Method for evaluating the severity of pathological process flow at chronic diffuse hepatic lesions

FIELD: medicine, hepatology.

SUBSTANCE: one should detect the level of hepato-specific enzymes (HSE) in blood plasma, such as: urokinase (UK), histidase (HIS), fructose-1-phosphataldolase (F-1-P), serine dehydratase (L-SD), threonine dehydratase (L-TD) and products of lipid peroxidation (LP), such as: dienic conjugates (DC), malonic dialdehyde (MDA). Moreover, one should detect the state of inspecific immunity parameters, such as: immunoregulatory index (IRI) as the ratio of T-helpers and T-suppressors, circulating immune complexes (CIC). Additionally, one should evaluate the state of regional circulation by applying rheohepatography (RHG), the system of microhemocirculation with the help of conjunctival biomicroscopy (CB) to detect intravascular index (II). In case of increased UK, HIS levels up to 0.5 mcM/ml/h, F-1-P, L-SD, L-Td, LP products, CIC by 1.5 times, higher IRI up to 2 at the norm being 1.0-1.5, altered values of regional circulation, increased II up to 2 points at the norm being 1 point, not more one should diagnose light degree of process flow. At increased level of UK, HIS up to 0.75 mcM/ml/h, F-1-P, L-SD, L-TD, LP products, CIC by 1.5-2 times, increased IRI up to 2.5, altered values of regional circulation, increased II up to 3-4 points one should diagnose average degree of process flow. At increased level of UK, HIS being above 0.75 mcM/ml/h, F-1-P, L-SD, L-TD, LP products, CIC by 2 and more times, increased IRI being above 2.5, altered values of regional circulation, increased II up to 5 points and more one should diagnose severe degree of process flow.

EFFECT: higher accuracy of diagnostics.

3 ex

 

The invention relates to medicine, in particular to Hepatology, and for diagnosing the severity of the pathologic process in chronic diffuse liver disease (hepatitis and cirrhosis).

Progressively increasing the flow of patients with chronic diffuse liver disease makes the search for new methods to assess the severity of patients.

Currently, there are a lot of laboratory and instrumental methods of assessing the severity of liver damage. Laboratory methods based on the determination in blood level enzymes (alanine aminotransferase, aspartate aminotransferase, gammaglutamyltranspeptidase, alkaline phosphatase), metabolites of hemoglobin (total bilirubin and its fractions), the selection of blood markers of viral hepatitis (HbsAg, antiV, etc) and hepatoma (alpha-fetoprotein). To instrumental methods, widely used in clinical practice include ultrasound examination of the liver, scintigraphy, computed tomography. To the combined methods of assessing the severity of liver damage include percutaneous liver biopsy with histological and cytological examination of biopsy material.

The above methods of assessment of the severity of the pathological process in chronic diffuse liver lesions are traditional and and enter the "standards for the diagnosis and treatment of patients with diseases of the digestive system", however, only their combined use allows to accurately diagnose the severity of the process. In addition, the above methods do not take into account changes of regional hepatic blood flow and systemic microcirculation, the intensity of lipid peroxidation, immune system. Therefore, not taken into account violations, which are critical to the pathogenesis of chronic diffuse liver diseases.

The aim of the present invention is to develop the most effective method of assessing the severity of the pathologic process in chronic diffuse liver disease, comprising determining the level of liver-specific enzymes (PSF) in the blood of the patient, taking into account the condition of the organ of circulation, the immune system, the activity of processes of lipid peroxidation (LPO).

This goal is achieved by the fact that initially carry out a comprehensive definition in plasma levels of liver-specific enzymes [urokinase (CC), histidase (GIS), fructose-1-hospitalilty (f-1-f)L-serendipitous (L-SD), L-trainingsgerate (L-TD)], products of lipid peroxidation [diene conjugates (DC), malondialdehyde (MDA)], in addition, determine the state of some parameters of non-specific immunity [immune the regulatory index, represents the ratio of T-helpers and T-suppressors (IRI), circulating immune complexes (CIC)], additionally assess the condition of regional blood flow (in particular, the pulse of the blood supply to the liver) using rogatory (WGT), systemic microcirculation using conjunctival biomicroscopy (KB) definition intravascular conjunctival index (CI) and depending on the obtained results diagnose the different severity of the pathological process. In case of increase of the level of the criminal code, the GIS to 0.5%, f-1-f, L-OL, L-DT, FLOOR products, the CEC up to 1.5 times increase immunoregulatory index (IRI) to 2 (normal 1.0 to 1.5), minor changes of indicators of regional blood flow, increasing intravascular KEY to 2 points at the rate not more than 1 score diagnose mild course of the process; when the level increases, the criminal code, the GIS to 0.75, f-1-f, L-OL, L-DT, FLOOR products, CEC 1.5-2 times increase of IRI to 2.5, moderate changes of indicators of regional blood flow, increasing intravascular KEY to 3-4 points diagnose average severity; when the level increases, the criminal code, GIS is more than 0.75, f-1-f, L-OL, L-DT, FLOOR products, the CEC in 2 and more times, increasing the IRI over 2.5 significant changes in indicators of regional blood flow, increasing intravascular KI 5 and the more points diagnose severe pathological process.

The severity of the pathological process was estimated by the proposed method in 240 patients. The most obvious are the following examples.

Examples of specific performance

1. Patient K., aged 47, case history No. 13014, was treated at GEA Bureau regional with 03.08.1999, 21.08.1999, with the diagnosis of chronic viral hepatitis b exacerbation". Along with the conventional laboratory and instrumental methods of research was to study the PSF (the criminal code of 0.13 units, GIS 0,34%, f-1-f 1,2 units, L-SD 64 µmol/l/h, L-LD 71 µmol/l/h), LPO products (DK 1.0 u/ml, MDA 7.9 µmol/l). The level of the CEC was 86, Iran 1,68, when RGG pulse volume of the liver was slightly decreased, while KB intravascular KI amounted to 2 points. Thus, the patient K. was diagnosed with a minor severity of the process.

2. Patient N., 53 years history No. 12035, was hospitalized in GEA Bureau regional with 06.04.2000, 24.04.2000, with the diagnosis of chronic viral hepatitis C, acute stage, chronic gastritis, chronic cholecystitis". Along with the conventional laboratory and instrumental researches conducted a study of level of PSF (CC 0,59 units, GIS 0,64% f-1-f 1,32%, L-SD 89 µmol/l/h, L-TD 102 µmol/l/h), LPO products (DK 1.4 units/ml, MDA is 13.1 µmol/l). The level of the CEC was 100, the IRI to 2.06; WGT pulse is the first volume of the liver was moderately reduced, when KB intravascular KI amounted to 3 points. Thus, the patient H. was diagnosed with the average severity of the pathological process.

3. Patient P., 56 years history No. 12546, was hospitalized in GEA Bureau regional with 24.08.2000, 18.09.2000, with the diagnosis of cirrhosis of the liver as the outcome of viral hepatitis C, acute stage; the syndrome of portal hypertension, varicose veins of the esophagus II-III degree; chronic gastritis, chronic colitis, intestinal dysbiosis".

Along with the conventional laboratory and instrumental researches conducted a study of level of PSF (CC 0,79 units, GIS 0,81%, f-1-f 1,8%, L-SD unit 148, L. 161 units), LPO products (W, MDA 18). The level of the CEC was 142, Iran 5,0; WGT pulse volume of the liver was significantly reduced, when KB intravascular KI was 5 points. Thus, the patient P. was diagnosed with a severe course of the pathological process.

The proposed method of assessing the severity of the pathologic process in chronic diffuse liver diseases is pathogenetically justified. Unlike existing methods, it allows us to estimate the severity of damage" at the organ level by defining a liver-specific enzymes, the intensity of lipid peroxidation and to correlate the obtained achiev Italy with disabilities emerged in the blood, the immune system in the development of HTTP.

The method of assessing the severity of the pathologic process in chronic diffuse liver lesions, including the selection and determination of enzymes in the peripheral blood, characterized in that conduct a comprehensive determination in plasma levels of liver-specific enzymes (PSF): urokinase (UK), histidase (GIS), fructose-1-hospitalilty (f-1-f), serendipitous (L-SD), trainingsgerate (L-TD); products of lipid peroxidation: diene conjugates (DC), malondialdehyde (MDA), determine the state parameters of nonspecific immunity: immunoregulatory index (IRI), which represents the ratio of T-helpers and T-suppressors, circulating immune complexes (CIC), in addition to assess the condition of regional blood flow using rogatory (RGG), system disturbances using conductively biomicroscopy (KB) definition intravascular index (CI), in case of increase of the level of the criminal code, the GIS to 0.5 μmol/ml/h, f-1-f, L-OL, L-DT, FLOOR products, the CEC up to 1.5 times increase IRI to 2 at the rate of 1.0 to 1.5, changes of indicators of regional blood flow, increasing intravascular KEY to 2 points at the rate not more than 1 score diagnose mild course of the process; when the licinii level of the criminal code, GIS to 0.75 μmol/ml/h, f-1-f, L-OL, L-DT, FLOOR products, CEC 1.5-2 times increase of IRI to 2.5, the change of indicators of regional blood flow, increased intravascular KEY to 3-4 points diagnose medium flow process; when the level increases, the criminal code, GIS more than 0.75 μmol/ml/h, f-1-f, L-OL, L-DT, FLOOR products, the CEC in 2 and more times, the increase in IRI over 2.5, the change indicators regional blood flow, increasing intravascular KI to 5 points and more points to be diagnosed with severe duration of the process.



 

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FIELD: medicine, hepatology.

SUBSTANCE: one should detect the level of hepato-specific enzymes (HSE) in blood plasma, such as: urokinase (UK), histidase (HIS), fructose-1-phosphataldolase (F-1-P), serine dehydratase (L-SD), threonine dehydratase (L-TD) and products of lipid peroxidation (LP), such as: dienic conjugates (DC), malonic dialdehyde (MDA). Moreover, one should detect the state of inspecific immunity parameters, such as: immunoregulatory index (IRI) as the ratio of T-helpers and T-suppressors, circulating immune complexes (CIC). Additionally, one should evaluate the state of regional circulation by applying rheohepatography (RHG), the system of microhemocirculation with the help of conjunctival biomicroscopy (CB) to detect intravascular index (II). In case of increased UK, HIS levels up to 0.5 mcM/ml/h, F-1-P, L-SD, L-Td, LP products, CIC by 1.5 times, higher IRI up to 2 at the norm being 1.0-1.5, altered values of regional circulation, increased II up to 2 points at the norm being 1 point, not more one should diagnose light degree of process flow. At increased level of UK, HIS up to 0.75 mcM/ml/h, F-1-P, L-SD, L-TD, LP products, CIC by 1.5-2 times, increased IRI up to 2.5, altered values of regional circulation, increased II up to 3-4 points one should diagnose average degree of process flow. At increased level of UK, HIS being above 0.75 mcM/ml/h, F-1-P, L-SD, L-TD, LP products, CIC by 2 and more times, increased IRI being above 2.5, altered values of regional circulation, increased II up to 5 points and more one should diagnose severe degree of process flow.

EFFECT: higher accuracy of diagnostics.

3 ex

FIELD: medicine, infectology, hepatology.

SUBSTANCE: in hepatic bioptate one should detect products of lipid peroxidation (LP), such as: dienic conjugates (DC), activity of antioxidant enzymes, such as: catalase (CAT)and superoxide dismutase (SOD). One should calculate by the following formula: C = DC/(SOD x CAT)x100, where DC - the content of dienic conjugates, SOD - activity of superoxide dismutase, CAT - activity of catalase. At coefficient (C) values being above 65 one should predict high possibility for appearance of cirrhosis, at 46-645 - moderate possibility and at 14-45 -low possibility for appearance of cirrhosis.

EFFECT: higher accuracy of prediction.

3 ex

FIELD: medicine, clinical toxicology.

SUBSTANCE: at patient's hospitalization one should gather the data of clinical and laboratory values: on the type of chemical substance, patient's age, data of clinical survey and laboratory values: body temperature, the presence or absence of dysphonia, oliguria being below 30 ml/h, hemoglobinuria, erythrocytic hemolysis, exotoxic shock, glucose level in blood, fibrinogen and creatinine concentration in blood serum, general bilirubin, prothrombin index (PTI), Ph-plasma, the state of blood clotting system. The state of every sign should be evaluated in points to be then summed up and at exceeding the sum of points being above "+20" one should predict unfavorable result. At the sum of "-13" prediction should be stated upon as favorable and at "-13" up to "+20" - prediction is considered to be doubtful.

EFFECT: higher accuracy of prediction.

2 ex, 3 tbl

FIELD: medicine, juvenile clinical nephrology.

SUBSTANCE: disease duration in case of obstructive pyelonephritis should be detected by two ways: either by detecting the value of NADPH-diaphorase activity, as the marker of nitroxide synthase activity in different renal department and comparing it to established norm, or by detecting clinico-laboratory values, such as: hemoglobin, leukocytes, eosinophils, urea, beta-lipoproteides, lymphocytes, neutrophils, the level of glomerular filtration, that of canalicular reabsorption, urinary specific weight, daily excretion of oxalates, arterial pressure, and estimating their deviation against average statistical values by taking into account a child's age.

EFFECT: higher efficiency of detection.

7 dwg, 1 ex, 6 tbl

FIELD: clinical medicine, pulmonology.

SUBSTANCE: one should carry out complex estimation of interleukin-1β) concentration in blood, saliva, bronchoalveolar liquid. Moreover, one should detect distribution coefficient (DC) for IL-1β as the ratio of IL-1β blood content to IL-1β salivary content. At increased IL-1β blood content by 10 times and more, by 2 times in saliva, unchanged level of bronchoalveolar IL-1β, at DC for IL-1β being above 1.0 one should predict bronchial obstruction. The method enables to conduct diagnostics of the above-mentioned disease at its earlier stages.

EFFECT: higher efficiency of prediction.

2 tbl

FIELD: medicine, diagnostics.

SUBSTANCE: the present innovation deals with genetic trials, with diagnostic field of oncological diseases due to analyzing DNA by altered status of gene methylation that take part in intracellular regulation of division, differentiating, apoptosis and detoxication processes. One should measure the status of methylation in three genes: p16, E-cadherine and GSTP1 in any human biological samples taken out of blood plasma, urine, lymph nodes, tumor tissue, inter-tissue liquid, ascitic liquid, blood cells and buccal epithelium and other; one should analyze DNA in which modified genes of tumor origin or their components are present that contain defective genes, moreover, analysis should be performed due to extracting and purifying DNA out of biological samples followed by bisulfite treatment of this DNA for modifying unprotected cytosine foundations at keeping 5-methyl cytosine being a protected cytosine foundation followed by PCR assay of bisulfite-treated and bisulfite-untreated genes under investigation and at detecting alterations obtained according to electrophoretic result of PCR amplificates, due to detecting the difference in the number and electrophoretic mobility of corresponding fractions at comparing with control methylated and unmethylated samples containing normal and hypermethylated forms of genes one should diagnose oncological diseases. The method provides higher reliability in detecting tumors, detection of remained tumor cells after operation.

EFFECT: higher efficiency of therapy.

1 cl, 3 dwg, 4 ex

FIELD: medicine, gastroenterology.

SUBSTANCE: one should carry out diagnostic studying, moreover, on the 5th -6th d against the onset of exacerbation in case of gastric and duodenal ulcerous disease one should detect the content serotonin, histamine and acetylcholine in blood, then during 2-3 wk one should conduct medicinal therapy to detect serotonin, histamine and acetylcholine level in blood again and at serotonin content being by 2-3 times above the norm, histamine - by 1.15-1.4 times above the norm and acetylcholine - by 20-45% being below the norm one should predict the flow of gastric and duodenal ulcerous disease as a non-scarring ulcer.

EFFECT: higher accuracy of prediction.

3 ex

FIELD: medicine.

SUBSTANCE: method involves taking blood from ulnar vein (systemic blood circulation) and from large vein of the injured extremity proximal with respect to lesion focus (regional blood circulation). Spontaneous NST-test value is determined and difference is calculated in systemic and regional blood circulation as regional-to-systemic difference. The difference value is used for predicting clinical course of pyo-inflammatory disease in extremities.

EFFECT: high accuracy of diagnosis.

4 cl, 2 tbl

FIELD: medicine, gastroenterology.

SUBSTANCE: one should introduce biologically active substance, moreover, in patient's blood serum one should detect the content of acetyl choline and choline esterase activity followed by 2-h-long intragastric pH-metry at loading with biologically active substance as warm 40-45%-honey water solution at 35-40 C, and at increased content of acetyl choline being above 1.0 mM/l, choline esterase being above 0.5 mM/l/30 min and pH level being 6.0-6.9 it is possible to consider apitherapy to be useful for treating ulcerous duodenal disease.

EFFECT: higher efficiency and accuracy of detection.

3 ex

FIELD: medicine, gastroenterology.

SUBSTANCE: it has been suggested a new method to detect pharmacological sensitivity to preparations as acidosuppressors. After the intake of the preparation a patient should undergo fibrogastroduodenoscopy 3 h later, then, through endoscopic catheter one should introduce 0.3%-Congo red solution intragastrically and the test is considered to be positive at keeping red color that indicates good sensitivity to the given preparation, and in case of dark-blue or black color the test is considered to be negative that indicates resistance to this preparation. The suggested innovation widens the number of diagnostic techniques of mentioned indication.

EFFECT: higher efficiency of diagnostics.

2 ex

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