Erworbene Funktionsstörungen von Granulozyten und Monozyten als Ursache verminderter Infektabwehr bei Diabetes mellitus

Summary

Potentially defective function of neutrophils and monocytes was studied systematically in a large group of diabetic patients (n=97). The test programm involved the determination of (1) local leukocyte mobilization (LLM) into an in vivo system of a plastic skin chamber, (2) phagocytosis activity index (PAI) for inert Latex particles, (3) bactericidal index of neutrophils (BIN) and monocytes (BIM) and (4) iodination test.

Nearly all (82/97) patients suffering from diabetes mellitus exhibited greatly decreased LLM regardless of type and stage of diabetes, with a mean value at 8 h of 7×10⁶ per cm² of skin abrasion surface (normals=16×10⁶/cm² per 8 h, p<0.001). PAI was also reduced at 10 min (157 for diabetics, 199±73, p=0.05), but mainly in patients with badly controlled diabetes, especially ketoacidosis. PAI after 5 min incubation correlated inversly with concomitant blood glucose levels. BIN and BIM were essentially identical and not impaired in well controlled diabetics, but greatly reduced in patients with severe hyperglycemia and in ketoacidosis.

The attempted correlation of clinical with our functional data was difficult. The nearly universal decrease of LLM in diabetic patients explains their increased suscepitibily to infections only in part. However, patients with combined functional defects (in addition decrease of PAI and/or BIN-BIM) tend to suffer from more frequent and severe infections episodes. At least the impairment of phagocytosis and bactericidal capacity seems to correlate with the degree of diabetes activity, which renders adequate disease control important, in order to prevent infections complications.