Method for differential diagnostics of exacerbation and remission in case of gastroduodenal diseases in children

FIELD: medicine, gastroenterology.

SUBSTANCE: one should study saliva of a sick child to detect the content of uric acid and at its value being 118.8 mcM/l and higher one should diagnose disease exacerbation and at 117.5 mcM/l and lower - remission. The innovation provides simplicity, atraumaticity and availability of diagnostics in pediatric practice.

EFFECT: higher accuracy and efficiency of diagnostics.

2 ex, 2 tbl

 

The invention relates to medicine, namely to a gastroenterologist, and can be used in General medical practice for the diagnosis of exacerbation or remission of gastroduodenal diseases in children.

The most informative is the way endoscopic examination with biopsy, which gives the opportunity to assess the function and structure of the gastroduodenal zone (Aijalon and other Modern instrumental methods in a comprehensive survey of the gastroduodenal mucosa in children. Methodical recommendations. Gorky. 1981).

However, this diagnostic method is quite complicated from the point of view of the need for special, expensive equipment, skilled endoscopist and morphologist. In addition, this method is fraught with the risk of complications and traumatic.

Known methods of laboratory diagnostics of phase gastroduodenal diseases: to increase the concentration of histamine in the basal portion of the gastric juice (Method for the diagnosis of acute peptic ulcer of the duodenum. Auth. mon. No. 1264410 from 23.10.86. Komarova L.G. and others). However, this method requires catheterization, which is traumatic for a child. And, in addition, the research methods of histamine in any biological fluid time-consuming.

For prettyprinting of the invention selected laboratory method of differential diagnosis of exacerbation and remission of gastroduodenal diseases, including biochemical analysis of saliva (Lghmev, Iaineiiia, Lowmortality "Method of differential diagnosis of exacerbation and remission of gastroduodenal diseases. Certificate No. 1262380, registered in the State register 16.10.85 year).

This method consists in the fact that the presence of exacerbation or remission of gastroduodenal disease is judged by the ratio of content in the saliva of ATP and pyruvic acids, taken as a percentage of norms, and thus the index below 0.5 diagnose aggravation, and above 0.5 to remission of the disease. The method is noninvasive, allows a high degree of accuracy make the diagnosis.

However, the known method requires two methods, which is associated with a high consumption of reagents, availability of special equipment and a large expenditure of time (5-6 hours).

The aim of the invention is to simplify the method by defining a single metric in the same biological environment - the saliva.

This goal is achieved by the fact that in the proposed method, including biochemical analysis of saliva, determine the content of uric acid in the saliva and when it is 118 µmol/l and above diagnosed with exacerbation of gastroduodenal diseases, and lower remission.

New in the way research is the Finance of uric acid in saliva, as previously identified in other biological environments and for other purposes.

So, it is known involvement of uric acid in the Genesis of hypertension, chronic kidney disease and other Purines in the body are polyfunctional compounds possessing the ability to adjust the ratio between the activity of the sympathetic and parasympathetic nervous system and imbalance of these systems can lead to a number of diseases, including gastrointestinal tract (Yearold, Iavow, Vigiano and other Pediatrics 1995, No. 3, s-84).

Determination of uric acid in the saliva is necessary and sufficient for a diagnosis of exacerbation or remission of gastroduodenal diseases in children.

The efficiency of the method is proved by the following facts:

A survey of 58 children with gastroduodenal diseases. 31 of them with aggravation and 27 - remission of the pathological process. In saliva was determined by the content of uric acid, the value of which changes during the acute phase in the range of 118.8-635,3 µmol/l and in the remission phase 15,8-117,5 µmol/L.

td align="center" namest="c1" nameend="c2"> 3. S.
Table 1

The concentration of uric acid in the saliva (µmol/l)
Group childrenThe concentration of uric acid
Gastroduodenal diseasesExacerbation

The limits of oscillation
reach 232.5+18,8 (n=31) p<0,001

118,8-635,3
Remission

The limits of oscillation
60,2+5,65 (n=27)

15,8-117,5
Table 2

The range of fluctuations of the concentration of uric acid in the saliva with gastroduodenal disease in children
No.The acute phaseNo.In the phase of remission
Last nameUric acid, mmol/lLast nameUric acid, mmol/l
1Patient B.145,61Patient A.of 21.2
2Century225,02B.32,9
3Century566,13Century47,7
4E.176,54Century117,5
5271,45G108,0
6I.206,06D.39,0
7I.165,07E.40,0
8K.180,38K.31,6
9K.142,19K.53,7
10K.405,010K.80,1
11K.190,811L.78,1
12L.316,412L.75,0
13L.118,813M80,0
14L.273,314M15,8
15L. 220,015M65,9
16L.184,416M47,4
17M210,017N.37,5
18M281,318N.49,0
19M255,819N.40,8
20N.305,020O.31,3
21N.247,021R.28,0
22O.139,222R.88,0
23P.164,023S.63,2
24R.188,024S.50,0
25S.252,62524,0
26S.635,326F.40,0
27S.158,327W.112,0
28S.169,0
29S.375,0
30S.187,5
31S.252,6

The diagnosis verified data gastrofibroskopija and PH-metry gastric juice.

It is established that all children with the content in the saliva of uric acid above 118,8 had exacerbation of the disease, whereas in children with a level of analyte below this value was diagnosed remission.

The method is as follows: in the morning on an empty stomach collect saliva by Slavyane in the centrifuge tube. Then the saliva is centrifuged 10 minutes at 3000 rpm/min

The principle of the method.

p> Uric acid restores phosphonoformate reagent with the formation of blue color, optical density at 640 nm is proportional to the concentration of uric acid in serum.

Part of a set.

1. Sodium wolframates, two-water, 5 g - 1 vial;

2. Sodium carbonate, 20.6 g - 1 packaging;

3. Posterolaterally reagent, 100 ml - 1 vial;

4. The main calibration raster uric acid, 6 mmol/l, 3 ml 1 vial.

Auxiliary reagents.

Sulfuric acid, concentrated (96%), reagent-grade - 1 ml.

The kit not included.

Equipment.

Spectrophotometer or photoelectrocolorimeter, centrifuge.

Sample.

Saliva diluted with distilled water 10 times.

Preparation of working solutions.

1. The sulfuric acid solution 0.35 mol/liter In a volumetric flask with a capacity of 50 ml pour 20 ml of distilled water, 1.0 ml of concentrated sulfuric acid and the volume was adjusted to the mark with water. The solution is stable.

2. A solution of sodium wolframalpha. The contents of the vial with sodium wolframates quantitatively transferred into a volumetric flask with a capacity of 50 ml and add distilled water to the mark. The solution is stable.

3. A solution of sodium carbonate. Package contents with sodium carbonate quantitatively transferred into a volumetric flask with a capacity of 200 ml, dissolved in distiller the bath water, and the volume was adjusted to the mark with water. The solution is stable.

4. Working calibration solution of uric acid. Measure exactly 1.0 ml of the primary calibration solution of uric acid, transferred to a volumetric flask with a capacity of 200 ml and the volume was adjusted with distilled water to the mark. The solution is stable for 2 weeks when stored at a temperature of 4-8°C. the resulting solution containing 30 mmol/l uric acid.

The course definition.

In centrifuge test tube add:

Blank test, mlThe calibration sample, mlExperienced sample, ml
Distilled water--4,0
Biological fluid--0,50
Mix
The sulfuric acid solution 0.35 mol/l--0,25
A solution of sodium wolframalpha--0,25
Mix thoroughly, inverting the tube and after 5 minutes, centrifuged 10 minutes at 3000 rpm/min
The supernatant -2,00
Working calibration solution uric acid-2,00-
Distilled water2,00--
Raster sodium carbonate1,001,001,00
Phosphonoformate reagent0,500,500,50
Mix thoroughly, inverting the tube and after 5 minutes, centrifuged 10 minutes at 3000 rpm/min

After 30 minutes, determine extensio at 640 (580-700) nm at a red optical filter of the FEC. Content calculations carried out by the formula

(Μmol/l)=Tu/Eat×CST×10, where

Tu - extenze experimental sample against blank sample;

Eats - extenze calibration sample against blank sample;

CST - concentration of the working calibration solution, 30 µmol/l;

10 - recalculation per diluted saliva.

Determine the content of uric acid in the saliva of the patient and when the content of its 118,8 and above diagnosed with exacerbation of gastroduodenal diseases, and when the value is below this figure - remission.

Clinical examples of execution of the method.

Example 1.

Patient Lebedeva Olga, 10 years. East is Riya disease No. 1136/1995, Was hospitalized in the Institute of pediatric gastroenterology with a diagnosis of peptic ulcer 12 duodenal ulcer in acute phase, chronic gastroduodenitis in the acute phase. When receiving a survey of uric acid in the saliva. As a result, the concentration of uric acid was 118,8 µmol/L. When you research the level of uric acid was varied to 211,6; 316,4; 331,6 µmol/L. All this testified to the exacerbation of the pathological process. Subsequent gastrofibroskopija examination confirmed the diagnosis and showed marked signs of deterioration. During treatment, remission was achieved. The concentration of uric acid decreased to 110.0 mmol/l, followed by improving the conventional laboratory parameters, including gastrofibroscope.

Example 2.

Sergei Voropaev, 12 years. Case history No. 674/1995, Arrived in Nizhny Novgorod research Institute of pediatric gastroenterology with a diagnosis of peptic ulcer 12 duodenal ulcer, chronic gastroduodenitis in remission. Upon receipt estimation of uric acid in the saliva. Value corresponded 117,5 µmol/l, indicating a phase of remission. These gastrofibroskopija (the mucosa of the stomach pale pink color, giperplazirovanne, the pylorus is closed, the bulb 12 duodenal ulcer is not deformed, the figure of the mucous maintain the Yong) confirmed the diagnosis.

The use of the proposed method for differential diagnosis of exacerbation and remission of gastroduodenal diseases in comparison with the known leads to a positive effect, which is expressed in the simplification and the reduction of time, possible traumas and availability of the object of research. The method further can be used to dynamically monitor the effectiveness of treatment.

The proposed method is especially valuable in pediatric practice as harmless, simple, and available to use in any conditions.

The method of differential diagnosis of exacerbation and remission of gastroduodenal diseases in children, including biochemical analysis of saliva, characterized in that the saliva determine the content of uric acid and when the value of 118.8 mmol/l and above diagnosed with exacerbation and when 117,5 µmol/l and below - the remission of gastroduodenal diseases.



 

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