Патоморфологічні та морфометричні особливості гострого апендициту в дітей з цукровим діабетом І типу

Abstract

Metabolic disorders caused by chronic hyperglycemia in the gastrointestinal tract of patients with type I diabetes mellitus (T1DM) not only affect natural course of this disease but also modify clinical course of concomitant abdominal purulent-inflammatory diseases in children due to changes of the internal intestinal wall. Purpose - to analyze pathomorphological and morphometric features of acute appendicitis in children with T1DM. Materials and methods. We carried out a pathomorphological and morphometric case-control study of the surgical specimens (appendices and fragments of the peritoneum). Two groups were created: the Group I (n=11) - patients with acute appendicitis, peritonitis and T1DM; the Group II (n=24) - patients with acute appendicitis, peritonitis but without T1DM. Statistical analysis was performed using software package STATISTICA v.10.0 (StatSoft, USA). Results. There were signs of diabetic angiopathy in the Group I and a significant number of inflammatory cells, represented by a large number of segmented nuclear leukocytes - 431±18.2 in 1 mm2, plasma cells - 146±11.13 in 1 mm2, lymphohistiocytic elements - 196±23,32 in 1 mm2. The density of the inflammatory cell infiltrate was 773±36.2 cells in 1 mm2. Morphometric features of the Group II are as follows, number of segmented nuclear leukocytes - 228±15,7 in 1 mm2, plasma cells - 112±10,41 in 1 mm2, lymphohistiocytic elements - 132±21,2 in 1 mm2. The density of the inflammatory cell infiltrate was 773±36.2 cells in 1 mm2. Conclusions. There is an increase in the density of the inflammatory cell infiltrate, the number of neutrophils, plasma cells, and lymphohistiocytic elements in samples of appendices and peritoneum in children with acute appendicitis and T1DM in comparison with the Group II (p˂0.001). Furthermore, those specimens feature presence of hyalinosis, thickening of the vascular wall and partial obliteration of small caliber vessels. In the Group II (patients without T1DM), the parietal and visceral peritoneum had a large number of inflammatory elements and presence of macrophage elements upon normal histological structure of the microcirculatory vessels. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.