PLASMA MEMBRANE BLEBBING OF LYMPHOCYTES AS A MARKER OF ENDOTHELIAL DYSFUNCTION IN PROGRESSIVE PERIPHERAL ARTERY DISEASE OF THE LOWER EXTRIMITIES
Objectives. To determine the role of membrane blebbing of the lymphocytes as a marker of the endothelial dysfunction in the progressive clinical course of the peripheral artery disease of the legs. Methods. The cohort prospective study was conducted enrolling 60 patients with the peripheral artery disease of the legs, with multilevel lesion of arteries, and ΙΙA stage of ischemia according to the classification of Fontaine-Pokrovsky. Based on the objective physical examination results all patients were divided into two groups; the 1st contained 30 patients with no progressive clinical course of the peripheral artery disease of the legs, the 2nd had 30 patients with a progressive clinical course. Membrane blebbing of the lymphocytes of the peripheral blood for all the patients was determined using the phase-contrast microscopy. For the objectification of the pathological process progression, Doppler ultrasound imaging of the lower limbs arteries was made to evaluate the residual vascular lumen during the first hospitalization and 6 months afterwards. Results. Membrane blebbing of the lymphocytes of the peripheral blood is an indicator which objectively reflects the violations in the endothelium functional state. At progressive clinical course the large number of lymphocytes was revealed at the terminal blebbing state 14.9 [13.8; 19.7]%, which reflects the intensity of the pathological process. During Doppler ultrasound imaging of patients with progressive clinical course, more pronounced narrowing of the superficial femoral artery lumen is registered, which makes up -14.3 [-11.2; -17.9]%. In case of a progressive clinical course the residual vascular lumen for the posterior tibial artery was 14.5 [5.4; 21.3]% and for the anterior tibial artery it was 16.7 [11.2; 19.4]%. Conclusions. The highest correlation coefficients with the progression of peripheral artery disease have initial (rS=0.87, p=0.001) and terminal membrane blebbing of the lymphocytes (rS=0.92, p=0.001). Complex diagnostics of the endothelium state, including membrane blebbing of the lymphocytes reflects the type of the pathological process course of the peripheral artery disease of the legs.