Method for predicting cirrhosis at chronic viral hepatitis

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

 

The invention relates to medicine, namely to infectious diseases, Hepatology, and relates how the possibility of predicting the occurrence of cirrhosis in chronic viral hepatitis.

There is a method of predicting the possibility of cirrhosis in chronic liver disease, which consists in determining the concentration of phospholipids in erythrocyte membranes in the calculation of the hemoglobin, and the values of 0.45 to 1.47 mmol diagnosed with cirrhosis of the liver [1].

The disadvantage of this method is its lack of accuracy, as determined by the concentration of only the total phospholipids in the blood. This method captures only gross changes, as is the amount of the phospholipid fractions of the spectrum.

The relative content of factions within the phospholipid spectrum of different categories of patients in the different period of the disease can vary and is important for assessing the changes in biochemical processes, and hence for the diagnosis [2]. In addition, determination of phospholipids in erythrocytes, which do not belong to immunocompetent blood cells, uninformative, as in patients with chronic hepatitis develops liver infiltration of immunocompetent cells [3], and cirrhosis are autoimmune diseases [4].

Closest to the beach is a method for predicting the possibility of cirrhosis in chronic viral hepatitis, including a needle biopsy of the liver and diagnosis of chronic active hepatitis, resulting predict the likelihood of cirrhosis of the liver [5].

However, this method is not sufficiently precise, as it does not take into account the condition of lipid peroxidation in the liver and antioxidant protection.

The technical result - improvement of the accuracy of the method.

This technical result is achieved by the fact that according to the method for predicting the possibility of cirrhosis in chronic viral hepatitis spend a puncture biopsy and determined in a liver biopsy sample products of lipid peroxidation (LPO): diene conjugates (DC), activity antioxidantnyh enzymes: catalase (CAT) and superoxide dismutase (SOD), calculate the coefficient according to the formula K=DK/(ACD·CAT),·100, where DK is the content of diene conjugates, SOD - superoxide dismutase activity, CAT - catalase activity, and values greater than 65 predict a high likelihood of cirrhosis of the liver, 46-65 - moderate, with 14-45 is low, and a value of less than 14 - no likelihood of cirrhosis of the liver.

New, previously unknown features of the claimed method are defined in a liver biopsy sample products of lipid peroxidation (LPO): diene is conjugate (DK), the activity of antioxidant enzymes: catalase (CAT) and superoxide dismutase (SOD), the ratio calculated by the formula K=DK/SOD·CAT),·100, where DK is the content of diene conjugates, SOD - superoxide dismutase activity, CAT - catalase activity, and forecasting when the values of the coefficient of more than 65 high likelihood of cirrhosis of the liver, 46-65 - moderate, with 14-45 is low, and a value of less than 14 - no likelihood of cirrhosis of the liver. These distinctive characteristics are not found in the analyzed literature and are not obvious from the prior art for professionals.

The method was developed on the basis of the analysis of processes of lipid peroxidation and systems antioxidative protection in liver tissue. He tested in clinical practice.

Thus, the claimed technical solution meets the criteria of the invention of “novelty”, “inventive step”, “industrially applicable”.

The method is as follows: in a patient with chronic viral hepatitis along with General clinical research methods carry out a needle biopsy of the liver on Mengisi obtained sampling in 0.9% sodium chloride solution is frozen and determine the products of lipid peroxidation (LPO): diene conjugates (DC), the activity of antioxidant enzymes: what tulasi (CAT) and superoxide dismutase (SOD), calculate the coefficient according to the formula K=DK/(ACD·CAT)·100, where DK is the content of diene conjugates, SOD - superoxide dismutase activity, CAT - catalase activity. If the values are over 65 predict a high likelihood of cirrhosis of the liver, 46-65 - moderate, with 14-45 is low, and a value of less than 14 - no likelihood of cirrhosis of the liver.

Specific examples of the implementation of the method

Example 1. Patient P. ill chronic hepatitis b, 32 years old, history - episode intravenous drugs for 8 years in the blood are defined antibodies to HBcorAg IgG, HBsAg, increase of transaminases in 1,5-2 times, hepatomegaly, took Essentiale courses. Complaints of weakness, fever, heaviness in the right hypochondrium. During the examination at the hospital revealed PCR for HBV DNA, increased transaminase activity 2.5 times, alpha-fetoprotein - 5 µmol/l (normal up to 4 µmol/l) histological examination of the liver - chronic hepatitis b, moderate activity, fibrosis is minimal. Conducted clinical research and needle biopsy of the liver on Mengisi obtained sampling was suspended in 0.9% solution of sodium chloride and it identifies the products of lipid peroxidation (LPO): diene conjugates (DC),the activity of antioxidant enzymes: catalase (CAT) and superoxide smutty (SOD). Then the calculated ratio by the formula K=DK/(ACD·CAT)·100. Factor K=74,3 was predicted a high risk of developing cirrhosis.

The patient was assigned to monotherapy with interferon at a dose of 3 million units 3 times a week. After 3 months of positive dynamics there still may be cytolysis syndrome, blood HBsAg, PCR for HBV DNA, alpha-fetoprotein-4 µmol/L. the Patient shows combination therapy, however, from further treatment, the patient refused.

After 3 years, the PA has applied for medical assistance with complaints of bleeding gums, weakness, reduced efficiency. During examination: increased activity of transaminases in 2 times, reducing PETIT to 70%, PCR for HBV DNA, ultrasound Liver heterogeneous, sealed, edge acute, extended fortna and splenic vein. On scintigraphy is the uneven distribution of RN, the accumulation of the radiopharmaceutical in the spleen - 60%, liver - 40%held laparoscopy, liver dense, hilly, histology - liver cirrhosis.

Example 2. Patient C. a history of blood transfusion about blood loss in trauma (10 years ago). Transaminases increased periodically over 8 years. Complaints of weakness, fatigue, pain in the right hypochondrium. During the examination in the hospital antibodies to viral hepatitis C, PCR for HCV RNA positive, transaminases increased 1.5 times, the alpha-fetoprotein - 5.4 km mcmo the e/l, Ultrasound - without features. When needle biopsies of chronic hepatitis With moderate activity, fibrosis reasonable. Serum showed increased content Mdasp 6.1-fold reduction of Maind/Mdsp 3.2-fold increase in catalase activity 2.3 times and decreased the activities of superoxide dismutase 8.4 times.

By a General clinical examination and needle biopsy of the liver on Mengisi obtained sampling was suspended in 0.9% solution of sodium chloride and it identifies the products of lipid peroxidation (LPO): diene conjugates (DC), the activity of antioxidant enzymes: catalase(CAT) and superoxide dismutase (SOD). Then the calculated ratio by the formula K=DK/(ACD·CAT)·100. The factor K was equal to 55.8. Was predicted moderate risk of developing cirrhosis of the liver.

Was assigned to therapy with IFN at a dose of 6 million units 3 times a week. After 3 months the effect of therapy positive syndrome cytolysis no, PCR for HCV RNA negative. Therapy decided to continue up to a year.

8 months after the end of treatment the patient was examined in the hospital, underwent a second liver biopsy, was diagnosed with chronic hepatitis With minimal activity, fibrosis remained moderate.

Example 3. The patient P. a history of opium addiction 4 years ago. Blood antic the La to HCV, PCR for HCV RNA, increased transaminase 2 times, alpha-fetoprotein - 5.2 mmol/L. Held needle biopsy of the liver, histological examination of chronic hepatitis With moderate activity, with no fibrosis.

Conducted clinical research and needle biopsy of the liver on Mengisi obtained sampling was suspended in 0.9% solution of sodium chloride and it identifies the products of lipid peroxidation (LPO): diene conjugates (DC), the activity of antioxidant enzymes: catalase (CAT) and superoxide dismutase (SOD). Then the calculated ratio by the formula K=DK/(ACD·CAT)·100.

Factor K=24,6 was predicted low degree of possibility of development of cirrhosis.

Was assigned to therapy with intron dose of 3 million units 3 times a week. After 3 months, the effect of positive therapy: a syndrome of cytolysis no, PCR for HCV RNA negative. Therapy decided to continue up to a year.

A year later syndrome cytolysis no, PCR for HCV RNA negative control was needle biopsy, histology data for hepatitis no, the coefficient K=13,4, the risk of cirrhosis no. The stated recovery.

This method was examined 27 people, 7 people had predicted a high risk of developing cirrhosis, the 5 - cirrhosis of the liver, and 2 - high degree of fibrosis. The forecast under the approved dynamics in all patients clinically and histologically.

Thus, as shown in clinical studies, the proposed method has high accuracy and reliability.

Literature

1. Copyright certificate №1142105, IPC And 61 In 10/00, 1985.

2. Nikitin, Y.P., Kurilovich S.A., David G.S. Liver and lipid metabolism. - Novosibirsk. - 1985; Phillips G.. // J. Clin. Invest. - 1960. - Vol.39. - P.1639-1650.

3. Koshil I. Guide to infectious diseases. - S.-Petersburg. - 1996, - s.

4. Sorenson S.N. Viral hepatitis in clinical practice. - S.-Petersburg. - 1996. - 306 S.

5. Manual medicine. Diagnosis and therapy. / Under. Ed. Rebenko and others - M.: Mir, 1997, vol. 1, s-634. (prototype).

6. Dunaevsky O.A. Viral hepatitis and differential diagnosis of liver diseases. Tver. - 1993 - 263 C.

A method for predicting the possibility of cirrhosis in chronic viral hepatitis, including a needle biopsy of the liver, characterized in that in a liver biopsy sample to determine the products of lipid peroxidation (LPO): diene conjugates (DC); the activity of antioxidant enzymes: catalase (CAT) and superoxide dismutase (SOD), calculate the coefficient by the formula

K=DK/(ACD·CAT)·100,

where DK is the content of diene conjugates;

SOD - superoxide dismutase activity;

CAT - catalase activity,

and when it is greater than 65 predicted irout high probability of cirrhosis of the liver, when 46-65 - moderate, with 14-45 is low, and a value of less than 14 - no likelihood of cirrhosis of the liver.



 

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