Method for diagnosing porto-portal and porto-central hepatic fibrosis

FIELD: medicine.

SUBSTANCE: method involves determining pulsating arterial blood flow parameters. To do it, measuring electrodes are applied in main liver body mass location zone. Electrode-to-electrode distance is additionally measured and hepatic index is calculated from formula HI=ρ*L2*Ad*ET*HBR/Z2*1000*S, where HI is the hepatic index (l/min/m2), ρ is the constant reflecting volume blood resistance (150 Ohm cm), L is electrode-to-electrode distance (cm), Z is the base impedance (Ohm), Ad is the differential rheogram amplitude (Ohm/s), ET is blood expulsion time (s), HBR is heart beat rate per 1 min, S is the body surface (m2), 1000 is the coefficient for converting to liters. HI value being greater than 0.225 l/min/m2, porto-portal and/or porto-central hepatic fibrosis is diagnosed.

EFFECT: wide range of functional applications.

2 tbl

 

The invention relates to medicine, namely to a gastroenterologist, and can be used for impedance metric diagnosis portaportal and orthocentrinae liver fibrosis.

Known morphological method of determining portaportal and orthocentrinae liver fibrosis assessed by semiquantitative R.G.Knodell (1981) histological index of fibrosis score of 3 [Serov V.V. Comparative morphological characteristics of chronic viral hepatitis b and C//ROS. Journe. Gastroenterol., gepatol., coloproctol. - 1999. No. 1. - P.36-40].

The lack of morphological method is its invasiveness, the trauma to the patient, the greater likelihood of complications such as bleeding, biliary peritonitis and the impossibility of obtaining reproducible results with repeated testing.

There is another way to diagnose portaportal and orthocentrinae liver fibrosis by counting the number of points on the classification of the counting scale M That using 3 parameters: platelet count, prothrombin time and the ratio of activity of Alat/ASAT. Patients with a score of 7 or more are diagnosed with fibrosis 3-4 points, i.e. portaportal and partienlarly liver fibrosis or suggest cirrhosis [usuk N, Znoiko OO, Safiullina NH, Kelly H. Puncture ipsia liver and the possibility of non-invasive monitoring of fibrosis in chronic viral hepatitis C//Klin. prospects Gastroenterol., gepatol. - 2002. No. 1. - P.9-16].

The disadvantages of the method include invasiveness, for example, the sampling of venous blood for testing.

The invention is directed to solving tasks: development of non-invasive way to diagnose portaportal and orthocentrinae liver fibrosis with high precision.

This object is achieved in that the examined impersonations determine the pulsating arterial blood flow, which impose the measuring electrodes in the area of the main body of the liver, additionally measured interelectrode distance and calculate the hepatic index (PI) according to the standard formula tetrapolar research:

PI=ρ·L2·Ad·Ti·HR/Z2·S·1000, where

PI - hepatic index (l/min/m2),

ρ - constant, reflecting the volume resistivity of the blood - 150 Ohm·cm

L is the interelectrode distance (cm)

Z - base impedance (Ohms),

Ad - amplitude differential rogramme (Ω/s)

T - the time of the expulsion of blood (sec),

Heart rate - the number of heartbeats per minute

S - body surface area (m2),

1000 - the value to be translated in liters and with the value of PI more 0,225 l/min/m2diagnose portaportal and/or partienlarly liver fibrosis.

The method is realized trail is accordingly.

Surveyed impose dot electrodes for registration of rogramme on the body area, in the projection which is the bulk of the liver, namely: on the anterior axillary line on the right on the upper and lower edge of liver dullness determined using the conventional method, percussion and connect them to the input of realtystore (for example, RPG 2-02), which provides the basic measurement of the impedance of the examined part of the body. Define an interelectrode distance L in cm include impedance metric device and its scale baseline impedance in Ohms.

According to the above formula in accordance with the values ρ, L, Z, Ad, Ti, HR and S are PI target and when it is more 0,225 l/min/m2diagnose portaportal and/or partienlarly liver fibrosis.

Examples of specific implementation method.

Example 1.

Patient Vlasov YEAR, 46 years old.

Diagnosis: Cholelithiasis. Chronic calculous cholecystitis. Chronic hepatitis minimal activity. Chronic pancreatitis.

The diagnosis is confirmed by laboratory and instrumental methods of examination. According to morphological studies of liver histology activity index process in the liver on a scale R.G.Knodell (1981) is equal to 3 points, which corresponds to chronic hepatitis minimum degree Akti is ness. Fibrosis of the liver parenchyma was missing that on a scale of stages of fibrosis (R.G.Knodell 1981) match 0 points.

Defined PI as follows: measured growth 156 cm, weight 70 kg, put the point electrodes on the body area corresponding to the main body of the liver, then put the patient on the couch. The electrodes are connected to the input of polyreactive included system monitoring of policeacademy and display said measured baseline impedance (Z) in the region of the body corresponding to the main body of the liver. In subjects he was 10,43 Ohms. When appropriate, the patient values ρ=150 Ohms·cm, L=8 cm, Ad=0.1 Ohm/sec, T=0,32 sec, HR=74 min, S=1,69 m2according to the formula defined PI, which was 0,123 l/min/m2.

PI=150·82·0,1·0,32·74/10,432·1000·1,69=0,123

The value of PI equal to 0,123 l/min/m2that is less than the threshold figures 0,225 l/min/m2so the conclusion: portaportal and/or orthocentrinae liver fibrosis is not.

Example 2. Patient Tugolukov there O.N., 29.

Diagnosis: Cholelithiasis. Chronic calculous cholecystitis. Chronic hepatitis mild activity.

The diagnosis is confirmed by laboratory and instrumental methods of examination. According to morphological studies of liver histology activity index is the process in the liver on a scale R.G.Knodell (1981) is equal to 2 points, that corresponds to a chronic hepatitis minimal activity. Fibrous strands into a slice with a violation of an edge of the plate, forming portaportal septa in liver tissue, which on a scale of stages of fibrosis (R.G.Knodell, 1981) corresponds to 3 points.

The patient has determined is necessary to calculate the data: height - 157 cm, weight 75 kg, ρ=150 Ohms·cm, L=8 cm, Ad=0.1 Ohm·s, T=0,28 sec, HR=70,5 in minutes Imposition of electrodes and the definition of the base impedance was performed similarly to the program of example 1. Baseline impedance (Z) 5,09 Ohms.

When these calculated data PI was 0,399 l/min/m2.

PI=150·82·0,1·0,28·70,5/5,092·1000·1,75=0,399

The value of PI equal to 0,398 l/min/m2more threshold numbers 0,225 l/min/m2so the conclusion: portaportal liver fibrosis.

Example 3. Patient Konareva YEAR, 58 y.o.

Diagnosis: Cholelithiasis. Chronic calculous cholecystitis. The Vater papilla stenosis of 1 degree. Latent cholangitis. Liver failure. Chronic hepatitis severe activity.

The diagnosis is confirmed by laboratory and instrumental methods of examination. According to morphological studies of liver histology activity index process in the liver on a scale R.G.Knodell (1981) is equal to 14 points, which corresponds to the chronic is hepatitis severe activity. Fibrous strands into a slice with a violation of an edge of the plate, forming portaportal and orthocentrinae septa in liver tissue, which on a scale of stages of fibrosis (R.G.Knodell, 1981) corresponds to 3 points.

The patient has determined is necessary to calculate the data: height of 145 cm, weight 51 kg, ρ=150 Ohms·cm, L=8 cm, Ad=0.1 Ohm/sec, T=0.30 s, HR=82,1 in minutes Imposition of electrodes and the definition of the base impedance was performed similarly to the program of example 1. Baseline impedance (Z) was 3.59 Ohms. When these calculated data PI was 1,237 l/min/m2.

PI=150·82·0,1·0,30·82,1/3,592·1000·1,4=1,237

The value of PI equal 1,237 l/min/m2more threshold numbers 0,225 l/min/m2so the conclusion: portaportal and partienlarly liver fibrosis.

A comparison of indicators PI in the absence or presence of portal fibrosis (0 or 1 score Knodell, 1981) in 15 patients with different histology activity index hepatitis and 16 patients with histology activity index hepatitis from 1 to 14 points, which according to morphological studies has portaportal and/or partienlarly liver fibrosis (3 points on Knodell, 1981). The results are presented in tables 1 and 2.

45
Table 1

Show is whether the hepatic index certain impedance metric method in patients with no (0 points) or presence of portal fibrosis of the liver (1 point)
No.Last nameAgeThe degree of fibrosis in pointsPI (l/min/m2)
1Shestakov3310,054
2Istomin6810,069
3Bogomjakov3610,095
4Boyarshinov4110,098
5Smooth3900,098
6Mosyagina421is 0.102
7Naumov6110,106
8Vlasov4600,123
9Lobzhanidze4110,142
10Levin4310,147
11Korotaev4810,173
12Shamanov10,193
13Volkova2110,204
14Blinova1710,214
15Pihteeva6310,225
M0,860,136
±m0,090,014

0,372
Table 2

Indicators of hepatic index defined impedance metric methods in patients with portaportal and/or portcontroller fibrosis
No.Last nameAgeThe degree of fibrosis in pointsPI (l/min/m2)
1Bushmakin6130,228
2Moseychuk5430,307
3Zueva7330,352
4Pepelyaev6230,355
5Vyatkina703
6Tugolukov there2930,399
7Pickova7230,442
8Bodansky6230,433
9Mineeva4530,445
10Wonder4530,481
11Belisheva3830,516
12Plasmawave2730,516
13Verkhotina3630,636
14Vlasov7130,675
15Makarova7030,813
16Konareva5831,237
M3,00,513
±m0,00,061

In patients without liver fibrosis (0 points) or portal fibrosis (1 point) the value of PI was in before the crystals from 0,058 to 0,225 l/min/m 2. In patients with portaportal and partienlarly fibrosis (3 points) the value of PI was within 0,228 to 1,237 l/min/m2. In patients without liver fibrosis or portal fibrosis average value of PI was 0,136±of 0.014 l/min/m2that is significantly less (ρ<0,001)than in patients with portaportal and partienlarly fibrosis (0,513±0,061 l/min/m2), with morphologically confirmed invasive examination of the liver taken as a control.

Method of statistical analysis determined the optimal diagnostic threshold, which amounted to PI 0,225 l/min/m2.

Advantages of the proposed method are its sensitivity due to the exact threshold numbers, the ability to re-research, non-invasive, high performance, simplification of the study due to the lack of regulated modes of treatment of liver biopsy specimens, low cost, as it eliminates the need to use expensive reagents and equipment to establish a pathological diagnosis.

The way to diagnose portaportal and orthocentrinae liver fibrosis, characterized in that the examined determine the pulsating arterial blood flow, which impose the measuring electrodes in the zone of location of the primary array p is Chaney, additionally measure the interelectrode distance and size of the body of the subject, I hope hepatic index (PI) according to the formula

PI=ρ·L2·Ad·Ti·HR/Z2·1000·S,

where PI - liver index, l/min/m2;

ρ - constant, reflecting the volume resistivity of the blood - 150 Ohm·cm

L is the interelectrode distance, cm

Z - base impedance, Ohm,

Ad - amplitude differential rogramme, Ω/s,

T - the time of the expulsion of blood,

Heart rate - the number of heartbeats, min,

S - size of the body, m2,

1000 - indicator for transfer to liters

and when the value of PI more 0,225 l/min /m2diagnose portaportal and/or partienlarly liver fibrosis.



 

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FIELD: medicine, surgery.

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EFFECT: higher accuracy of evaluation.

1 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves recording peripheral differential upper extremity blood vessel rheogram and phonocardiogram in synchronous way. The second phonocardiogram beginning and the deepest rheogram points are detected. Pulse way propagation time reduction being found, arterial bloodstream tone growth conclusions are drawn.

EFFECT: high reliability of the results.

18 dwg, 3 tbl

FIELD: medicine, neurology.

SUBSTANCE: a patient should be in initial position when his/her sight is directed towards the ceiling and in 3-5 min it is necessary to register a background rheoencephalogram, then a patient should fix the sight at a pointer's tip being at the distance of about 30 cm against the bridge of nose along the middle line, then the sight should be directed into marginal position due to shifting pointer to the left. Then the sight should be returned into initial position and 3 min later it is necessary to register rheoencephalogram of vertebro-basilar circulation, calculate rheographic index (RI), coefficient for RI ratio on returning the sight from left-hand marginal position into initial one (k2) and at k2>1.098 from the left and (or) k2>1.085 from the right one should detect alteration in vertebro-basilar circulation by reflector mechanism. The method excludes biomechanical impact in stimulating proprioceptive receptors of muscular-ligamentous system under stretching.

EFFECT: higher accuracy and reliability of detection.

2 ex, 2 tbl

FIELD: medicine, resuscitation.

SUBSTANCE: one should detect cerebral perfusion pressure (CPP), intracranial pressure (ICP), values for blood saturation with oxygen in radial artery and jugular vein bulb (SaO2, SjO2), additionally one should study lactate level in jugular vein bulb and radial artery, calculate venous-arterial difference according to lactate (▵lactate), cardiac ejection (CE) due to thermodilution and hemoglobin level. Values for cerebral oxygen transport function should be calculated by the following formulas: mĎO2 = 0.15 x CE x CaO2 x 10; mVO2 = 015 x CE x (CaO2 - CjO2) x 10; CaO2 = 1.3 x Hb x SaO2; CjO2 = 1.3 x Hb x SjO2. In case of noninvasive detection - due to pulsoxymetry one should measure peripheral saturation (SpO2), due to parainfrared spectroscopy - cerebral oxygenation (rSO2) and cardiac ejection due to tetrapolar rheovasography (CEr), detect and calculate the values of cerebral oxygen transport system according to the following formulas: mĎO2 = 0.15 x CEr x CaO2 x 10; mVO2 = 0.15 x CEr x (CaO2 - CjO2) x 10; CaO2 = 1.3 x Hb x SpO2; CjO2 = 1.3 x Hb x rSO2. At the value of mĎO2 86-186 ml/min and more, MVO2 33 - 73 ml/min, ▵lactate below 0.4 mM/l one should evaluate cerebral oxygen transport system to be normal and the absence of cerebral metabolic disorders. At mĎO2 values below 86 ml/min, mVO2 being 33-73 ml/minO2, ▵lactate below 0.4 mM/l one should state upon compensated cerebral oxygen transport system and the absence of metabolic disorders. At mĎO2 being below 86 ml/min, mVO2 below 33 mM/l, ▵lactate below 0.4 mM/l one should conclude upon cerebral oxygen transport system to be subcompensated at decreased metabolism. At the values of mĎO2 being 86-186 ml/min and more, MVO2 below 33 ml/min, ▵lactate below 0.4 mM/l one should establish subcompensated cerebral oxygen transport system at decreased metabolism. At values of lactate being above 0.4 mM/l and any values of mĎO2 and mVO2 one should point out the state of decompensation in cerebral oxygen transport system and its metabolism. The innovation enables to diagnose disorders and decrease the risk for the development of secondary complications.

EFFECT: higher efficiency and accuracy of evaluation.

1 cl, 3 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves setting a patient in vertical posture with stabilogram and rheoencephalogram being concurrently recorded with frontomastoid and accipitomastoid leads being used retaining head position with stressed neck extensor muscles state and head position with relaxed neck extensor muscles state. Stabilogram parameters characterizing vertical posture stability and rheographic index of each of four brain basins. When combining better filling of cerebral basins with blood and higher standing stability, training is carried out in keeping head positions allowing better filling of cerebral basins. If better filling of cerebral basins with blood follows with no increased standing stability, the trainings are carried out in keeping head position with stressed neck extensor muscles state. The training sessions are given twice a day for 15 min during two weeks.

EFFECT: enhanced effectiveness of treatment.

2 cl, 3 tbl

FIELD: medicine.

SUBSTANCE: method involves determining pulsating arterial blood flow parameters. To do it, measuring electrodes are applied in main liver body mass location zone. Electrode-to-electrode distance is additionally measured and hepatic index is calculated from formula HI=ρ*L2*Ad*ET*HBR/Z2*1000*S, where HI is the hepatic index (l/min/m2), ρ is the constant reflecting volume blood resistance (150 Ohm cm), L is electrode-to-electrode distance (cm), Z is the base impedance (Ohm), Ad is the differential rheogram amplitude (Ohm/s), ET is blood expulsion time (s), HBR is heart beat rate per 1 min, S is the body surface (m2), 1000 is the coefficient for converting to liters. HI value being greater than 0.225 l/min/m2, porto-portal and/or porto-central hepatic fibrosis is diagnosed.

EFFECT: wide range of functional applications.

2 tbl

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