Method for predicting the onset of clinical flow of exudative pericarditis in case of large-focus myocardial infarction at the background of cytomegaloviral infection activation

FIELD: medicine, cardiology.

SUBSTANCE: one should detect the level of activity of IgM and IgG immunoglobulins to cytomegalovirus on the 5th and 15th d of large-focus myocardial infarction. At increased diagnostically valuable result of specific immunoglobulins of type M by 0.10-0.20 times and for type G by 0.73-2.09 times it is possible to predict favorable clinical flow of large-focus myocardial infarction without exudative pericarditis. At the value of specific immunoglobulins exceeding diagnostically valuable result for type M - by 0.86-1.67 times and for type G by 2.42-3.01 times one should predict early clinical flow of post-infarction pericarditis. The method enables to carry out prophylactic measures in due time.

EFFECT: higher accuracy of prediction.

5 ex, 2 tbl

 

The invention relates to medicine, namely cardiology, and can be used, in particular, to early predict the onset of clinical disease, exudative pericarditis when krupnooptovom myocardial infarction.

To date in clinical cardiology is not known how to predict the onset of clinical disease, exudative pericarditis after myocardial infarction. However, in the literature there are instructions on etiological belonging herpetofaunal to the occurrence of lipid disorders and development against this background of myocardial infarction. Part of the genomes of HSV-1 and HSV-2 in the nuclei of cells in the intima and media of the aorta (near atherosclerotic plaques were detected postmortal [Krylov A.A., Kupchinsky R.A. //the Role of persistent infection with herpesvirus Epstein-Barr in the etiology of atherosclerosis and its complications. Ter. Archive.-1998.-№ 6.-74-76]. High titers of antiviral antibodies IgA, IgM and IgG antibodies to herpetofauna were found in patients with atherosclerotic changes in the coronary vessels. The authors suggested that periodic stimulation of herpetofauna (particularly cytomegalovirus) plays an important role in atherogenesis and the occurrence of coronary pathology [L: the height, h, and S., Wang Q. //The detection of the antibodies of human cytomegalovirus in sera of patients with coronary heart disease.-Chung. Hua. Nei. Kotsa. Chih.-1996.-V.35 No. 11.-P.741-743].

The disadvantages of these methods are:

- 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;

- uninformative factors specific viral inflammation for the assessment of complicated clinical course krupnovesovogo myocardial infarction due to the simple fact of the detection of antibodies to the virus in serum;

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

Closest to the present invention is a method of determining high diagnostically significant titers of antiviral antibodies to CMV, correlated with C-reactive protein in patients in the acute phase of myocardial infarction and a control group of patients with stable angina [Anderson J.L., Carlguist L., Muhlestein JB, Horne B.D. et el //Evaluation of C-reactive protein, an inflammatory marker, and infectious serologi as risk factor for coronary artery disease and myocardial infarction. - J. Am. Coil. Cardiol.-1998.-V.32.-No. 1.-P.35-41]. The author noted that increased titers of specific antibodies is a risk factor for acute myocardial infarction.

However, this method has disadvantages:

the method is based on the determination of antibodies to CMV only patients with INPh is rccom attack without taking into account the amount of necrosis;

the method detects antibodies to CMV only in the acute and acute stage of myocardial infarction, which does not allow to evaluate their activity in the early postinfarction period;

- no way to predict early clinical course of exudative pericarditis when krupnooptovom myocardial infarction in the dynamics of the disease.

The aim of the presented invention is to increase the value and specificity of immunological evaluations of specific antibodies to cytomegalovirus to predict the onset of clinical disease, exudative pericarditis when krupnooptovom myocardial infarction at simultaneous simplicity and availability for its wide 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 cytomegalovirus in the 5th and 15th day krupnovesovogo myocardial infarction and in excess of the diagnostically significant result of specific immunoglobulin M (0,10-0,20 times for a class of G in 0,73 -2,09 times predict a favorable clinical course krupnovesovogo myocardial infarction without exudative pericarditis; and when the values of specific immunoglobulins in excess of diagnostically significant result for a class M of 0.86-1,67 times and class G 2.42-3,01 RA is and predict early clinical course of postinfarction pericarditis.

In the literature it is noted that in clinical practice the most frequent viral pericarditis (46%) [Toradjo-Martinez R., 1988; Suzuki, S., K. Yano, 1996; Babonian S., Davies M.J. et al., 1997]. It is known that 60-80% are infected with cytomegalovirus [Adaskevich V.P., 2000]. Herpetofauna have some cardiotropic in the form of heart disease with marked changes in the nuclear chromatin until complete lysis, granular dystrophy and loss of transverse iscertainly, in some cases changes in the nuclei of endothelial and fibroblasts. Exadactylos function CMV mainly due to cytoplasmic effects of the virus, as well as changes in lipid metabolism. When immune disorders, and hormonal therapy herpes infection develops more frequently and is characterized by a more severe course, due to the lack of immunity or excessive immune response [Isakov V.A., Aspelia J.V., 1999]. Immunosuppression associated with impaired immune status in patients with myocardial infarction with persistent form or latent for CMV infection may predispose to reactivation [Isakov V.A., Aspelia YU, 1999].

Highly reactive immunoglobulin M are synthesized first, and are markers of viraemia (the half-life of 4-8 days) [Long V.G., 2000]. Low immunoglobulins of class G appear later, but are defined in p is destroy and reconvalescent phase in high titers, exceeding diagnostically significant result when immunochemical titration (half-life 20-28 days).

So, despite the literature data about the high infection rates, cardiotropic and exadactylos ability herpetofauna, studies aimed at predicting the beginning of the clinical course of exudative pericarditis when krupnooptovom myocardial infarction on the background of aquarii cytomegalovirus infection, was not carried out. Existing literature data on the prediction of the clinical course of myocardial infarction using immunochemical indicators make it possible to determine the activity of cytomegalovirus in serum in acute and acute stages of the disease, but does not allow you to diagnose early clinical course of postinfarction pericarditis.

Distinctive features of the proposed method of forecasting is to identify patients with Rupniecibas myocardial infarction in acute and early post-infarction period with a higher risk debut exudative pericarditis in the presence of positive blood titers of specific antibodies by cardiotropic exsudativum cytomegalovirus. The presented method allows to predict the debut of postinfarction exudative pericarditis by immunochemical parameters specification the specific activity of cytomegalovirus. Unlike other above studies, the present method takes into account the peculiarities of the pathogenetic involvement of cytomegalovirus in acute and early post-infarction period, than differs from those described in the literature.

The proposed method of the invention was tested on 58 patients with Rupniecibas myocardial infarction complicated and not complicated exudative pericarditis on the basis of the departments of cardiology of the Regional clinical hospital № 1, Regional hospital, Research and production complex “Environmental medicine”, OAO “Astrakhan-Gazprom”City clinical hospital № 3 during 1997-2002, Traditional instrumental and laboratory data do not allow us to estimate the prognosis of the clinical course krupnovesovogo myocardial infarction in determining debut postinfarction exudative pericarditis. In this regard, we also performed ELISA testing of serum of patients with Rupniecibas myocardial infarction complicated postinfarction pericarditis with or without cause, by the definition of the levels of immunoglobulins IgM and IgG to CMV, stipinovich to the wells and reagents company “DSL” (USA). The view of the received data produced by the spectrophotometer “ELx800 Universal Microplate Reader” company “Bio - Tek instruments INC (USA). The results of the reaction is viewed as the good 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. Reliable are the values that fall within the confidence interval of the coefficient of variation of not more than 15%.

The data are processed by the method of variation statistics (table 1,2).

Below are the results of testing.

Clinical example # 1: a Patient F., 43,, case history No. 2898, was admitted to the cardiology Department NPMC “Environmental medicine” 06.03.2001, complaining pressing pain in the chest, severe weakness. When entering a state of moderate severity. In the lungs vesicular breathing, wheezing no. Respiratory rate 18 in 1 minute. Borders of relative heart dullness extended to the left by 1.5 outwards from the left of the mid-clavicle line. Heart sounds are muffled. The heart rate of 68 beats per 1 minute, rhythmic. HELL 120/80 mm Hg Liver is not enlarged. Peripheral edema no. ECG: sinus Rhythm, in leads I, aVL, V2-6- QS.ST above contour lines at 1 mm, T is negative. Preliminary diagnosis: ischemic heart disease. Krupnooptovyj (transmural) myocardial infarction of anterolateral wall and interventricular septum from 06.03.2001, class of gravity II. atherosclerosis of the aorta. Circulatory insufficiency I.

The pericardial friction noise n which were heard throughout the observation of the patient in the hospital. On the background of therapy with nitrates, β-blockers, anticoagulants, antihypoxants positive dynamics. On the 5th day of myocardial infarction on ECG: comparison with ECG from 06.03.2001 g dynamics of myocardial infarction corresponds to the period; in leads I,aVL, V2-6-QS, ST segment went down to the contour, T-negative. ECHO KG from 14.03.2001 g: separation of the pericardial sheets on the back wall of the left ventricle 0.2 see Blood: erythrocytes 4,39×1012/l, hemoglobin 147 g/l, leukocytes 6,6×109/l, basophils 0%, eosinophils 3%, stab neutrophils 2%, segmented neutrophils 76%, lymphocytes 18%, monocytes 4%, ROE of 20 mm/hour; ELISA serum: IgM to CMV - 0.20 and IgG to CMV 2,09 (table 1,2).

The clinical observation of acute and early post-infarction period krupnovesovogo myocardial infarction proceeded without features. Clinical symptoms of post exudative effusion were noted. ECG from 21.03.2001, as compared with ECG from 21.03.2001, formed a negative teeth So the ECHO-KG from 21.03.2001: compared with the ECHO-KG from 11.03.2001 g speakers are not. Blood: erythrocytes 4,4×1012/l, hemoglobin 145 g/l, leukocytes 4,6×109/l, ROE 23 mm/hour; ELISA serum: IgM to CMV - 0,19 and IgG to CMV 2,09 (table 1,2).

Clinical example # 1 shows that low titers of IgM (exceeding JR in for 0,19 0,20 time) and IgG (exceeding JR at 2.09 times) to Cmopletely in patients with a favorable course of krupnovesovogo (transmural) myocardial infarction without the development of postinfarction exudative pericarditis.

Clinical example 2: Patient N., 60 HP, case history No. 1335, received 31.03.2001, Department of cardiology NPMC “Environmental medicine” complaining constricting pain in the chest. When entering a state of moderate severity. In the lungs vesicular, no wheezing. Borders of relative heart dullness extended to the left by 2 cm outwards from the left heart-clavicle line. Over precordial area heard the rough noise of friction of the pericardium. Pulse 80 beats per 1 minute, rhythmic. HELL 140/80 mm Hg Liver is not enlarged. No edema.

Signs of dry fibrinous pericarditis (pericardial friction noise) remained until 02.04.2001, ECG from 31.03.2001 g: sinus rhythm, the wrong, the ST segment above contours at 0.5 mm, T is negative; V2-6-QS, ST segment above the contour 1mm, T is negative. Diagnosed with CHD. Krupnooptovyj (transmural) myocardial infarction of anterior-septal, lateral area on 31.03.2001, Epistemologically pericarditis from 31.03.2001, Nodal premature beats. Atherosclerosis of the aorta and peripheral vessels. NC I.

05.04.2001, lung auscultation is defined vesicular breathing, wheezing no. Respiratory rate 18 in 1 minute. Heart sounds are muffled. The pericardial friction noise is not heard. Pulse 74 hit in 1 minute, rhythmic. HELL 120/80 mmHg ECG from 05.04.2001 g: comparison with ECG from 31.03.2001 g ECG dynamics appropriate to esthet the time of myocardial infarction (IaVL-QS, T - negative, V2-6-QS, ST above contours at 0.5 mm, T is negative). The ECHO-KG: the separation of the pericardial sheets on the back wall of the left ventricle 0,2 see Blood: erythrocytes: 4,55×1012/l, hemoglobin 167 g/l, leukocytes 17,2×109/l, basophils 0%, eosinophils 3%, stab neutrophils 2%, segmented neutrophils 80%, lymphocytes 16%, monocytes 1%, ROE of 28 mm/hour, ELISA serum: IgM to CMV - 0.10 and IgG to CMV to 0.73 (table 1,2).

On the background of treatment with nitrates, β-blockers, antioxidants, anticoagulants positive dynamics. ECG from 20.04.2001, compared with ECG from 05.04.2001, leads IaVL, V3-6negative teeth T became deeper. The ECHO-KG: in the pericardial fluid is not lazerette. Blood: erythrocytes 3,94×1012/l, hemoglobin 126 g/l, leukocytes 9,1×109/l, ROE 49 mm/h; ELISA serum: IgM to CMV - 0.10 and IgG to CMV - 0,74 (table 1,2).

In the clinical example No. 1 and 2 illustrate the low titers of IgM (exceeding ZR in the 0.1-0.2 times) and IgG (exceeding JR 0.74-2.09 times) to CMV in patients with Rupniecibas myocardial infarction, not complicated syndrome Dressler with postinfarction exudative pericarditis. Development epistemological dry pericarditis caused by the reaction of the pericardium on krupnooptovyj necrosis in the myocardium and is not associated with the concentration of specific antibodies of class IgM and IgG to CMV (table 1,2).

To inchesi example No. 3: the Patient E., 39 L., case history No. 545, was admitted to the medical Department of the Regional hospital 03.10.1997 g with complaints pressing pain in the chest, shortness of breath, weakness. History krupnooptovyj myocardial infarction anterior-septal area in April 1997

05.10.1997, began to disturb the intense pressing pain in the chest, radiating to both arms, shortness of breath, severe weakness. Objective data: Acrocyanosis. In the lungs vesicular breathing, wheezing no. Respiratory rate 20 in 1 minute. Borders of relative heart dullness extended to the left by 1.5 cm outwards from the left of the mid-clavicle line. Heart tones are muffled, rhythmic. Pulse 80 beats per 1 minute. Systolic murmur at the point of listening to the aorta and at the apex of the heart. HELL 120/80 mm Hg Abdomen is soft, painless on palpation. The liver is not enlarged. No edema. ECG: sinus Rhythm, right. Electrical axis rejected to the left. In leads I, II, aVL, V1-4the ST segment above contours at 0.5-1 mm, T (±). ECG from 10.10.1997, as compared with ECG from 05.10.1997, in leads I, II, aVL, V1-4the ST segment went down to the contour T is negative. Blood: leukocytes, erythrocytes 4,2×1012/l, hemoglobin 130 g/l, leukocytes 9,8×109/l, eosinophils 1%, basophils 0%, stab neutrophils 3%, segmented neutrophils 78%, lymphocytes 18%, monocytes 4%; ELISA serum: IgM to CMV - 0.88 and IG to CMV 3,01 (table 1,2).

20.10.1997, notes the deterioration: appeared again pressing pain in the chest, shortness of breath. Increased signs of cardiac decompensation. However, in traditional instrumental and laboratory indicators of the dynamics is not observed. ELISA serum: IgM to CMV - 1,12 and IgG to CMV - 2,99 (table 1,2).

With 21.10.1997, increased body temperature up to 37,6°C. In the lungs vesicular breathing fine basal rales lower angle of the left scapula. Respiratory rate 26 in 1 minute. Borders of relative heart dullness extended to the left by 2 cm laterally from the left-middle-heart line and 0.5 cm outwards to the right from the right edge of the sternum. Heart tones are muffled, rhythmic. On top listens attentively the noise of friction of the pericardium, aggravated by tilting the patient forward. Positive symptoms of exudative pericarditis: Foam, Potena, Lauenburger. The lower edge of the liver below the edge of the right costal arch 2.5 see Leg and foot edema. ECG from 21.10.1997, as compared with ECG from 10.10.1997, concordantly the rise of the ST segment in leads I, II, aVL, V1-4T (±). The ECHO-KG: the separation of the pericardial sheets on the front wall of the right ventricle in systole 0.6 cm, diastole 0.4 cm; posterior wall of the left ventricle in systole 0.8 cm, diastole 0.5 cm Blood: erythrocytes 3,8×1012/l, hemoglobin 130 g/l, leukocytes 10,5×109/l, ROE 25 mm/H. diagnosed with CHD. Re coarsely calowy myocardial infarction anterior-septal from 05.10.1997, Functional class II. Postinfarction syndrome Dressler from 21.10.1997, Postinfarction cardiosclerosis. Atherosclerosis of the aorta, the coronary arteries. NC II B.

Clinical example # 3 shows that the increase in the titers of specific antibodies to CMV - IgM (excess of diagnostically significant result on the 5th day of the survey 0.88, 15th - 1.12 times) and IgG (excess of diagnostically significant result on the 5th day of the survey in 3,01, 15th - 2.99 times) can be used as a prognostic test debut postinfarction exudative pericarditis (table 1,2).

Clinical example # 4: a Patient Century, 56 L., case history No. 8195, was admitted to the cardiology Department No. 1 NPMC “Environmental medicine” 06.08.1997, complaining of shortness of breath, pain in the chest and pressing nature, heaviness in the right hypochondrium, swelling of legs and feet. In April 1997 after re krupnovesovogo myocardial infarction noted syndrome Dressler. Deterioration with 29.07.1997,: appeared pressing pain in the chest, shortness of breath, swelling. Upon receipt marked clinical signs of recurrence of postinfarction pericarditis: expanding the left border of the relative dullness of the heart to the anterior axillary line, muting, heart sounds, positive signs Potena, Foam, Lauenburger. The ECHO-KG from 03.09.1997,: under the rear wall of the left ventricle lazerette e-hon the negative space in the systole 1.4 cm, diastole 0,9 see ECG: Cicatricial changes of the myocardium; sinus tachycardia; single supraventricular extrasystole, moderate coronary insufficiency in the V4-6(the ST segment on the contour, T is negative). Blood from 03.09.1997: erythrocytes 3,7×109/l, hemoglobin 37 g/l, leukocytes 5,1×1012/l, ROE 6 mm/h, eosinophils 5%, stab neutrophils 2%, segmented neutrophils 66%, lymphocytes 27%, monocytes 4%; ELISA serum: IgM to CMV - 1,6 7, IgG to CMV 2,94 (table 1,2).

ECHO KG from 09.09.1997, and 15.09.1997,: separation of the pericardial sheets under the rear wall of the left ventricle in systole 1.4 cm, diastole 1,0, see ECG: cicatricial changes of the myocardium in the anterior-septal and lateral wall; compared with ECG from 08.09.1997, arrythmia is not registered. Blood on the 15th day of the survey: erythrocytes 4,87×109/l, hemoglobin 154 g/l, leukocytes 4,87×1012/l, ROE 4 mm/h, PETIT 90%; ELISA serum: IgM to CMV was 1.43 and IgG to CMV - 2,86 (table 1,2).

This clinical example # 4 shows the possibility of predicting the clinical course of postinfarction pericarditis in significantly higher performance on the content of IgM to CMV (excess of diagnostically significant result 1.67 times) and IgG to CMV (excess of diagnostically significant result 2.94 times) (p<0,05) (table 1,2).

Clinical example # 5: the patient K., 69 years old, medical history, No. 8455-97, ustupila 27.09.1997, complaining of intense choking chest pain, shortness of breath, nausea. In 1992 and 1997, he moved krupnooptovyj myocardial infarction anterior-septal area. On the 27th day of repeated myocardial infarction appeared intense pain in the chest, shortness of breath. The patient with suspected recurrence of myocardial infarction hospitalized in the cardiology Department NPMC “Environmental medicine”. When receiving the status of the crane heavy. Marked cyanosis of the lips, acrocyanosis. Lung heard a lot of scattered dry rales over all lung fields, axillare and nizhnezadnimi departments in both lungs - wet medium and fine bubble wheezing. Respiratory rate 26 / min. Borders of relative heart dullness extended to the left until the left anterior axillary line. To the left of the sternum in the fourth intercostal space shall be heard the noise of friction of the pericardium. With 10.10.1997, was worried about a severe pain in the chest on the right, a dry cough, listen to the noise pleural friction and traiterous rales on the right in the paravertebral and subscapularis areas. With 29.10.1997, shortening of percussion sound right, auscultatory marked right weakening vesicular breathing; III ribs heard back rales, Accelero - noise pleural friction. X-ray signs of right-sided focal pneumonia and pleurisy. ECHO KG from 29.10.1997,: separation of the sheets per the card on the back wall of the left ventricle in systole 1.2 cm, diastole 0,9 see On the ECG: concordantly the rise of the ST segment and the negative rumen T in leads I, aVL, V5V6; cicatricial changes of the myocardium V1-4, atrial fibrillation. Blood on the 5th day of the survey: erythrocytes 3,8×1012/l, hemoglobin 125 g/l, leukocytes 10,6×109/l, ROE 6 mm/h, eosinophils 1%, stab neutrophils 3%, segmented neutrophils 89%, lymphocytes 7%, PETIT 89%; ELISA serum: IgM to CMV 0,71, IgG to CMV - 2,47.

In the dynamics of the disease has insignificant positive dynamics on the background of prednisone 20 mg/day, furosemide 80 mg/day, sifloks 1000 mg/day acetylsalicylic acid 50 mg/day. The ECHO-KG from 04.11.1997, and 19.11.1997,: separation of the pericardial sheets under the left ventricle in systole 0.3 cm, diastole 0,2 see Blood on the 15th day of the survey: erythrocytes 3,5×1012/l, hemoglobin 120 g/l, leucocytes-10,9×109/l, ROE 20 mm/h, PETIT 90%, eosinophils 0%, stab neutrophils 3%, segmented neutrophils 67%, lymphocytes 20%, monocytes 4%; ELISA serum: IgM to CMV - 1.16 and IgG to CMV - 2,77.

In the clinical example # 5 refers to the high content of specific antibodies to cytomegalovirus (exceeding diagnostically significant result IgM to CMV in of 0.71-1.16 times and IgG to CMV in 2,77-2,47 times) in patients with postinfarction exudative pericarditis when Dressler syndrome, which may serve t is the train diagnostic markers in the differential diagnosis with recurrent myocardial infarction already on the 5th day of examination for the patient.

Presents clinical examples No. 3,4,5 confirm the importance of immunoassay testing the serum of patients with Rupniecibas myocardial infarction to determine the titers of antibodies to cytomegalovirus. When determining the growth of IgM titers in excess of diagnostically significant result of 0.86-1,67, predict the debut of postinfarction pericarditis.

Presents clinical examples demonstrate the importance of clinical application of the proposed method of the invention for predicting a favorable course of postinfarction pericarditis. The proposed method of the invention predict the onset of clinical disease, exudative pericarditis when krupnooptovom myocardial infarction on the background of activation of cytomegalovirus infection 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 (firm Corning Costar Corporation, One Alewife Center, USA), highly active antibodies adsorbed to the wells stripyoung tablet to specific antigens of HSV, stored frozen at a temperature of minus 24°before statement response.

2. High informative value of the results of the immunoassay test savored the blood of patients with Rupniecibas myocardial infarction, complicated and not complicated postinfarction pericarditis, using a set of reagents firm “DSL” (USA), taking into account data obtained on a spectrophotometer “ELx800 Universal Microplate Reader” company “Bio-Tek instruments INC (USA).

3. Ease of use in the method of the invention prognostic evaluation of specific immunoglobulins in the clinical course krupnovesovogo myocardial infarction, defined by the technical simplicity of execution and speed of obtaining results specific immunoassay studies (duration of reaction for about 6 hours).

4. Diagnostic efficiency: the way of his own invention allows to improve the results of diagnostics and forecasting of postinfarction pericarditis at an early stage of the survey.

5. therapeutic efficacy of the method of the presented invention prognostic evaluation of specific immunoglobulins associated with improving the quality of laboratory diagnostics and forecasting, the adequacy of therapy, improvement in clinical course and outcome krupnovesovogo myocardial infarction and its complications - post exudative pericarditis.

6. The economic efficiency of the method presented in the invention, as defined by the forecast of an early debut of postinfarction pericarditis and conduct timely the antiviral prophylactic prepare patients risk group with Rupniecibas myocardial infarction with positive high titers of specific antibodies to cytomegalovirus, manifested in the decrease in the number of days of stay of the patient in the hospital.

The proposed method can be used for prognostic evaluation krupnovesovogo myocardial infarction in cardiology and therapy hospitals. This will enable timely preventive measures of reactivation of cytomegalovirus infection in acute and early post-infarction period, will change the approach to the traditional treatment of postinfarction pericarditis, will improve the results of its clinical course and outcome of the disease.

Table 1

Comparison of activity levels of immunoglobulins IgM antibodies to cytomegalovirus in ELISA testing of serum in patients with Rupniecibas myocardial infarction, complicated and uncomplicated exudative pericarditis.
The treatment groupnExcess ZR activity levels of immunoglobulins IgM to CMV (N times)
Favorable clinical course krupnovesovogo myocardial infarction without postinfarction exudative pericarditis460,16±0,04**

0,10-0,20**

R*>0,05

R**<0,05
Clinical course krupnovesovogo myocardial infarction complicated by xstation pericarditis 120,89±0,47*,**

0,86-1,67 R.**

R*<0,05

R**<0,05
Note:

N - a certain number of excess diagnostically significant result;

n - number of examined patients;

R* is the criterion of validity of the differences of characteristics in comparison with a control group of donors;

R** - criterion validity differences of characteristics in comparison with the other group surveyed.

Table 2

Comparison of activity levels of immunoglobulins IgG antibodies to cytomegalovirus in ELISA testing of serum in patients with Rupniecibas myocardial infarction, complicated and uncomplicated exudative pericarditis.
The treatment groupnExcess ZR activity levels of immunoglobulins IgG to CMV (N times)
Favorable clinical course krupnovesovogo myocardial infarction without pericarditis461,13±0,52**

0,73-2,09 R.**

R*>0,05

R**<0,05
Clinical course krupnovesovogo myocardial infarction, acute exudative pericarditis122,30±0,86*,**

2,42-3,01 R.**

R*<0,05

R**<0,05
Note:

N - a certain number of excess diagnostically significant result;

n - number of examined patients;

R* is the criterion of validity of the differences of characteristics in comparison with a control group of donors;

R** - criterion validity differences of characteristics in comparison with the other group surveyed.

Way to predict the onset of clinical disease, exudative pericarditis when krupnooptovom myocardial infarction on the background of activation of cytomegalovirus infection by ELISA testing of serum, wherein the determined activity levels of immunoglobulin IgM and IgG antibodies to cytomegalovirus in the 5th and 15th day krupnovesovogo myocardial infarction and in excess of the diagnostically significant result of specific immunoglobulin M (0,10-0,20 times and for class G to 0.73-2.09 times predict a favorable clinical course krupnovesovogo myocardial infarction without exudative pericarditis, and when the values of specific immunoglobulins in excess of diagnostically significant result for a class M of 0.86-1,67 time and class G 2.42-3,01 times, predict early clinical course of postinfarction pericarditis.



 

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3 ex

FIELD: medicine, cardiology.

SUBSTANCE: one should detect the level of activity of IgM and IgG immunoglobulins to cytomegalovirus on the 5th and 15th d of large-focus myocardial infarction. At increased diagnostically valuable result of specific immunoglobulins of type M by 0.10-0.20 times and for type G by 0.73-2.09 times it is possible to predict favorable clinical flow of large-focus myocardial infarction without exudative pericarditis. At the value of specific immunoglobulins exceeding diagnostically valuable result for type M - by 0.86-1.67 times and for type G by 2.42-3.01 times one should predict early clinical flow of post-infarction pericarditis. The method enables to carry out prophylactic measures in due time.

EFFECT: higher accuracy of prediction.

5 ex, 2 tbl

FIELD: biochemistry.

SUBSTANCE: one should test blood serumal samples in immunoenzymatic assay by applying a test system ELI-N-1, the components of which are being antigens of nervous tissue or their immunochemical analogs specifically binding antibodies with tendency to antigens of nervous tissue, and, also, idiotypical antibodies to them, or their variable parts. Prediction should be performed according to the level of idiotypical and anti-idiotypical autoantibodies to antigens of nervous tissue and, also, according to their ratio. Thus, a new test system has been elaborated that enables to predict the flow of available nervous-psychic diseases.

EFFECT: higher accuracy of prediction.

2 cl, 7 ex

FIELD: medicine, obstetrics.

SUBSTANCE: in pregnant women at pregnancy terms being after 39 wk in average portion of morning urine one should detect due to a solid-phase immunoenzymatic assay the concentration of pregnancy-associated protein-A (PAPP-A). At the level of PAPP-A being 768.2 ng/ml and more it is possible to conclude upon physiological mature pregnancy. The innovation is noninvasive and enables to increase accuracy in predicting true over-mature pregnancy.

EFFECT: higher efficiency and accuracy of diagnostics.

2 ex, 1 tbl

FIELD: medicine, biotechnology.

SUBSTANCE: the present innovation deals with elaborating diagnostic reagents for testing prionic protein in mammalian cerebral tissue due to IEA technique and refers to antibodies specifically reacting with prionic protein PrP or its fragment. The innovation includes polyclonal antibodies obtained to synthetic peptides including amino acid sequences of bovine prionic protein 143-168, 101-134 and 211-241, their conjugates with horseradish peroxidase and diagnostic reagents obtained upon their basis that enable to detect prionic protein in mammalian cerebral tissues.

EFFECT: higher specificity of detection.

15 cl, 8 ex, 8 tbl

FIELD: veterinary and medicine.

SUBSTANCE: invention, in particular, relates to production and use of biological preparations intended for differential diagnostics of brucellosis and to a method of differentially diagnosing brucellosis. Method involves serologic analysis of sera using antigenic "IFK", which is horse-radish peroxidase-labeled electrophoretically purified polypeptide fraction of virulent strain B.arborus 54. Diagnosis of brucellosis is stated when anti-brucellosis antibodies in sick animal sera diluted to 1/100 and higher are revealed at CSP reaction intensity 2.1 and higher.

EFFECT: elaborated method increasing immuno-enzymatic test specificity and allowing performing differentiation of postvaccinal immunological reactions and postinfectious reactions induced by microorganisms having antigenic affinity with brucellas, especially Yersinia enteriocolitica.

2 cl, 4 ex

FIELD: biotechnology, analytical chemistry.

SUBSTANCE: claimed method includes providing of complexes between antigen molecules and specific antibodies on carrier surface, wherein said complexes are disclosed by addition of enzyme label thereto followed detection thereof based on formation of enzyme reaction product. Enzyme label addition is carried out by two protein interaction, namely bacterial ribonucleaze barnase and barstare, which is inhibitor thereof, wherein either of the two is added to immunoreagent, and the other one is added to enzyme label. Abovementioned complexes have high affinity, specificity, and binding constant of 1014 M-1.

EFFECT: new method for antigen detection.

6 dwg, 2 ex

FIELD: veterinary virology.

SUBSTANCE: the present innovation deals with interaction of antibodies with an antigen, with antibodies labeled with horseradish peroxidase, addition of substrate mixture and registration of reaction results. Moreover, one should apply plotting boards with presorbed antibodies and general immunoenzymatic conjugate. The innovation enables to shorten terms for diagnosis and obtain more significant results of diagnostics.

EFFECT: higher efficiency.

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