Method for predicting bronchial obstruction at chronical bronchitis

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

 

The invention relates to medicine and can be used in pulmonology for the early diagnosis of obstructive disorders, developing on the background of the progression of the inflammation in the Airways in chronic bronchitis.

The actual problem pulmonology is to increase the effectiveness of early diagnosis of chronic obstructive pulmonary disease (COPD), due to the high prevalence, growth, morbidity, mortality, and increased economic costs worldwide. The main forms of COPD are chronic obstructive bronchitis (COB) and emphysema.

One of the main highly informative methods of diagnosis of bronchial obstruction in chronic bronchitis (CB) is the study of respiratory function (respiratory function) and, in particular, the assessment of forced expiratory volume in 1 second (FEV1) (Chuchalin A.G. Chronic obstructive pulmonary disease. M.: ZAO Publishing house BINOM. SPb.: Nevsky dialect. 1998: 512). The change in FEV1when HB is a marker of an already existing violations of bronchial obstruction and indicates the severity of these changes. To well-known markers of possible violations of bronchial obstruction in HB are the risk factors (Smoking, occupational hazards, male gender, age older than 40 years) and clinical symptoms (chronic cough with PR is the production of sputum, with or without (global strategy: diagnosis, treatment and prevention of chronic obstructive pulmonary disease. Report of the working group of the National Institute of Heart, Lung, and Blood, and the world Health Organization. 2001: 32). At the same time, quantitative laboratory criteria for prediction of obstructive disorders in HB, not developed.

The modern trend in the study of the pathogenesis of chronic inflammation in COPD is the concept of biomarkers and, in particular, the role of cytokines. One of the members of the class of cytokines is interleukin-1β (IL-1β)participating in the development of acute and maintaining the chronic inflammatory process (Simbirtsev A.S. Biology of the family of interleukin-1 person. Immunology. 1998; 3: 9-17).

The aim of the invention is the development of early quantitative prognostic criteria of bronchial obstruction in HB.

The objective is achieved by determining the content of IL-1β in serum, saliva and bronchoalveolar lavage fluid (closely connected with), and the evaluation of the distribution coefficient for IL-1β HB patients without obstructive ventilation disorders.

The distribution coefficient (CR) is the ratio of substances in the system of blood-saliva, which determines the activity and permeability gepatozellliarnogo barrier (GSB) for various substances (L. Komarova, Alekseeva UP New ideas about functions from the young friends of the glands in the body. Nizhny Novgorod, 1994: 96.)

A method for predicting bronchial obstruction when HB is that the use of quantitative laboratory criteria risk of developing human bronchial obstruction, comprising determining the level of IL-1β in serum, saliva, bronchoalveolar lavage fluid (closely connected with), and the CU for IL-1β in patients with HB unchanged obstruction (FEV1that differs significantly from that used subjective parameters (risk factors, gender, age).

The proposed method is as follows. In a patient with HB normal FEV1in the morning on an empty stomach take blood from the cubital vein, with its further centrifugation and isolation of serum, collect saliva and using bronchial lavage get washed away from the bronchial tree. In the above-mentioned biological environments determine the concentration of IL-1β (PG/ml) and compute CR=IL-1β blood (PG/ml) (IL-1β saliva (PG/ml)). The obtained results are compared with the normal values. The increase in the content of IL-1β more than 10 times in the serum, 2 times in saliva, its normal parameters is closely connected with, and the increase in CR for IL-1β more than 1.0 indicate the formation of violations of bronchial obstruction.

Diagnostic effectiveness of the proposed method was studied in 53 men 39-72 years in the period of exacerbation HB. In 2 patients (group 1) diagnosed with chronic non-obstructive bronchitis (HNB), in 33 patients (group 2) - diagnosis COB. The control group consisted of 10 healthy men aged 23-25. The diagnosis of HB was established by the clinic (complaints, anamnesis, objective data of the study), the results of laboratory, functional, radiological and bronchoscopic examinations. The decrease of FEV1less than 80% of predicted values (average of 59.38,1%, p<0,05) in patients HB testified violation of bronchial obstruction.

Serum was obtained by centrifugation of blood taken from the cubital vein. Saliva was collected in the morning on an empty stomach after rinsing the mouth with water by Slavyane in a test tube for 10 minutes is closely connected with received during fibrobronchoscopy (bronchoscope Olympus BF (Japan)) by fractional injection of physiological solution for 20-40 ml with subsequent aspiration.

IL-1β (PG/ml) was determined by a set of reagents ProCon IL-1β (, St. Petersburg) by ELISA. In the control group, the levels of IL-1β serum amounted to 35.34,9 PG/ml in saliva - 273,343,9 PG/ml and is closely connected with - 305,080,3 PG/ml.

The results of the study of IL-1β in various biological environments in patients with HB are presented in table 1. In the period of exacerbation HB in serum in all groups surveyed identified a statistically significant increased levels of IL-1β with its maximum concentration in obstructive naru is aniah compared with the control group - 1160,3440,2 PG/ml, p<0,01. For patients HNB the level of IL-1β serum was 3 times lower than in patients of the 2nd group and amounted to 379.249,1 PG/ml, p<0,01.

Salivary secretion of IL-lβ HNB exceeded standards 2.2 times (624,739,5; p<0.01)and the level of this cytokine in patients with obstructive form of bronchitis did not differ from the control group (484to 91.1; p>0,05).

Excessive accumulation of IL-1β in the blood more than 10 times the level of norms and maximum salivary concentration of this biomarker is more than 2 times of the standard in patients with HB are quantitative markers, determining the formation of bronchial obstruction.

CR for IL-1β in healthy individuals amounted to 0.130,04. In group 1 examined CU was determined in the range of 0.610,11; p<0,05 and with obstructive variant bronchitis - 2,301,02; p<0,01 (PL. 2). The shift of the CU in the direction of its increase at all variants of the disease indicates a high activity GSB and reducing its permeability to IL-1βthat can be considered as an early prognostic criterion for the formation of COB.

Table 1

The content of Il-1β (PG/ml) in the serum, saliva and is closely connected with at exacerbation of chronic bronchitis (Mm)
The group surveyedSalivaSerum cu is VI Closely connected with
Chronic non-obstructive bronchitis (n=20)624,739,5**to 379.249,1**417,561,2
Chronic obstructive bronchitis (n=29)484,0to 91.11160,0440,2**571,429,4*
Control group (n=10)273,343,935,34,9305,080,3
Note: one star-the difference is significant compared with the control group (p<0.05), and two asterisks-the difference is significant compared with the control group (p<0,01)

Table 2

The distribution factor for interleukin-1β with various forms of chronic bronchitis.
The group surveyedThe distribution coefficient
The control group0,130,04
group 1 (HNB)0,610,11*
group 2 (COB)2,301,02**
Note: one star-the difference is significant compared with the control group (p<0,05); two star-the difference is significant compared with the control group (p<0,01).

Exacerbation of HB was accompanied by a maximum accumulation of IL-1β closely connected with at bronchia Inoi obstruction - 571,4of 29.4 PG/ml, p<0,05. Patients HNB level endobronchial IL-1β did not differ from the control group - 417,561,2 PG/ml; p>0,05.

Thus, the combination of high concentrations of IL-1β blood, saliva, unmodified activity endobronchial IL-1β and increasing the distribution coefficient for IL-1β may serve as an early prognostic criterion of bronchial obstruction in patients with chronic bronchitis without modification of FER.

A method for predicting bronchial obstruction in chronic bronchitis, characterized in that conduct a comprehensive study of the concentration of interleukin-1β (IL-1β) in the blood, saliva, bronchoalveolar lavage fluid and determination of distribution coefficient (CU) for (IL-1β) as the ratio of the number of IL-1β blood to the amount of IL-1β saliva and with the increasing content of IL-1β more than 10 times in the blood, 2 times saliva, unmodified level bronchoalveolar interleukin-1β and KR for IL-1β more than 1.0 predict bronchial obstruction.



 

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