Method for predicting pulmonary hypertension

FIELD: medicine.

SUBSTANCE: method involves measuring forced exhalation volume per 1 s (FEV1) in l, full right ventricle evacuation time (RVE) in ms and angiotensin II value (AII) in ng/l. Discriminant relationship is built as D=0.504·RVE+3.038·FEV1 - 2.0·AII. D being less than 83.88, pulmonary hypertension occurrence is predicted within 1 year. D being equal to or greater than 83.88, no pulmonary hypertension is predicted to occur.

EFFECT: enhanced accuracy of prediction.

 

The invention relates to medicine, namely, pulmonology, and can be used for prediction of pulmonary hypertension in patients with chronic obstructive lung disease.

The prototype was elected as a method for predicting pulmonary hypertension in patients with bronchial asthma by integral evaluation using the discriminant equation of the initial functional state of the endocrine system (Swinarski. Hormonal regulation in patients with bronchial asthma in the stages of formation of pulmonary hypertension and pulmonary-cardiac insufficiency. Diss... Prof. the honey. Sciences, Blagoveschensk, 1997. - S-209). The method consists in the fact that investigate the source levels of angiotensin II, norepinephrine, thyroxine, cortisol, parathormone and decide discriminant equation (D). The actual value of D is compared with the boundary value discriminantal functions and by comparing the results give a prognosis of pulmonary hypertension.

The known method has the following disadvantages:

1. Application of the method is linked to a comprehensive study of the hormonal profile.

2. Does not take into account the significant role of disorders of bronchial obstruction in the Genesis of pulmonary hypertension.

3. Does not take into account the significant role of the functional state of the right ventricle of the heart in the Genesis of pulmonary hypertension.

The purpose of the image is etenia is to increase the efficiency of the prediction of pulmonary hypertension through integrated assessment of bronchial obstruction, functional States of the right ventricle (PI) of the heart and the renin-angiotensin-aldosterone system (RAAS).

The objective is achieved by the fact that the assessment of bronchial obstruction, functional States mud hearts and RAAS is performed on the basis of the measurement values, respectively, of the forced expiratory volume in 1 second (OFB1)), time proglucagon exile (VPI) and angiotensin 11(A11).

The inventive method has the following methods:

a) using spirometry determine FEV1measured in litres;

b) using Doppler echocardiography to determine the VPI, measured in MS.

C) using a radioimmunoassay method determine the level AII, measured in ng/l;

g) integrated assessment of bronchial obstruction, functional States mud hearts and RAAS for predicting pulmonary hypertension is carried out by solving the discriminant of the equation (E):

D=0,504·VPI+3,038·FEV1-2,0·AII,

where D is the discriminant function, the boundary value of which 83,88.

The appearance of pulmonary hypertension during the year is projected at less 83,88, and when D is equal to or greater than the boundary values of the predicted absence of pulmonary hypertension.

The forecast is calculated for a year.

Below are two examples of using the proposed method.

Example 1. P., 41 years old, diagnosis: Bronchial what I have asthma. Mixed form. Moderate severity. The remission phase. NAM I.

Forced expiratory volume in 1 second was 2,32 l; time proglucagon exile - 310 MS; the concentration of angiotensin II in blood serum at 27.1 ng/L. the Value of the initial systolic pressure in the pulmonary artery was 18.4 mm Hg in order To predict pulmonary hypertension resolved discriminant equation:

0,504·310+3,038·2,32-2,0·27,1=109,08.

Because discriminant function more boundary values 83,88, was not predicted the occurrence of pulmonary hypertension. During 12 months of follow-up systolic pulmonary artery pressure was kept in the range of 16.6-23.5 mm Hg, pulmonary hypertension is not registered.

Example 2. O., 46 years old, diagnosis: Bronchial asthma. Mixed form. Moderate severity. The remission phase. NAM II.

Forced expiratory volume in 1 second was 1,96 l; time proglucagon exile - 287 MS; the concentration of angiotensin II in blood serum at 36.1 ng/L. the Value of the initial systolic pressure in the pulmonary artery was 22.3 mm Hg in order To predict pulmonary hypertension resolved discriminant equation:

0,504·287+3,038·1,96-2,0·36,1=78,35.

Since the discriminant function is less than the boundary values 83,88, predicted the occurrence of pulmonary hypertension. After 3 months the CA in a patient registered pulmonary hypertension. The systolic pressure in the pulmonary artery in the remission phase increased to 32.6 mm Hg

The proposed method was tested at the clinic of the far Eastern scientific center of physiology and pathology of respiration SB RAMS. Using the method, carried out the prediction of pulmonary hypertension in 18 patients with bronchial asthma.

The results of the validation of the proposed method has shown its effectiveness. Correct prediction was determined in 80.2% of cases.

A method for predicting pulmonary hypertension in patients with chronic obstructive lung disease, characterized in that examine the original values of forced expiratory volume in 1 s (FEV1in l, time proglucagon exile (VPI) in MS, angiotensin II (AII) in ng/l and solve discriminant equation

D=0,504·VPI+3,038·FEV1-2,0·AII,

and when the value D is less than 83,88 predict the occurrence of pulmonary hypertension in the course of the year, and when the value D is greater than or equal 83,88, predict the absence of pulmonary hypertension.



 

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