Differential diagnosis method for distinguishing compensated and decompensated chronic tonsillitis form

FIELD: medicine.

SUBSTANCE: method involves carrying out infrared saliva spectroscopy and determining mean values of infrared radiation pass band in frequency ranges of 3085-2832 cm-1, 2120-1880 cm-1, 1600-1535 cm-1, 1543-1425 cm-1, 1430-1210 cm-1, 1127-1057 cm-1. Mean value in the range of 1600-1535 cm-1 being greater than 35.9, in the range of 1543-1425 cm-1 being greater than 57.9, in the range of 1430-1210 cm-1 being greater than 54.5, compensated chronic tonsillitis is considered to be the case. The mean value in the range of 1600-1535 cm-1 being less than 32.5, in the range of 1543-1425 cm-1 being less than 65.2, compensated chronic tonsillitis is to be diagnosed. The mean value in the range of 1600-1535 cm-1 being less than 35.9, in the range of 3085-2832 cm-1 being greater than 72.8, compensated chronic tonsillitis is to be diagnosed. The mean value in the range of 1600-1535 cm-1 being less than 35.9, in the range of 1127-1057 cm-1 being greater than 51.7, compensated chronic tonsillitis is to be diagnosed. The mean value in the range of 1600-1535 cm-1 being less than 35.9, in the range of 2120-1880 cm-1 being greater than 79.7, compensated chronic tonsillitis is to be diagnosed. The mean value in the range of 1600-1535 cm-1 being less than 35.9, in the range of 2120-1880 cm-1 being less than 79.7, decompensated chronic tonsillitis is to be diagnosed.

EFFECT: high reliability and simplicity of differential diagnosis.

3 dwg

 

The invention relates to medicine, namely to otorhinolaryngology.

The problem of chronic tonsillitis is most relevant in otorhinolaryngology not only its prevalence is 15% of the total population and 22.1-40.1 per cent among children, but the absence of objective criteria for the diagnosis of compensated form with immunological compensated and decompensated forms of chronic tonsillitis with immune decompensation, which positively addressed the issue of surgery - tonsillectomy.

The state of immunological activity of lymphoid tissue of the tonsils is not always the same as established by clinical signs diagnosis of compensated or decompensated forms of chronic tonsillitis. Used for the clinical diagnosis of chronic tonsillitis criteria (size, presence of adhesions, scars, septic traffic indication of Giza, Zack, Transfiguration, submandibular lymphadenitis and others) are not associated with immunological function of the tonsils and can't testify about compensation or decompensation.

A prototype of the proposed method, the authors propose a laboratory method of diagnostics of the immunological activity of the tissue of the tonsils by determining the average number of cells of the lymphoid series (small lymphocytes and lymphocytes in stage blast is transformatsii) contents of the mouths of the crypts of the tonsils in one big square camera Goryaeva by counting cells in 10 boxes (5 in the top and bottom rows of the grid) using prednisolone samples which increases the migration of the formed elements of the tissue of the tonsils on the surface, the openings of the gaps and crypts; what characterizes the functional activity of the tonsils. Prednisolone stimulates formation in cells regulatory peptide-vasocardin, which blocks the enzyme hyaluronidase, resulting in enhanced barrier function of the blood-tissue interfaces barriers, in particular the permeability of the capillary bed. In patients with compensated chronic tonsillitis at the baseline lymphocyte count 73±4 after taking prednisone - increase to 207±10, an increase in the migration of lymphocytes into the lumen of the crypt to 304±8% (p<0,01).

In patients with decompensated chronic tonsillitis without comorbidity to prednisone the number of lymphocytes 5±1, then 6±1; increasing migration of lymphocytes into the lumen of the crypt to 117±5% (p<0,05). In healthy individuals initial number of cells of the lymphoid series in the contents of the crypt 22±2, after administration of prednisolone -38±3, increasing the migration of lymphocytes into the lumen of the crypt - 187±6% (p<0,05).

When decompensation of the functions of the tonsils number of cells of the lymphoid series in the lumen of the crypts significantly reduced compared with patients with compensated chronic tonsillitis - more than 12 times and with a healthy - 4 times, what evidence is em about the absence of any functional reserve in the tonsils (Blackie AV, Vikulov CENTURIES, Bolotov PN. Morphofunctional state of the tonsils. J. Russian otolaryngology". 2004. - №2 (9). - P.114-116).

In the opinion of the authors, the method has some disadvantages - difficulty in holding him and interpretation, and hence a low degree of reliability.

The authors propose a method of differential diagnosis of compensated and decompensated forms of chronic tonsillitis research saliva using infrared spectroscopy. Infrared spectroscopy was carried out using an infrared analyzer "ICARUS" on 9 channels for 1 min, after 1 sec. As the study material was used saliva in an amount of 5 ml Were examined 56 people, including 22 patients with compensated chronic tonsillitis, 24 patients with decompensated chronic tonsillitis and a control group of healthy individuals -10 people.

The most informative was 1, 2, 3, 4, 5, 6 the channels corresponding to the ranges 3085-2832 cm-1, 2120-1880 cm-1,1600-1535 cm-1, 1543-1425 cm-1, 1430-1210 cm-1and 1127-1057 cm-1, which was determined average values of the transmittance of infrared radiation.

The sample of the saliva of the patient for 30 seconds in each range was performed 10 cycles of measurement of the rate of transmission of infrared radiation. Thus was SF is milovana learning multidimensional sampling with 6 variables (ranges) and volume (rows) 560, where each row had the label of one of the States: compensated chronic tonsillitis, asthma chronic tonsillitis and control. The sample was analyzed PC method hierarchical decision trees (classification trees). / Potemkin VG MATLAB 6: a design environment for engineering applications. - M.: DIALOG-MIFI, 2003. - 448 S./.

Algorithm " decision trees" is a sequential hierarchical structure consisting of nodes, which contain the rules, i.e. the logical structure of the form " If...then". The leaf nodes of the tree are the leaves, corresponding to the found solutions and brings together a number of rows (States) of the training sample.

The aim of building a " decision tree" is revealing in the training set meaningful patterns or systematic relationships between indicators infrared transmittance values (dimensionless) and the conditions of the patient, which can then be applied to new measurements, the samples of saliva, thus diagnosing the patient's condition. This method combines effective analytical apparatus generating solutions with ease of use and intuitive and easily interpretable outcomes.

The method of decision trees allows to predict the membership of a sample of saliva specific patients the NTA to one of its States: compensated chronic tonsillitis, decompensated chronic tonsillitis and the absence (control). As a result of this procedure produced the decision rules:

According to these rules for a successful forecast is 99,3%.

Based on these data the authors concluded that when the value of the average transmittance of infrared radiation in the 3 range more 35,9, 4 range more 57,9, and in the range of less than 5 54,5 - diagnosed chronic tonsillitis, compensated form; when the value of the average transmittance in the 3 range over 32.5 - diagnosed chronic tonsillitis, asthma form; if the average transmittance in the range of less than 3 32,5 and 4 range less 65,2 - diagnosed chronic tonsillitis, compensated form; if the average transmittance in the range of less than 3 35,9 and 1 range more 72,8 - diagnosed chronic tonsillitis, compensated form; if the average transmittance in the range of less than 3 35,9 and 6 more range of 51.7 - diagnosed chronic tonsillitis, compensated form; if the average transmittance in the range of less than 3 35,9 and 2 more range 79,7 - diagnosed chronic tonsillitis, compensated form; the ri value of the average transmittance in the range of less than 3 35,9, and in 2 the range of less than 79,7 - diagnosed chronic tonsillitis, asthma shape. This is used by the authors for the differential diagnosis of compensated and decompensated forms of chronic tonsillitis in patients with clinically diagnosed chronic tonsillitis.

In addition, the proposed method for the diagnosis of chronic tonsillitis according to a study in the saliva of the patient by the method of infrared spectroscopy, painless, quick, and can be performed on an outpatient basis.

Clinical examples.

Patient G., survey map No. 29 preliminary clinical diagnosis of compensated chronic tonsillitis (complaints of sore throat, sore, feeling of a foreign body, breath; a history of frequent sore throats (1 per year); tonsil 2 degrees, hilly, wide gaps, introducing tube, adhesions with nebnymi fit the symptoms of Giza, Zack and Transfiguration). The study of saliva using an analyzer "ICARUS". The average transmittance of infrared radiation were: 1 range 73,8; 2 range 68,3; 3 range 38,4; 4 range 59,1; 5 range 56,3; 6 range 54,6. Turning to the method of "decision trees", which are represented graphically in the text above. Always start with the 3 main range, which our patient 38.4; look in the "decision tree" - which then corresponds to the 3 range < =35,9 it and go to 1 range, which our patient equal 73,8 that obliges us to make a graphic image of a "decision tree". This corresponds to the "decision tree" 1 range <=72,8, and this gives us the right to confirm this patient delivered her diagnosis of chronic tonsillitis compensated form, and to recommend conservative treatment. Thus, using the logic of decision rules developed and proposed " decision tree"for us to confirm this diagnosis in specific patient enough to use the average transmittance in only two bands (3 and 1) of the 6 investigated.

Patient A., map of survey No. 31, a preliminary diagnosis of decompensated chronic tonsillitis (complaints of sore throat, scratchy, the appearance of purulent "grains" on the tongue, bad breath, weakness, malaise, low-grade fever, joint pain; a history of frequent sore throats (1 year), frequent Colds (up to 4 times per year); increase and tenderness to palpation of the submandibular lymph nodes, tonsils 2 degrees, hilly, wide gaps, introducing tube, subepithelially festering follicles, adhesions with nebnymi dochkami, symptoms of Giza, Zack and Transfiguration). The study of saliva using the apparatus analyzer "ICARUS". Show is whether the average transmittance of infrared radiation were: 1 range 71,6; 2 range of 72.6; 3 range 31,1; 4 range of 55.3; 5 range 51,8; 6 range of 50.9. Begin with the main 3 range, the average transmittance for him in our patient is equal to 31.1. Turn to our proposed "decision tree" and see that it corresponds to 3 range >35,9, and it is commanded to move 1 range, the average transmittance of which our patient equal 71,6, which corresponds to the "decision tree" 1 range >72,8 that, and this again makes us go to 6 range, the average transmittance of which our patient equal 50,9, which corresponds to the "decision tree" 6 range >51,7 that, and this again makes us go to 2 range, the average transmittance of which our patient equal to 72.6, which corresponds to the "decision tree" 2 range > 79,7 that, and this already gives us the right to confirm in this patient diagnosed with chronic decompensated tonsillitis form and recommend surgery (tonsillectomy). Thus, in this particular patient, using the logic developed decision rules using the proposed "decision tree"to confirm this diagnosis were used, the average transmittance of infrared radiation already in four ranges (3, 1, 6 and 2) of the 6 investigated.

Thus, the practical doctor, putting Kleene what if the patient is diagnosed with chronic tonsillitis and additionally examining saliva on the device-analyzer "ICARUS", with 6 ranges data average transmittance of infrared radiation, we have developed and graphically presents the scheme of a "decision tree" differentiates offset from decompensated forms of chronic tonsillitis.

The method of differential diagnosis of compensated and decompensated forms of chronic tonsillitis research saliva, characterized in that in patients with clinically diagnosed chronic tonsillitis spend infrared spectroscopy saliva, determine average values of the transmittance of infrared radiation in the range 3085-2832 cm-1, 2120-1880 cm-1, 1600-1535 cm-1, 1543-1425 cm-1, 1430-1210 cm-1, 1127-1057 cm-1and if the value of the average in the range 1600-1535 cm-1more 35,9, in the range 1543-1425 cm-1more 57.9, in the range 1430-1210 cm-1less 54,5, diagnosed with compensated chronic tonsillitis, if the value of the average transmittance in the range 1600-1535 cm-1less 32,5 and in the range 1543-1425 cm-1less 65,2, diagnosed with compensated chronic tonsillitis, if the value of the average in the range 1600-1535 cm-1less 35,9 and in the range 3085-2832 cm-1more 72,8, diagnosed with compensated chronic tonsillitis, if you meant the e average transmittance in the range 1600-1535 cm -1less 35,9 and in the range 1127-1057 cm-1more 51,7, diagnosed with compensated chronic tonsillitis, if the value of the average transmittance in the range 1600-1535 cm-1less 35,9 and in the range 2120-1880 cm-1more 79,7, diagnosed with compensated chronic tonsillitis, and if the value of the average transmittance in the range 1600-1535 cm-1less 35,9 and in the range 2120-1880 less 79,7, diagnosed with decompensated chronic tonsillitis



 

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