A method for predicting the risk of eclampsia in pregnant women
The invention relates to medicine, in particular to obstetrics. The essence of the method: pregnant women after 20 weeks of pregnancy in the serum by ELISA determine the content of circulating immune complex of the basic protein of myelin with immunoglobulin G and its value is more than 0.5 μg/ml predict a high likelihood of developing eclampsia. The method allows an objective and timely manner to assess the risk of eclampsia. 1 PL.
The invention relates to medicine, in particular to obstetrics.
Eclampsia, a severe complication of preeclampsia, becomes a direct cause of death in developed countries from 0,21 to 1.4% in less wealthy countries, its importance as a cause of maternal mortality increases to 17%. In the Russian Federation for 2001 eclampsia was the cause of maternal mortality in 3.6% of cases. Worse outcome and fetal - perinatal mortality due to eclampsia ranges from 18 to 40% (Serov C. N., Markin, S. A., A. Lubnin Y. Eclampsia. A guide for physicians. - M: Medical information Agency, 2002, c.8.).
Timely identification of pregnant women with high the warrior and perinatal mortality.
A known method for predicting eclampsia by examining clinical symptoms during pregnancy, leading among them is acute headache, the emergence of a background pre-eclampsia is considered to be the forerunner of similar eclampsia (Serov C. N., Markin, S. A., A. Lubnin Y. Eclampsia. A guide for physicians. - M: Medical information Agency, 2002, c.39.).
The disadvantage of this method is the lack of specificity of the symptom acute headache during pregnancy, because headache syndrome is multifactorial and can exist for diseases and pathological processes not associated with pregnancy (Serov C. N., Markin, S. A., A. Lubnin Y. Eclampsia. A guide for physicians. - M: Medical information Agency, 2002, S. 39-82.)
A known method for predicting the development of eclampsia with increasing proteinuria (Serov C. N., Markin, S. A., A. Lubnin Y. Eclampsia. A guide for physicians. - M: Medical information Agency, 2002, S. 213.)
The disadvantage of this method is to establish the fact that the presence of proteinuria is not necessary for the diagnosis of eclampsia. Approximately 20% of patients with eclampsia do not have proteinuria (CE is 02, c.213.)
Closest to the claimed is a method for predicting eclampsia through the study of relations intoxication indicators: uric acid (mg)/urea (mg) × 100, when the value of 23,3 predicted the risk of developing eclampsia (CIT. by Ivchenko C. N., Bogdanova, Y. Eclampsia. - Kiev: Health, 1984, c.74.)
The disadvantage of this method is the low sensitivity of serum uric acid levels - an average of 42% and a specificity of 81% (CIT. according to Schechtman, M. M., I. Elokhin B. Some methods of forecasting of late toxemia of pregnancy. // Obstetrics and gynecology. - 1996, №3, p.4.). Therefore, this test cannot be used to predict the development of eclampsia.
The objective of this invention is to provide an effective method for predicting the development of eclampsia at the stage before the appearance of traditional clinical and laboratory data, by detecting circulating immune complex of the basic protein of myelin and immunoglobulin class G (CEC exchange rate - IgG) in the serum of pregnant women after 20 weeks of pregnancy.
This object is achieved in that in pregnant women after 20 weeks of pregnancy in serum enzyme-linked immunosorbent AMI class G and values greater than 0.5 μg/ml predicted a high probability of developing eclampsia.
The novelty of the method: pregnant women after 20 weeks of pregnancy are examined in the serum content of circulating immune complex of the basic protein of myelin with immunoglobulin class G and values greater than 0.5 μg/ml predict a high likelihood of developing eclampsia.
This indicator chosen due to the fact that basic myelin protein is one of the main endotoxins that can cause complex toxic damage to the nervous system. CEC exchange rate - IgG is a highly sensitive marker for the destruction of myelin, is a specific indicator of damage to the nervous tissue, acts as a neurospecific convulsive peptide. The increase of its concentration in the blood directly correlates with the amount and degree of brain damage and the degree of disturbance of the nervous regulation in various diseases, which are accompanied with a convulsive syndrome and traumatic brain injury in the clinic of nervous diseases and neurosurgery (Chekhonin VP, Gurin O. I., Dmitriev, I. B., Semenov, A. C., E. Savchenko A., Grigoriev, M. E. Basic myelin protein. Structure, properties, functions, role in the diagnosis of demyelinating diseases. // Issues of medicinal chemistry, 2000, №6). However, works kasumist method is as follows: a pregnant woman in pregnancy after 20 weeks are taken from the cubital vein 5 ml of blood and serum by ELISA to determine the concentration of circulating immunolo complex (CEC) exchange rate - IgG. The obtained results were evaluated as follows: when the level increases, the CEC exchange rate - IGg more than 0.5 μg/ml predicted a high risk of developing eclampsia.
Pregnant Meters, 30 years old, no history of pregnancy and childbirth 53/596. This third pregnancy: the first one ended term births without complications, the second medical abortion without complications. About this pregnancy was observed in the antenatal clinic with 9 weeks of pregnancy, before delivery, only 10 times. When performing dynamic monitoring and inspection of the signs of pre-eclampsia were not found: the level of HELL from 100/60 to 120/80 mm RT. Art., proteinuria was absent, local swelling with 36 weeks 1-St degree, at an initial body mass index of 20.3 kg/m2the weight gain for the entire pregnancy was 13 kg, other clinical, laboratory and ultrasound data without pathological changes. The CEC level, exchange rate - IgG in pregnancy 34-35 weeks amounted to 0.016 μg/ml, in the period 38-39 weeks - 0,088 µg/ml, Delivery at term without complications. A girl was born 3900 g, 53 cm, 8 points on the Apgar scale. Discharged from the hospital on the 5th day with the child in a satisfactory condition home.
Pregnant And., 20 years, no history of the tion from 11 weeks of gestation, before delivery, a total of 12 times. With 36 week period was marked by increased AD to 140/80, 150/80 mm RT. Art., swelling degree 2, we found a decrease in urine output to 850 ml, the daily loss of protein in urine 0.8 g, hematocrit 40%, changes in the fundus - angiopathy 1 degree. Has a diagnosis of pre-eclampsia mild. Hospitalized in the Department of pathology of pregnancy maternity hospital, where the diagnosis is confirmed. The CEC level, exchange rate - IgG in pregnancy 37 weeks was 0,144 μg/ml, in the period 38-39 weeks 0,186 µg/ ml On the background of therapy of pre-eclampsia mild and activities for labor induction occurred in childbirth 39-40 weeks without complications. The boy was born 3300 g, 50 cm, 6-8 points on the Apgar scale. Discharged from the hospital on day 7 with a child in a satisfactory condition home.
Pregnant B., 22 years old, no history of childbirth 930/651. Parvovirinae. Extragenital history is not burdened. About this pregnancy was observed in female consultation. With the 36th week of pregnancy there is an increase of the blood pressure to 140/90, 150/90 mm RT. century, the emergence of generalized edema and proteinuria 0.33 g/L. During pregnancy 37-38 weeks. hospitalized in the maternity hospital where diagnosed with severe pre-eclampsia (alopecia 1 B St, signs of chronic placental insufficiency). The CEC level, exchange rate - IgG at this time - 0.78 µg/ml After prior intensive therapy - rodorazresheniye by cesarean section, extracted boy 3100 g, 49 cm, 7-8 points on the Apgar scale. After the operation was conducted intensive therapy and was discharged in satisfactory condition with the child for 10 days.
Pregnant X., 34 years old, history of births No. 577, hospitalized in the maternity hospital №5 ambulance with a diagnosis of Pregnancy 39-40 weeks. Severe pre-eclampsia. Breech presentation of the fetus. The beginning of the first stage of labor”. This pregnancy 4, childbirth 4. Unemployed. In female consultations were observed. The state of admission is very difficult. AD - 190/110, 180/100 mm RT. Art., CVP - 0 mm RT.art., generalized edema (anasarca). Complaints of a headache, most pronounced in the occipital and temporal areas. Determined increased tendon reflexes on both sides. In the fundus - angiopathy in hypertensive type 2 tbsp. Laboratory studies: hypoproteinemia - 44 g/l, thrombocytopenia - 156×109/l, proteinuria of 3.14 g/L. the Level of the CEC exchange rate-IgG - 1,3 μg/ml against the backdrop of ongoing intensive therapy - attack of convulsions, disturbance with the girl 3800 g, 52 cm, 6-7 points on the Apgar), the patient died. Autopsy conclusion No. 53 - Severe pre-eclampsia. Eclampsia. Complications: Respiratory distress syndrome.
Thrombosis of the microvasculature. Tubulars kidney. Brain edema. Degeneration of parenchymatous organs.
The claimed method applied to dynamic continuous bezvyhodnom survey 176 pregnant, with analysis of the course they have pregnancy and childbirth: 70 - with uncomplicated pregnancy, the 51 - in preeclampsia mild, 50 - when preeclampsia is severe, 5 - in eclampsia. The results of the study are presented in table 1.
Thus the proposed method for predicting eclampsia in pregnant women through research in the serum level of the CEC exchange rate - IgG allows us to objectively and in a timely manner to assess risk and predict with a high degree of probability of the occurrence of eclampsia. The reliability of the estimate of the risk of eclampsia is confirmed clinically and sensitivity of 100% and specificity 98,0%.
A method for predicting the risk of eclampsia in pregnant women by exploring syvorotkina circulating immune complex of the basic protein of myelin with immunoglobulin G in the serum after 20 weeks of pregnancy and when it is more than 0.5 μg/ml predict a high likelihood of developing eclampsia.
FIELD: medicine, ophthalmology.
SUBSTANCE: in lacrimal liquid one should detect the content of interleukin 8 (IL-8) and that of interleukin 1 beta (IL-1β) to calculate prognostic coefficient (PC) due to dividing the first value by the second one by the following formula: At PC value being below 10.0 one should predict favorable disease flow, and at PC value being above 10.0 - unfavorable flow.
EFFECT: higher accuracy of prediction.