Disruption of microhemocirculation

Disruption of microhemocirculation contributes to the violation of tissue trophism, the development of tissue hypoxia, metabolic disorders in the cells of the bronchial mucosa. The consequence of this are atrophic changes in the bronchial mucosa. In 40% of MM patients, bilateral diffuse atrophic endoscopy develops. At the same time, in patients with MM, in contrast to patients with CLL, outside the attachment of AML, in no case was a latent inflammatory process occurring in the bronchial mucosa, despite the fact that CLL also shows markedly abnormal microhemomas in the process of tumor progression. – circulation. This can be explained by a more pronounced decrease in cellular and humoral immunity in patients with CLL compared with patients with MM . In patients with CLL, due to the deep mismatch of all parts of the cellular and humoral immunity, against the background of a violation of the trophism of the bronchial tissues, the inflammatory process quickly develops and then acquires a chronic course.

Disruption of microhemocirculation in the vessels of the lungs and bronchi, along with pronounced secondary immunodeficiency, lymphoid and plasma cell infiltration of the lung tissue, paraproteoinosis of the lungs, contribute to the occurrence of severe and prolonged pneumonia in patients with MM. So in patients with MM I group, where no microcirculation disorders were detected, pneumonia was not registered. In group II, pneumonia was diagnosed in 10 patients (18% of the total number of patients in this group), in group III in 23 patients (42%).

The effect of cytostatic therapy on microhemocirculation indices in patients with MM was studied. In cases where, after carrying out cytostatic treatment, it was possible to reach the phase of a stable “plateau”, a decrease in blood paraprotein was noted, endobronchial LDF was repeated for MM patients. In all, an increase in the PM indices was noted, but in no case did the PM indices completely normalize. An improvement in the amplitudes of oscillations in the endothelial and cardiac ranges was noted. (Table 31).

The persistence of endobronchial microhemocirculation disorders in patients with MM, after reaching the “stable plateau” phase, is explained by the multifactorial nature of the microcirculatory disorders. In addition to the syndrome of increased blood viscosity and anemia, impaired platelet and plasma hemostasis, vascular endothelium, regulation of tissue vascular tone, pH and pO 2 , hormonal background and many other factors affect the microcirculation . In the majority of patients with MM, the plateau phase maintains a minimum PIg production.

As in CLL patients with MM, a high degree of effectiveness of the endobronchial LDF method was noted for identifying vascular and intravascular disorders of the microvasculature of the mucous bronchi in the early stages of the pathological process. The role of LDF in the diagnosis of endothelial dysfunction of microvasculature vessels is very important . The use of this method allows to assess the dynamics of microcirculatory disorders in the mucous membrane of the proximal bronchi during the treatment of myeloma.

According to the data of zonal rheography of the lung in patients of the I group, there were no violations of the general and regional ventilation of the lungs, the vertical gradient of ventilation characteristic of healthy people remained unchanged . The ratio of MOVR of the upper zones / MOVR of the lower zones did not have significant differences compared with the control . No significant impairment of the pulsatory blood flow in this group was also detected. The regional VPO indicators and the total VPO indicator of both lungs did not differ from the control indicators.

Note: P 1 – the significance of differences compared with the control; P 2 – the significance of the difference between the indices of LDF, before and after achieving remission.

In patients with MM of group II, during reopulmonography, there is a decrease in general and regional ventilation of the lungs . A significant decrease in ventilation in the middle and lower zones of both lungs, a decrease in the total MOBP from all zones of the lungs by 29.4% (P <0.05) and redistribution of ventilation from the lower and middle to the upper zones of both lungs were diagnosed . A decrease in the rheographic index of systolic blood filling (SCR) and the index of minute pulsatory blood flow (MPCr) in the right lung was diagnosed. The mccr of the right lung is reduced, compared with the control, with a reliability of <0.05. In the left lung, a significant decrease in blood flow occurred only in the middle zone. The cumulative index of MCR had no significant difference with the control (P> 0.05) . A significant increase in vascular resistance was noted in the lower and middle (to a lesser extent) zones of both lungs, which can be judged by the decrease in HSC and in the length of the Q-interval . But there was no significant redistribution of pulmonary blood flow in patients of group II. Estimating the state of the venous outflow in the small circle of blood circulation due to DSC change, an increase in this index was found in the middle and lower zones, with the greatest values ​​of the coefficient in the basal regions of the lungs. Significantly reduced VPO upper and lower zones and the left lung as a whole (P <0.001). Despite the fact that in the right lung the integral indicator of HPE did not have significant differences with the control, the total index of HPE of both lungs was reduced .

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