The method of early prediction of clinical course of exudative pericarditis in patients with systemic diseases

 

(57) Abstract:

The invention relates to medicine, namely cardiology and rheumatology, and can be used in particular for the early prediction of occurrence, clinical course and outcome of exudative pericarditis in systemic diseases. The method is to determine the activity levels of immunoglobulin IgM and IgG antibodies to herpes simplex virus on the 5th and 15th day of admission to hospital and at higher titers of diagnostically significant result of specific IgM in 1.0-1.7 times and IgG 2.1-3.0 times predict the occurrence of complications of systemic disease exudative pericarditis; and at low values of immunoglobulins to herpetofauna, not reaching diagnostically significant result or exceeded for IgG to 1.01-1.99 times, predicts favorable course of systemic lupus erythematosus and rheumatoid arthritis without effusion. Effect: raising awareness of the prediction of the clinical course and outcome of exudative pericarditis in systemic diseases with simultaneous simplicity and availability for widespread use in clinical practice. table 2.

The invention relates to the region is investing appearance, clinical course and outcome of exudative pericarditis in systemic diseases.

In clinical medicine is not currently known methods for predicting the clinical course of exudative pericarditis in systemic diseases. However, the known scientific work to study the etiological diagnosis of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) without pericarditis. Identified antibodies to herpetofauna in the serum of patients with SLE (80,4%) and RA (80%) indicated the involvement of herpes simplex virus (HSV-1) in the pathogenesis of systemic diseases [Rantapaa-Dahlgvist S., Neumann-Andersen G., Backman C., Dahlen G. et al. //Echocardiographic findings, lipid and lipoprotein(a) in patients with systemic lupus lupus. - Clin. Reumatol. - 1997. - V. 16. - N 2. - P. 140-148; Mousavi-Jazi m, L. Bostrom, Lovmark C. et al. // Infreguent detection of cytomegalovims and Epstein-Barr vims DNA in synovial membrane of patients with rheumatoid arthritis. - J. Rheumatol. - 1998. -V. 25. No. 4. - R. 623-628]. In the literature there are data about the definition of causal facilities HSV-1, HSV-2 and HSV-6, including the detection of high titers of specific immunoglobulins IgG, their Association with clinical manifestations of RA [Mousavi-Jazi m, L. Bostrom, Lovmark S. et al. // Infreguent detection of cytomegalovims and Epstein-Barr virus DNA in synovial membrane of patients with rheumatoid arthritis. - J. Rheumatol. - 1998. -V. 25. No. 4. - R. 623-628].

The disadvantages of these methods, the CSO flow system diseases due to the simple fact of the detection of antibodies in serum;

the objective impossibility of predicting complications such as lupus and rheumatoid pericarditis without registration dynamic changes in the levels of specific antibodies conjugated with different nature of the clinical course of systemic diseases;

the lack of data about the value of herpetofauna in the early clinical course of exudative pericarditis in systemic diseases.

The closest method to the present invention is a method for detecting IgA, and IgM antibodies to HSV-1 and complexes of complement in pericardial biopsy samples of patients with clinical symptoms of recurrent exudative pericarditis [R. Afrasiabi, Sikop P. A., S. M. Albini et aL, // Recurrent pericarditis and dermatitis helpetiforms. (Evidence for immune complex deposition in the pericardium). - Chest. - 1990. - V. 97. No. 4. - P. 1006-1007].

However, this method has the disadvantages of:

- high invasive techniques pericardial biopsy, limiting the use in diagnosis and prognosis of exudative pericarditis;

- the method is not sufficiently accurate because of specific immunoglobulins is not defined in the dynamics;

the method is based on the definition of herpetofaunal only in patients with idiopathic pericarditis; research activity of HSV is technical for ex-sedatives of pericarditis in systemic diseases.

The aim of the presented invention is to improve the informativeness prediction of clinical course and outcome of exudative pericarditis in systemic diseases with simultaneous simplicity and availability for widespread use in clinical practice.

The goal of the invention is achieved by the fact that determine the activity levels of immunoglobulin IgM and IgG antibodies to herpes simplex virus on the 5th and 15th day of admission to hospital and at higher titers of diagnostically significant result of specific IgM in 1.0-1.7 times and IgG 2.1-3.0 times predict the occurrence of complications of systemic diseases - exudative pericarditis, and at low values of immunoglobulins to herpetofauna, not reaching diagnostically significant result or exceeded for IgG to 1.01-1.99 times, predict the impossibility of developing exudative pericarditis in systemic diseases.

In clinical practice the most common pericarditis (46%), caused by influenza viruses (often group “A”), Coxsackie, herpes simplex and cytomegaly [Toradjo-Martinez R., 1988; Suzuki, S., K. Yano, 1996; Babonian S., Davies MJ. et aL, 1997]. It is known that over 90% are infected with herpes simplex virus and up to 20% have different clanname changes in nuclear chromatin until complete lysis, granular dystrophy and loss of transverse iscertainly, in some cases changes in the nuclei of endothelial and fibroblasts, the effects of focal and diffuse lymph plasmocytoma myocarditis and pericarditis. Exadactylos function due to HSV cytoplasmic action of the virus, as well as changes in lipid metabolism in the result of the passage of the virion through the inner leaflet of the nuclear membrane in endoplasmatic reticulum and cover its additional shell of glycoproteins and lipids.

In primary and recurrent herpetofauna infection observed sequential synthesis of IgM, IgG. During the first 1-3 weeks of the disease in humans revealed antibodies, presents IgM, which usually disappear quickly (half-life of 4-8 days) [Long Century A.D., 2000]. When often recurrent herpetoviridae infection antibody titers, as a rule, higher than in healthy people or patients with rare manifestation of the disease. Lysis of infected cells due to the binding of IgG (half-life 20-28 days) one active center of the determinants virousspecificakih antigen localized on the cell surface, and the other with Fc-receptor of T lymphocytes, macrofagnacelennaya, associated with autoimmune changes in the body, and additional iatrogeny, resulting from hormonal therapy in patients with persistent form herpetofaunas of infection may predispose to activation of the HSV. The purpose of cytostatics, immunosuppressants, corticosteroids, and intercurrent disease cause depression natural T-killers, the output of viruses in a liquid environment, and the “dispersion” of the virus by blood flow to the various organs of the passage of ITGI from latent in the clinically distinct forms [Isakov C. A., Aspelia Y. C., 1999]. Thus, the increased production of antiviral antibodies to herpetofauna is not concurrent with the increase in the activity of the autoimmune process. In connection with this fact the blood was taken for research in the dynamics in patients with systemic diseases on the 5th and 15th day of admission to hospital as worsening immunosuppression in the treatment of systemic disease with corticosteroids, cytostatics, immunosuppressants. Given the small period of circulation of immunoglobulin M (during the acute phase of inflammation, i.e. mainly during the “viraemia”), products for next day low level of antibodies, the focus for vozniknove the side of the reactivation of latently persisting virus and prevent the development of recurrence. When expressed IMMUNOSUPRESSIVE herpes infection develops more frequently and is characterized by a more severe course, due to the lack of immunity or excessive immune response [Isakov C. A., Aspelia Y. C., 1999]. In these cases, patients with systemic diseases low efficiency of therapy of SLE and RA, the high activity of the autoimmune process, the development of various complications.

So, despite the literature data about cardiotropic and exudate-producing ability of herpetofauna, studies aimed at predicting the occurrence of pericardial effusion in the pericardium in systemic diseases, was not carried out. Anecdotal evidence about the presence of herpes viruses in systemic diseases (systemic lupus erythematosus (SLE), rheumatoid arthritis (RA)), not related to the dynamics of the clinical course and outcome of the disease, do not allow to estimate the probability of a complicated course of a systemic disease exudative pericarditis. Distinctive features of the proposed method of forecasting is early identification of patients with higher risk of exudative pericarditis provided similar mechanism of pathogenesis and extent is activated early origin of the complicated course of systemic diseases, when clinical manifestations exudative pericarditis is insignificant. Unlike other above studies, the present method takes into account the peculiarities of the pathogenetic involvement of herpetofauna in the face of declining immunity in autoimmune diseases with favorable and complicated by pericarditis clinical course than differs from those described in the literature.

The proposed method of the invention was tested on 29 patients with systemic diseases (SLE - 12, PA - 17), complicated and not complicated exudative pericarditis, during 1997 to 2002, on the basis of the departments of cardiology Alexander Mariinsky Regional clinical hospital №1 (2,78%), efferent blood surgery and hemodialysis Scientific-industrial medical complex “Environmental medicine”, JSC “Astrakhangazprom” (2,78%), rheumatology (91,67%) and cardiology (2,78%) of the City clinical hospital №3 of them. Kirov (94,45%). Traditional instrumental and laboratory data do not allow us to estimate the prognosis of the clinical course of systemic diseases and the occurrence of pericarditis. In this regard, we also performed ELISA testing of serum of patients with systemic diseases, the agents of the company “DSL” (USA). The view of the received data produced by the spectrophotometer “ELx 800 Universal Microplate Reader” company “Bio - Tek instruments INC (USA). The results are interpreted as positive when reaching diagnostically significant result (JR), obtained by calculating the ratio of the average of the sample optical density (OD environments) to Cutt-Off (optical density control sera) by a factor equal to IgM 1.0 to 1.1 times; IgG is 1.1 times or more. The data are processed by the method of variation statistics (table.1, 2).

Below are the results of testing.

In the clinical characteristics of patients showed that high activity (PB - III) autoimmune process in systemic diseases is not always complicated by the occurrence of exudative pericarditis. So, only to 47.4% of patients with SLE and 12.5% with RA disease was complicated by the occurrence of exudative pericarditis. In patients with exudative pericarditis in systemic diseases (SLE, RA), there was an increase in the titer of immunoglobulin IgG to herpetofauna (HSV1+2in 100% of cases. The excess of diagnostically significant titers of IgG to HSV averaged 2,18±0.45 times (table.1). Only in 73,3% of patients with pericarditis in systemic diseases mentioned Vysok years, case history No. 86 56, Mon., was admitted to the rheumatology Department of the City clinical hospital №3 of them. Kirov 29.07.97, complaining of intense pain in the shoulder, wrist, elbow, knee, hip, ankle joints, stiffness periodically throughout the day, expressed weakness, shortness of breath, swelling in the legs and hips. The patient feels that he is about 5 years old when I was diagnosed with RA. The deterioration in the last month. Objectively a serious condition. Sick right physique, low power. Peripheral lymph nodes are not enlarged. Expressed ulnar deviation of both brushes. In the area of the wrist joints are cysts, size 23 see the Deformation of the fingers on the neck of a Swan.” Brush collects in the fist 50%. The hold is broken. Self-service is difficult. It is hard to walk. Motion in all joints is limited and painful. Defigure wrist, knee joints due to periarticular infiltration, atrophy maastrich muscles of the shoulders, hips. Percutere above the lungs pulmonary sound, below the angle of the blades is determined by its dullness. Auscultation in the lungs vesicular respiration, below the angle of the blades weakened, no wheezing. The frequency of respiratory magic cube MOV is correct. Pulse 86 beats per 1 minute, single ventricular extrasystoles. HELL 170/90 mm RT.article Swelling of legs, thighs. Belly painless on palpation. The liver below the edge of the right costal arch on 1 see the Spleen is not enlarged. During instrumental examination ECG - sinus rhythm, hypertrophy of levego ventricle, changes of repolarization processes; ECHO kg of fluid in the pericardium is not lazerette. The laboratory examination of blood from 29.07.97 g: erythrocytes 3,01012/l, hemoglobin 71 g/l, colour index of 0.7, seromucoid 0,44 ye., blood glucose of 5.6 mmol/l, urea 6,0 mm/l, leukocytes 13,8109/l, erythrocyte sedimentation rate of 37 mm/h, C-reactive protein positive on 3 “plus”, removechar 1:160; in the immunological IgG - 8,39, IgA - 0,73, IgM - 0,83.

Diagnosis: rheumatoid arthritis, activity III, stage III, slowly progressive course. NFS III. Rheumatoid excude-tive pericarditis. MK III.

Treated with voltaren, diclofenac, prednisolone, nitro-granuloma, adelfan, sulfokamfokain, Dibazol, paraffin and sverhchistoty magnetic currents on the wrists. On the 5th day of stay of the patient in the hospital the patient's condition deteriorated: was pronounced shortness of breath, pains in the heart area compressive nature. In legality heart: vehnee III edge, right outwards from the right edge of the sternum at 2 cm, left on the left anterior axillary line. Auscultation over the aorta and in the apex appeared weak blowing noise pericardial friction. Data instrumental examination (ECG, ECHO-KG) are similar to those from 29.07.97, With ELISA testing of serum against the background of persistent leukocytosis and increased ESR revealed high titers of specific immunoglobulins IgM HSV - 1,71, IgG HSV - 2,69 (PL.1, 2). On the 15th day shortness of breath increased, there was a sudden weakness. During instrumental examination ECG - sinus rhythm, reducing voltage peaks, changes of repolarization processes, inperceptable changes in I, aVL, V4-V6; ECHO KG rear wall of the left ventricle lazerette exudate 0.6 cm; the radiograph on the right pleural cavity defined by liquid until the sixth ribs. On the 15th day laboratory examination activity levels of immunoglobulins exceeded diagnostically significant results: HSV IgM 1.7, IgG HSV - 2.69 times (table.1, 2).

Described clinical example # 1 demonstrates the possibility of forecasting rheumatoid exudative pericarditis already with 5-day (15-day) admission of the patient to the hospital. Enzyme-linked immunosorbent opreate diagnostically significant result 2.69 times) confirms the reactivation of HSV in the background protivorevmaticski therapy nonsteroidal anti-inflammatory drugs, prednisolone, and the occurrence of rheumatoid pericarditis on the 5th day stay patient in the hospital (table.1, 2).

Example No. 2. Patient K., 41 year history No. 961-132, was admitted to the rheumatology Department of the City clinical hospital №3 of them. Kirov 17.02.98, with complaints of pain in the heart, shortness of breath during exercise, increased blood pressure up to 200 mm RT.art., weakness, headaches. Ill for about 15 years. Last inpatient treatment in 1997 Constantly receives 3 tablets of prednisolone per day. Deterioration notes about 2-3 months. When entering a state of moderate severity. Sick right physique, moderate power. The joints are not visually changed, palpation painless, the amount of movement is stored. The skin is hyperpigmented spots. Peripheral lymph nodes are not enlarged. Percutere above the light lung sound auscultation on the lateral surface of the left - unit scattered dry rales. Borders of relative heart dullness extended to the left by 1.5 cm Heart tones are muffled, rhythmic. Auscultation is determined by the accent of II tone the aorta systolic murmur at Botkin - ERB and at the apex of the heart. Heart rate 76 beats per 1 minute is ternasco positive, more to the right. The liver is not enlarged. Tibia slightly pasty. During instrumental examination ECG - sinus tachycardia, left ventricular hypertrophy; ECHO kg of fluid in the pericardium is not lazerette. The laboratory examination of blood: erythrocytes 3,51012/l, hemoglobin of 100 g/l, leukocytes 7,3109/l, erythrocyte sedimentation rate of 30 mm/h, CRP positive on 3 “plus”, seromucoid 0,52 ye., urea 8.0 mm/l, cholesterol - 4.4 mm/l, LE - cells are found in the diagnostic titers.

Diagnosis: systemic lupus erythematosus, subacute period, activity II with lesions of the skin, blood vessels, lung, heart, kidney. Chronic renal failure first degree.

Treated with cyclophosphamide, prednisolone, nitrogranulong, adelfan, sulfokamfokain, Dibazol, capatina.

On the 5th day of stay of the patient in the hospital the patient's condition deteriorated: was pronounced shortness of breath, appeared to increase body temperature to 37,7 With increased pain in the heart, weakness. In the lungs without the speakers. The border of the relative cardiac dullness extended to 1.5 cm outwards from the left mid-clavicle line. Heart sounds are muffled. ECG: sinus tachycardia, left ventricular hypertrophy; ECHO kg of fluid in the pericardium is not l 0,8, seromucoid 0,52 ye., urea 8.0 mm/l, leukocytes 7,3109/l, ESR 35 mm/h, C-reactive protein positive 4 “plus”, cholesterol - 4.4 mm/l, LE-cells are found in the diagnostic titers; IgG - 1,38, IgA - 0.99, And IgM -1,28; immunoassay test: HSV IgM - 0,54, IgG HSV - 2,97 (PL.1, 2).

On the 15th day on the background of the above complaints over the apex of the heart became listens weak “soft” noise pericardial friction. During instrumental examination ECG - sinus tachycardia, left ventricular hypertrophy, reduced voltage; ECHO KG rear wall of the left ventricle lazerette exudate: the divergence of the leaves of the pericardium in the systole - 1.0 cm in diastole - 0.9 cm, ECHO signs of pericarditis. According to the results they supermontage research: IgM HSV - 1,09, IgG HSV - 2,98 (PL.1, 2).

The final clinical diagnosis: systemic lupus erythematosus, subacute period, activity II with skin involvement (“butterfly”), vessels (“net levado”), lungs (lupus-defined signes of pneumonit), heart (lupus-pericarditis), kidneys (lupus nephritis). Chronic renal failure 1 degree.

This clinical example No. 2 shows the accuracy of predicting the early clinical course of exudative pericarditis on the 5th and 15th day postoptimization immunoglobulin IgM (excess of diagnostically significant result of 1.09 times) and IgG to HSV (excess diagnostically significant result in 2,98 times) (table.1, 2). Presents clinical examples 1 and 2 demonstrate the importance of immunoassay testing the serum of patients with systemic diseases and increase the activity levels of specific immunoglobulins IgM (excess diagnostically significant result in 1-1,1-fold) and IgG to HSV (excess of diagnostically significant result 2.1-3 times) make it possible to predict early clinical course of exudative pericarditis (table.1, 2).

Low levels of activity do not reach diagnostically significant result for IgM antibody to HSV at 100% (the excess is 0.07 to 1.0 times). Positive titres of specific immunoglobulins IgG to HSV were detected in 90,47% of patients with SLE and RA, not complicated by pericarditis. However, the titers of specific immunoglobulin IgG was within excess of diagnostically significant result 1.1-2,09 time. In this group of patients had a favorable course of systemic diseases with decreased activity of the autoimmune process and complete subsidence of the inflammatory process.

Example No. 3. Patient S., 51, case history No. 7969/1208, was admitted to the rheumatology Department of the City clinical hospital №3 of them. Kirov 05.12.00, with a diagnosis of Rheumatoid polierte intense pain and stiffness in the morning in the shoulder, wrist, proximal interphalangeal joint, knee, ankle joints; pains are of a permanent nature, alone, the intensity of the above. Ill for about 10 years (worried about the pain in the knee joints). Notes the deterioration in the last 2 months: pains in the joints of the hands, increased in the knee joints. The condition for admission is not quite satisfactory. Patient adynamic physique. The gentle gait. Pale skin rash no. Subcutaneous tissue is poorly developed. Peripheral edema no. Peripheral lymph nodes are not enlarged. The movement is not hindered. Defigure wrists due to periarticular infiltration of the wrist, metacarpophalangeal, proximal interphalangeal joints. Tenderness to palpation of the shoulder, wrist joints. Atrophy of the muscles of the forearms, hands, legs. Percutere above the light lung sound auscultation-vesicular respiration, wheezing no. Respiratory rate 16 in 1 minute. The borders of relative cardiac dullness is not changed. Heart tones are muffled, rhythmic. The heart rate of 68 beats per 1 minute. Blood pressure 120/90 mm RT.article The abdomen is soft, palpation painless. Liver and spleen not sure about the mental examination of the radiograph - the narrowing of the joint space of the wrist, metacarpophalangeal joints; ECG: sinus rhythm; ECHO-KG - in the pericardial fluid no. In laboratory studies of blood: erythrocytes 3,81012/l, hemoglobin 124 g/l, leukocytes 5,1109/l, ESR 48 mm/h, seromucoid 0,52 ye., removechar 1:160; enzyme-linked immunosorbent study the activity levels of IgM HSV - 0, IgG HSV - 0,07 (PL.1, 2).

Diagnosis: rheumatoid arthritis, activity III, stage II, slowly progressive course NSF I.

Treated with diclofenac, prednisolone, gemodeza, electrophoresis and sverhchistoty magnetic currents on the wrists. The patient's condition has improved: pain in the affected joints become less intense, the stiffness decreased. Complications from pulmonary and cardiovascular systems are not observed. The liver and kidneys without pathology.

If you re a laboratory study of blood on the 15 th day: erythrocytes 3,761012/l, hemoglobin 124 g/l, leukocytes 5,3109/l, erythrocyte sedimentation rate of 24 mm/h, removechar not defined, C-reactive protein negative; in the immunological - circulating immune complexes 62, IgA, 2,49, IgM 0,87, IgG 13,763, when enzyme-linked immunosorbent study the activity levels of IgM HSV - 0, IgG HSV - 0,07 (PL.1, 2). According to the tool, which can be found above clinical example # 3 a patient with a low titre of specific immunoglobulin IgM (not reaching diagnostically significant result) and IgG to HSV (excess diagnostically significant result in of 0.07 times) demonstrated favorable for rheumatoid arthritis without the development of exudative pericarditis (table.1, 2).

Example No. 4. Patient R., aged 47, case history No. 7963/1202, was admitted to the rheumatology Department of the City clinical hospital №3 of them. Kirov 05.12.00 was diagnosed with Rheumatoid arthritis, activity III, stage III, seropositive. Slowly progressive course FSB stage III. Complaints to constant intense pain in the knee, wrist, bestoflongbeach, proximal interphalangeal joints, elbow joints; moderate pain in the shoulder, hip, ankle joints, stiffness in the day. Ill for about 20 years. Over the last 5 years notes the deterioration: increased joint pain, increased deformation. Recent deterioration in about 2 weeks. Objectively a serious condition. Pale skin color. Peripheral lymph nodes are not enlarged. Pastos legs. Movement is difficult. Severe periarticular infiltration of the knee, elbow, wrist, proximal interphalangeal joints. Subluxations type “Swan neck”. Ulnar deviation. Deformity of the ankle, knee joints due to bone changes. The symptom of balloteli positive on both sides. Tenderness to palpation of the above joints. Percutere above the light Le heart clear rhythmic. The heart rate of 68 beats per 1 minute. HELL 130/80 mm RT.article Belly painless on palpation. The liver is not enlarged.

On the 5th day of a hospital stay during instrumental examination on the radiograph of the above joints marked narrowing of the joint space and radiographic signs of RA; ECG - left ventricular hypertrophy and impaired repolarization processes; ECHO CS - pathological changes it is not revealed, the pericardium was normal. In laboratory studies of blood: erythrocytes 4,021012/l, HB 140 g/l, leukocytes 6,0109/l, erythrocyte sedimentation rate of 52 mm/h, eosinophils 1%, segmented neutrophils 82%, lymphocytes 17%, C-reactive protein positive on two “plus”, fibrinogen 3.33 g/l, seromucoid 0.6 g/l, removechar 1:160; enzyme-linked immunosorbent study the activity levels of IgM HSV - 0, IgG HSV - 1,29 (PL.1, 2).

Treatment: prednisolone, voltaren, delagil. On the background of therapy the patient's condition has improved: pain and stiffness throughout the day were moderate, and low intensity in constant intense in the elbow, knee, wrist, bestoflongbeach, Pro-csinalnak interphalangeal joints; shoulder, hip, ankle joint pain and stiffness do not bother. the cardiovascular system is not observed. The liver and kidneys without pathology.

On the 15th day of the hospital stay of patient ECG - left ventricular hypertrophy and impaired repolarization processes; ECHO CS - pathological changes it is not revealed, the pericardium was normal. When repeated laboratory analysis of blood: erythrocytes 4,01012/l, hemoglobin 139 g/l, leukocytes 6,7109/l, erythrocyte sedimentation rate of 14 mm/h, removechar not defined, C-reactive protein negative; in the immunological - circulating immune complexes 153, IgA 1,5054, IgM 1,0011, IgG 11,303, when enzyme-linked immunosorbent study the activity levels of IgM HSV - 0, IgG HSV - 1,21 (PL.1, 2).

The patient was discharged with improvement under the supervision of a primary care physician rheumatologist on the 18th day of admission to hospital. In the clinical example # 4 showed a low titer IgM (not reaching diagnostically significant result) and the excess titer of diagnostically significant result of IgG to HSV is 1.29 times, which indicates a weak reactivation of HSV on the background of cytostatic agents, activation of the system process nedostatochna for involvement in the pathological process of the pericardium (PL.1, 2).

Example No. 5. Patient S., 51, case history No. 969/173, was admitted to the rheumatology Department of the City clinical hospital №3 of them. Kirov 14.0 is rangelimit, pneumosclerosis), kidneys (lupus nephritis). Symptomatic hypertension. Circulatory insufficiency II A. complaints of shortness of breath when walking, coughing up pink phlegm, pain searing character in the chest, swelling of the legs, cold hands, feet. Sick for 22 years. The last hospitalization in 1992. Takes prednisone (daily dose of 4 tablets). The deterioration in about 2 months. State upon receipt of moderate severity. Sick right physique, hypersthenics. Skin pale pink color. Swelling of the legs. Peripheral lymph nodes are not enlarged. The independent movement. The grip is not broken. Brush collects in the fist 100%. Determined by tenderness to palpation of the knee, and ankle joints. Percutere above the light lung sound auscultation - hard vesicular breath left dry rales. Mixed shortness of breath. Respiratory rate 20 in 1 minute. Borders of relative heart dullness: upper - III edge, right - 1 cm laterally from the right edge of the sternum, the left - on the left mid-clavicle line. Marked accent of II tone on the aorta systolic murmur at the apex and in the V point. Heart tones are muffled, rhythmic. Pulse 80 beats per 1 minute, the speedy, high. Arterial dialogische departure in the norm.

On the 5th day of a hospital stay remained complaints of shortness of breath when walking, coughing, pain, burning nature of the sternum. Objective data. Similar to those from 14.02.01, During instrumental examination ECG - sinus rhythm, disruption of the processes of repolarization, left ventricular hypertrophy; ECHO-KG - myocardial hypertrophy of the left ventricle moderate, calcification of the aorta, pericardial fluid no. In laboratory studies of blood: erythrocytes 3,81012/l, hemoglobin 102 g/l, leukocytes 5,1109/l, ESR 15 mm/h, fibrinogen 2,22 g/l, LE cells in diagnostically significant titles; enzyme-linked immunosorbent study the activity levels of IgM HSV - 0, IgG HSV - 2,09 (PL.1, 2).

Treated with cyclophosphamide, furosemide, verospiron, capatina, adelfan. The condition has improved. On the 15th day during instrumental examination ECG and ECHO-KG without dynamics. When repeated laboratory examination of blood: erythrocytes 3,81012/l, hemoglobin 104 g/l, leukocytes 5,1109/l, ESR 15 mm/h, in the immunological - circulating immune complexes - 153, IgA - 1,5054, IgM - 1,0011, IgG - 11,303; enzyme-linked immunosorbent study the activity levels of IgM HSV - 0, IgG HSV - 2,08 (PL.1, 2). The patient was discharged on the 18th day with the improvement of the em diagnostically significant result, and the excess of diagnostically significant result of IgG to HSV 2.09 times shows the presence of weak reactivation herpetofauna in the blood (table.1, 2). So, the titles of specific immunoglobulins IgM and IgG to HSV, not reaching diagnostically significant result, or for the IgG class defined within excess of diagnostically significant result 1.1-2,09 times are not important for the development of clinical disease, exudative pericarditis in systemic diseases (clinical example # 3, 4, 5) (table.1, 2).

Presents clinical examples demonstrate the importance of clinical application of the proposed method of the invention for predicting a favorable and complicated exudative pericarditis clinical course of systemic diseases at an early stage in the examination of patients.

The proposed method of the invention predict early clinical course of exudative pericarditis in systemic diseases there was a positive effect:

1. The high specificity of the proposed formula for forecasting immunochemical tests (100%) associated with the use of high-quality centrifuge tubes, single use ETA to specific antigens of herpes simplex virus storage frozen at a temperature of minus 24-30C to setting reaction.

2. Highly informative immunoassay testing the serum of patients with systemic diseases (SLE, RA) using a set of reagents firm “DSL” (USA), taking into account data obtained on a spectrophotometer “ELx 800 Universal Microplate Reader” company “Bio-Tek instruments INC (USA).

3. Prognostic efficiency: the way of his own invention will improve the prediction results exudative pericarditis in systemic diseases (systemic lupus erythematosus, rheumatoid arthritis) at an early stage of the survey.

4. therapeutic efficacy of the method of the invention predict early clinical course of exudative pericarditis in systemic diseases associated with improved early prediction of exudative pericarditis in systemic diseases (SLE, RA), the use of preventive therapy in patients with an increased risk of developing exudative pericarditis.

5. Ease of use in the method of the invention predict the onset of clinical disease, exudative pericarditis in systemic diseases (SLE, RA), defined by the technical simplicity of execution and speed of obtaining results of enzyme-linked immunosorbent research is Osinovaya early clinical course of exudative pericarditis in patients with systemic diseases (systemic lupus erythematosus and ramatayim arthritis) in rheumatology, cardiology and therapy hospitals. This will change the approach to traditional therapy of systemic diseases, and exudative pericarditis, will improve the results of the clinical course and outcome of the disease.

The method of early prediction of clinical course of exudative pericarditis in patients with systemic diseases by ELISA testing of serum, wherein the determined activity levels of immunoglobulin IgM and IgG antibodies to herpes simplex virus on the 5th and 15th day of admission to hospital and at higher titers of diagnostically significant result of specific IgM in 1.0-1.7 times and IgG 2.1-3.0 times predict the occurrence of complications of systemic diseases - exudative pericarditis, and at low values of immunoglobulins to herpetofauna, not reaching diagnostically significant result or exceeded for IgG to 1.01-1.99 times, predict the impossibility of developing exudative pericarditis in systemic diseases.

 

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The invention relates to medicine, more specifically to methods of screening drugs, namely the selection of the drug and its optimal dose for the treatment of a specific patient

FIELD: medicine, psychiatry.

SUBSTANCE: one should isolate DNA out of lymphocytes of peripheral venous blood, then due to the method of polymerase chain reaction of DNA synthesis one should amplify the fragments of hSERT locus of serotonin carrier gene and at detecting genotype 12/10 one should predict the risk for the development of hallucino-delirious forms of psychoses of cerebro-atherosclerotic genesis.

EFFECT: more objective prediction of disease development.

3 ex

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