Influence of diabetes mellitus on the development of pulmonary dysfunction in community-acquired pneumonia

Aim: To determine the influence of type 2 diabetes mellitus (DM 2) on the functional state of alveolar-capillary permeability (ACP) and inflammatory process intensity in community-acquired pneumonia (CAP).

Material and Methods. Patients hospitalized with CAP and DM 2 (n = 24), CAP (n = 24) and DM 2 (n = 32) were enrolled in a singlecenter cross-sectional study. All patients underwent: ventilation scintigraphy to assess the state of ACP, biochemical study of oxidative processes in blood plasma using spectrophotometry. The examination was performed on the 1st-3rd day from the beginning of their hospitalization.

Results. A statistically significant increase in ACP at the 30th minute of the examination was observed in both the affected lung (39.2%) and the intact lung (34.1%) in CAP + DM2 patients vs. 30.9% and 28.2% in CAP patients and 23.2% in DM 2 patients. The highest production of trypsin-like proteinases (TLPs, 153.3 BAEE/min·mL), elastase-like proteinases (ELPs, 130.7 BAEE/min·mL), thiobarbituric acid (TBARS, 8.4 μmol/mL), and bityrosine (12*10–3 units) was observed in CAP + DM 2 patients with the minimum activity of α1-proteinase inhibitor (α1PI) of 28.5 IU/mL vs. all comparison groups. The correlation analysis revealed strong direct relations between the ACP value and the activity of TLPs, ELPs, TBARS and negative relations with α1PI.

Conclusion. The peculiarity of pulmonary dysfunction manifestation in CAP+DM 2 patients consists in increased ACP both in the affected and intact lungs. The inflammatory process in CAP + DM 2 patients is characterized by the minimum activity of the inhibitor and the maximum activity of proinflammatory enzymes. These correlations testify to a systemic inflammation being more pronounced when the two nosologies occur simultaneously, which affects the state of ACP.

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