Method of diagnosing hormone-active hype-plastic processes in adrenal glands at arterial hypertension

FIELD: medicine; cardiology.

SUBSTANCE: electrocardiogram of patients with arterial hypertension is subject to twenty-four-hours monitoring. Spectral analysis of variability of heart beating is conducted and low-frequency, very low frequency and high frequency wave components of heart beating are selected. Strength of wave components of heart beating is determined as general, day and night ones. Generalized factor W is calculated by original relation. Value of W is used for diagnosing absence or presence of hormone-active hyper-plastic process of adrenal glands.

EFFECT: screening testing at out-patient conditions.

2 ex, 2 tbl

 

The invention relates to medicine, namely cardiology, and can be used for the diagnosis of hormone-active hyperplastic processes of the adrenal glands in arterial hypertension.

The known method for laboratory determination of the levels of hormones (aldosterone, renin, cortisol, adrenocorticotropic hormone, and so on) and electrolytes (potassium, sodium) were taken from the cubital vein. Meanwhile, there is a direct correlation between biochemical parameters of peripheral blood and organ manifestations of diseases of the adrenal glands (Gay, Antonenko, Ehistory / in kN.: Arterial hypertension. Chapter IV. Endocrine hypertension. - L.: Medicine. - 1978, pp.109-143).

Closest to the present invention is a method for laboratory determination of hormones in the blood, flowing from the adrenal glands. Blood sampling for the study is performed with selective catheterization of the Central adrenal vein by the Seldinger technique (Manual angiography / Ed. by Prof. Ichristine. - M.: Medicine, 1977. - s-253; Diagnosis of disease and syndrome Itsenko-Kushinga using angiography and determination of hormones in blood samples from the adrenal veins and inferior Vena / Aggrieve, Vnislavov, Shiribanov, Joe // journal of roentgenology. - 1983. No. 3. - P.18-23; Diagnosis and surgical treatment of the primary is about hyperaldosteronism / Psites, Liepaloto, Nasonovia, Averianov, Havoline // Surgery. - 2002. No. 9. - P.7-16).

The disadvantages of the method are:

1. Invasive methods of blood collection.

2. The risk of thromboembolic complications.

3. The risk of anaphylactic complications in the administration of contrast medium.

4. The necessity of using expensive angiographic equipment.

5. The need to attract highly qualified medical personnel to perform blood collection.

6. The strict conditions of storage and transportation of collected material.

7. The necessity of using expensive laboratory equipment and supplies.

8. The high cost of research.

The main task to be solved by the invention is to develop a non-invasive, no contraindications, low-cost method for the diagnosis of hormone-active hyperplastic processes of the adrenal glands in arterial hypertension.

The technical result consists in the elimination of the above disadvantages of the known methods, to reach those that spend daily monitoring of an electrocardiogram. The values of high-frequency (HF), low frequency (LF) and very low frequency (VLF) wave components of spectral analysis variablest the heart rhythm and the balance, expressed in points, according to the assigned codes are used in the calculations according to the formula:

W=10,1·X1-9,5·x2-1,8·X3-6,7·X4+1,9·X5+7,3·X6-2,4·X7+5·X8-2,6·X9+4,5·X10-2,9·X11+5,6·X12+2·X13-0,5·x14-32,1.

When W>0 is diagnosed hormone-active hyperplastic process the adrenal glands.

The method is as follows. Spend daily monitoring of an electrocardiogram. The spectral components of the variability of the 5-minute intervals R-R sinus rhythm - HF, LF, VLF and their ratios assign codes (table 1).

Table 1.
CodeIndex
X1VLF total
X2VLF day
X3VLF night
X4LF total
X5LF day
X6LF night
X7HF total
X8HF day
X9HF night
X10VLF day / VLF night
X11LF day / LF night
X12LF day / day HF
X13LF night / HF night
X14HF day /HF night

The absolute values of all indicators measured on 5-point scales (table 2).

Table 2.
CodeAbsolute value ofScore
X1-X3>=20005
1500-19994
1000-14993
500 to 9992
<5001
X4-X6>=5005
400-4994
300-3993
200-2992
<2001
X7-X9>=2005
150-1994
100-1493
50-992
<501
X10 X11; x14<0,55
0,5-0,994
1,0-1,493
1,5-1,992
>=2,01
X12>-5,05
4,0-4,94
3,0-3,93
2,0-2,9/td> 2
<2,01
X13<1,05
1,0-1,94
2,0-2,93
3,0-3,92
>=4,01

Values, expressed in points, according to the assigned codes are used in the calculations according to the formula:

W=10,1·X1-9,5·x2-1,8·X3-6,7·X4+1,9·X5+7,3·X6-2,4·X7+5·X8-2,6·X9+4,5·X10-2,9·X11+5,6·X12+2·X13-0,5·x14-32,1.

When W>0 is diagnosed hormone-active hyperplastic process the adrenal glands.

Examples of specific performance

Example 1. Patient SGV, 61 years over 20 years suffers from arterial hypertension (clinical diagnosis: Arterial hypertension stage III IV risk with a primary lesion of the cerebral blood vessels (stroke from 1985); the heart in the form of coronary heart disease: stable angina II FC. PEAK (March 2002). Neil FC II). Conducted daily monitoring of an electrocardiogram with the processing of the results obtained by the proposed method. W=7.4, indicates the presence in a patient with hormone-active hyperplastic process the adrenal glands. Patients received targeted research adrenal glands (ultrasound, computed tomography): the detection of the Jena hyperplasia of the right adrenal gland. In systemic blood content of cortisol amounted to 1200 nmol/L. application of the proposed methodology resulted in changes in the diagnostic algorithm, and in subsequent clinical diagnosis. The patient is directed to a specialized surgical clinic.

Example 2. Patient III, 45 years (number of outpatient card 3786) over the 6-year-old says the AD. Conducted daily monitoring of an electrocardiogram. The obtained results are processed developed way. W=9,0. Diagnosed with hyperplastic process the adrenal glands, the patient is directed to a computer tomography. When examination revealed a tumor of the right adrenal up to 3 cm in diameter.

The proposed method allows to diagnose hormone-active hyperplastic processes of the adrenal glands in patients with arterial hypertension and can be used as a screening method in outpatient practice.

Method for the diagnosis of hormone-active hyperplastic processes of the adrenal glands in hypertension, including monitoring of ECG, conducting spectral analysis, the determination of the power of the wave components of the heart rate, the calculation of W by the formula:

W=10,1 X1-9,5 x2-1,8 X3-6,7 X4+1,9 X5+7,3 X6-2,4 X7+5 X8-2,6 X9+of 4.5 X10-2,9 X11+5,6 X12+2 X13-0,5 X14-32,1,

where X1 is the total capacity of the PTS is ery low frequency wave component spectral analysis of HRV,

X2 - value of daily power very low frequency wave component spectral analysis of HRV,

X3 - is the night of power very low frequency wave component spectral analysis of HRV,

X4 - is the total power of low-frequency wave component spectral analysis of HRV,

X5 - value of daily power low-frequency wave component spectral analysis of HRV,

X6 - value night-power low-frequency wave component spectral analysis of HRV,

X7 - is the total power of a high frequency wave component spectral analysis of HRV,

X8 - value of daily high-frequency wave component spectral analysis of HRV,

X9 - is a night of high-frequency wave component spectral analysis of HRV,

X10 - ratio values day power very low frequency wave component spectral analysis of heart rate variability and significance of the night of power very low frequency wave component variability spectral analysis R the TMA heart,

X11 - ratio values of the daily power of low-frequency wave component spectral analysis of HRV and values the night power of low-frequency wave component spectral analysis of HRV,

X12 - ratio values of the daily power of low-frequency wave component spectral analysis of HRV and daily values of high-frequency wave component spectral analysis of HRV,

X13 - ratio values of night-power low-frequency wave component spectral analysis of HRV and night values of high-frequency wave component spectral analysis of HRV,

X14 - ratio values of daily high-frequency wave component spectral analysis of variability of Sredets and night values of high-frequency wave component spectral analysis of HRV, and each indicator is scored on the table, and when W >0 is diagnosed hormone-active hyperplastic process the adrenal glands.



 

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