Structural changes of the stromal and vascular components of n.tibialis in the case of diabetes mellitus

Authors

  • O. V. Besedinska Буковинський державний медичний університет, Ukraine

DOI:

https://doi.org/10.14739/2310-1237.2013.3.22699

Keywords:

diabetes mellitus, peripheral nerve, microangiopathy

Abstract

Introduction

Diabetic microangiopathy is a complex of pathologic changes in the vessels of the haemomicrocirculatory blood stream and in the perimicrovascular zones, which develop under diabetes mellitus.

However, the structural changes in the vessels of peripheral nerves under diabetes mellitus are insufficiently highlighted in professional literature, and thus become the object of the present study.  

Objective of the research

The objective of the research is to study the structural changes in the stromal and vascular components of n.tibialis under diabetes mellitus.

Materials and methods  

Morphological research of the tissues of n.tibialis of patients with diabetes mellitus was carried out. 192 cases were studied, among them 96 (50%) of autopsy material and 96 (50%) of operational material (tissues of the amputated lower extremities of patients diagnosed with “diabetic foot”). Each n.tibialis was studied separately in its lower, middle and upper segments.   

Research results and their discussion

All cases under study were divided into four groups.

The first group included 30 cases (15,63%) with the initial manifestation of diabetic microangiopathy in individual arteriolae and capillaries. Venulae were hyperemic. Connective tissue surrounding the vessels was swollen, with slight lymphocytic infiltration. No structural changes in the stromal component, except perivascular oedema, were detected.

The second group consisted of 49 patients (25,52%) with the symptoms of moderate diabetic microangiopathy. Microscopic research showed that in addition to the changes characteristic for initial diabetic microangiopathy hyalinosis of segmental character manifested in these patients. Plasmatic saturation was spread over the whole vascular wall. Venular wall was deformed, sometimes with aneurismal prominence. Perivascular enlargement of connective tissue was observed. Structural changes in the stromal component were observed in the lower segment of n.tibialis, specifically the symptoms of oedema of endo-, peri- and epineurium were registered.

The third group included 82 cases (42,71%) with the symptoms of moderate diabetic microangiopathy. Cell proliferation in the vascular wall was minimal or even absent totally. The walls of the affected vessels were almost completely replaced by hyaline. Sclerosis progressed in endo-, peri- and epineurium of the lower segment, partial epineurium detachment was observed. Interstitial edema was registered in the middle segment.  

The fourth group consisted of 31 cases (16,14%) with marked diabetic microangiopathy. Histologically, only solitary endotheliocytes were registered in the affected capillaries and arteriolae in all the segments of n.tibialis, while the thickened vascular wall was completely replaced by hyaline masses immensely narrowing vascular lumen, at times to its total obliteration. Venulae were dilated and deformed. Interstitial edema was spread over the upper segment of n.tibialis. Sclerosis was observed in the lower and middle segments, with partial epineurium detachment in the middle segment, and epi- and perineurium detachment in the lower one.

Conclusions:

  1. Structural changes in the stromal component of n.tibialis under diabetes mellitus are spread from the distal to the proximal nerve segment, and are manifested in sclerosis and interstitial edema, which first appear in the epineurium, are gradually expanded to peri- and endoneurium, and lead to gradual epi- and perineurium detachment.   
  2. Under diabetes mellitus structural changes are observed in all sections of the haemomicrocirculatory blood stream of peripheral nerves; they are manifested in arteriolae and capillaries in plasmatic saturation, in thickening of basal membranes and hyalinosis of vascular walls, in proliferation of endotheliocytes, pericytes, myocytes, all characteristic for diabetic microangiopathy; in venulae these changes are manifested in widening and the appearance of aneurismal dilation.

Prospects of further research

The prospects of further research in this field lie in the study of molecular mechanisms affecting the haemomicrocirculatory blood stream of peripheral nerves under diabetes mellitus.

References

Багрій М.М. Протокол патогістологічного дослідження судинної стінки / М.М. Багрій // Вісник проблем біології і медицини. − 2007. − № 2.− С. 35–38.

Балаболкин М.И. Диабетология / М.И. Балаболкин. – М.: Медицина, 2000. – С. 457–481.

Бальченко А.В. Сахарный диабет и сердечнососудистые заболевания / А.В. Бальченко // Ліки України. − 2009. − № 4. − С. 78–81.

Геращенко С.Б. Периферійний нерв (нейро-судинно- десмальні взаємовідношення в нормі та при патології) / С.Б. Геращенко, О.І. Дєльцова, А.К. Коломійцев, Ю.Б. Чайковський. – Тернопіль: Укрмедкнига, 2005. – 342 с.

Салтыков Б.Б. Диабетическая микроангиопатия / Б.Б. Салтыков, В.С. Пауков. – М.: Медицина, 2002. – 240 с.

Сергієнко О.О. Діабетичні нейропатії: сучасний погляд на проблему, огляд літератури та власних досліджень / О.О. Сергієнко, А.С. Єфімов // Журнал АМН України. – 2002. – № 3. – С. 487–507.

Удовеченко О.В. Роль микроангиопатии в развитии синдрома диабетической стопы / О.В. Удовеченко, М.Б. Анциферов // Актуальные вопросы патогенеза, диагностики и лечения поражений нижних конечностей у больных сахарным диабетом. – М., 2003. – С. 13–29.

Юшков П.В. Гистопатология эндокринной системы / П.В. Юшков. – М.: Издательский дом Куприянова, 2007. – 197 с.

Alberti K.G.M.M. International Diabetes Federation: consensus on Type 2 diabetes prevention / K.G.M.M. Alberti, P. Zimmet, J. Shaw // Diabetes Medicine. – 2007. – P. 451–463.

Boulton AJM. International Guidelines on the Outpatients Management of Diabetic Peripheral Neuropathy / AJM. Boulton, J. Jerwell, A.A. Sergienko [et al.] // The Medicine Group (Education). – London, 1998. –P. 17.

Bromberg M.B. Handbook of peripheral neuropathy / M.B. Bromberg, A.G. Smith. – London: Taylor&Francis, 2005. – 704 p.

Nathan D.M. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy / D.M. Nathan, J.B. Buse, M.B. Davidson // Проблемы эндокринологии. – 2007. – Т. 53. – № 5. – C. 31–33.

Shin J.Oh. Color Atlas of Nerve Biopsy Pathology / J.Oh. Shin. – London: CRC Press LLC, 2002. – 272 p.

Vinik A. Dermal neurovascular dysfunction in type 2 diabetes / A. Vinik, T. Erbas, T. Park // Diab Care. – 2001. – Vol. 24. – P. 1468–1475.

Downloads

How to Cite

1.
Besedinska OV. Structural changes of the stromal and vascular components of n.tibialis in the case of diabetes mellitus. Pathologia [Internet]. 2014Mar.5 [cited 2024Nov.13];(3). Available from: http://pat.zsmu.edu.ua/article/view/22699

Issue

No. 3 (2013)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Лицензия Creative Commons
    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

  1. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).