The values of the mean square deviation of PM (σ), reflecting the preservation of the mechanisms of blood flow regulation in the microcirculatory bed, in patients of groups I and II did not have significant differences compared with the control (P> 0.05), and decreased in group III ( P <0.001) . The coefficient of variation (Kv), which characterizes the dependence of tissue perfusion on blood flow modulation, increased during tumor progression and in all groups significantly exceeded control (P <0.001) .
When analyzing the rhythmic components of blood flow oscillations, a decrease in e-range fluctuations was observed in patients of groups II and III. In group I patients, the amplitude of oscillations in the E-band did not differ from the control indices (Table 30). A decrease in the amplitude of oscillations in the E-band indicates endothelial dysfunction and a decrease in the production of nitric oxide in MM patients in the later stages of the tumor progression. The decrease in endothelial oscillations correlated with the stage of the disease (r = –0.72, P <0.01), the level of paraprotein (r = –0.56, P <0.05) and blood creatinine (r = –0.56 P <0.05). Since in patients with another lymphoproliferative disease – CLL, there are no changes in endothelial oscillations, it can be assumed that, in MM, important factors for the development of endothelial dysfunction are paraproteinmia,dysproteinemia and uremic intoxication. Endothelial dysfunction of the microvasculature vessels contributes to a severe and prolonged course of inflammatory processes of the bronchopulmonary system in patients with MM and an increase in pressure in the pulmonary artery system.
In patients with MM, no significant changes in the oscillations in the H-, M-, D- bands were detected. The amplitudes of oscillations in the C-band in patients with MM decreased in the course of tumor progression; in group I, they did not have significant differences compared to control; in groups II and III, the indices of cardiac waves decreased significantly (P <0.05 and P <0.001, respectively). A decrease in cardiac wave values indicates a decrease in arterial blood flow into the microvasculature due to the development of a syndrome of increased blood viscosity. According to the data of endobronchial biopsy, in patients of the third group, protein stasis is more pronounced than in patients of the second group; therefore, in the presence of renal insufficiency, the smallest indicators of vibration amplitudes in the C-band were recorded.Significant inverse correlations were found between the level of serum paraprotein of the blood and a decrease in fluctuations in the C-range (r = –0.7, P <0.01), between the duration of MM disease and a decrease in the fluctuations in the C-range r = – 0.58, P <0.05), between the level of blood creatinine and the decrease in fluctuations in the C-band (r = –0.5, P <0.05).
It is obvious that similar violations of microhemocirculation occur in the lungs. Thus, in a significant number of patients with MM II and III groups, during radiological methods of examination, there is an increase and deformation of the pulmonary pattern, which is caused by stagnation of blood in small vessels with the development of pneumosclerosis, since due to the increased viscosity of the plasma, blood flow slows down pulmonary capillary system.