij zhurnal. 2017;34(3):13-8. [in Russian].
7. Yarec YuI. Citologicheskie osobennosti lokal’nyh ran na razlichnyh ehtapah reparativnogo processa. Problemy zdorov’ya i ehkologii. 2009;3(21):41-4. [in Russian].
8. Alekseeva NT, Gluhov AA, Ostroushko AP. Rol’ kletok fibroblasticheskogo differona v processe zazhivleniya ran. Vestnik ehksperimental’noj i klinicheskoj hirurgii. 2012;5(3):601-8. [in Russian].
9. Barinova ME, Sulaeva ON. Geterogennost’ reakcii makrofagov pri zazhivlenii ran nizhnih konechnostej u bol’nyh saharnym diabetom. Morfologіya. 2009;3(1):22-7. [in Russian].
10. Belova OV, Zimina IV, Torhovskaya TI, Nikitina NA, Sergienko VI. Immunologicheskaya funkciya kozhi v svete novyh dannyh. Chast’ 3. Makrofagi kozhi. Rossijskij immunologicheskij zhurnal. 2015;18(2):155-63. [in Russian].
11. Maksimova NV, Lyundup AV, Lyubimov RO, Mel’nichenko GA, Nikolenko VN. Patofiziologicheskie aspekty processa zazhivleniya ran v norme i pri sindrome diabeticheskoj stopy. Vestnik RAMN. 2014;11-12:110-7. [in Russian].
12. Brancato SK, Albina JE. Wound macrophages as key regulators of repair. Am J Pathol. 2011;178:19-25.
13. Murray PJ, Wynn TA. Protective and pathogenic functions of macrophage subsets. Nature Reviews Immunology. 2011;11:723-37.
14. Alekseeva NT. Uchastie kletochnogo komponenta v regeneracii rany. Zhurnal anatomii i gistopatologii. 2014;3(1):9-15. [in Russian].
15. Sarbaeva NN, Ponomareva YuV, Milyakova MN. Makrofagi: raznoobrazie fenotipov i funkcij, vzaimodejstvie s chuzherodnymi materialami. Geny & kletki. 2016;11(1):9-17. [in Russian].
16. Domarackaya EI, Payushina OV. Perspektivy ispol’zovaniya mezenhimnyh stromal’nyh kletok dlya gegeneracii povrezhdennoj kozhi. Uspekhi sovremennoj biologii. 2017;137(1):56-69. [in Russian].
17. Barron L, Wynn TA. Fibrosis is regulated by Th2 and Th17 responses and by dynamic interactions between fibroblasts and macrophages. Am. J. Physiol. Gastrointest. Liver Physiol. 2011;300(5):723-8.
18. Daley JM, Brancato SK, Thomay AA, Reichner JS, Albina JE. The phenotype of murine wound macrophages. J. Leukoc. Biol. 2010;87(1):59-67.
19. Eming SA, Krieg T, Davidson JM. Inflammation in wound repair: molecular and cellular mechanisms. J. Invest. Dermatol. 2007;127(3):514-25.
20. Ishida Y, Gao JL, Murphy PM. Chemokine receptor CX3CR1 mediates skin wound healing by promoting macrophage and fibroblast accumulation and function. J. Immunol. 2008;180(1):569-79.
21. Umerov EE. Osobennosti morfologicheskoj struktury kozhi pri ishemicheskih troficheskih yazvah s uchetom makrofagal’noj aktivnosti vospalitel’nogo infil’trata. Svіt medicini ta bіologії. 2013;4:89-91. [in Russian].
22. Gulikyan GN, Karapetyan GE, Kirichenko AK, Vinnik YuS, Pahomova RA. Patomorfologiya troficheskoj yazvy venoznoj ehtiologii v ehksperimente pri autotransplantacii zhirovoj tkani. Moskovskij hirurgicheskij zhurnal. 2017;2(54):25-9. [in Russian].
23. Mihajlov AYu, Pronichev VV, Solov’ev AA, Styazhkina SN, Chernenkova ML, Ledneva AV. Ehffektivnost’ primeneniya stimuliruyushchih autofaktorov dlya regeneracii mestnyh vospalitel’nyh i yazvennyh processov. Permskij medicinskij zhurnal. 2014;33(5):58-64. [in Russian].
24. Іzosіmov VV, Umerov EE, Hryvenko SH, vynahidnyki; Іzosіmov VV, Umerov EE, Hryvenko SH, patentovlasnyki. Sposіb dіagnostyki perebіgu ranovogo procesu u trofіchnyh vyrazkah pry hronіchnіj venoznіj nedostatnostі nyzhnіh kіncіvok. Patent Ukrainy № 119601. 2017 Ver 25. [in Ukrainian].
25. Іzosіmov VV, Umerov EE, Hryvenko SH, vynahіdnyki; Іzosіmov VV, Umerov EE, Hryvenko SH, patentovlasnyki. Sposіb prognozuvannya perebіgu ranovogo procesu u trofіchnyh vyrazkah pry hronіchnіj venoznіj nedostatnostі nyzhnіh kіncіvok. Patent Ukrainy № 123242. 2018 Lyut 26. [in Ukrainian].

«Bulletin of problems biology and medicine» Issue 1 Part 1 (148), 2019 year, 291-295 pages, index UDK 616-001.4-07+616.5-002

10.29254/2077-4214-2019-1-1-148-291-295