Method for differential diagnostics of toxic encephalopathy against the impact of the complex of toxic substances and disculatory (vascular) encephalopathy

FIELD: medicine, neurology, professional pathology.

SUBSTANCE: one should carry out either biochemical blood testing and electroencephalography or SMIL test, or ultrasound dopplerography of the main cranial arteries, rheoencephalography (REG) to detect the volume of cerebral circulation and hypercapnic loading and their digital values. Then it is necessary to calculate diagnostic coefficients F by the following formulas: Fb/e=6.3-0.16·a1+0.12·a2-1·a3+0.2·a4, or FSMIL=9.6+0.16·a5-0.11·a6-0.14·a7+0.07·a8, or Fhem=48.6-0.04·a9+0.15·a10+13.7·a11-0.02·a12+24.7·a13, where Fb/e -diagnostic coefficient for biochemical blood testings and EEG; FSMIL - diagnostic coefficient for SMIL test; Fhem - diagnostic coefficient for hemodynamic testing; 6.3; 9.6 and 48.6 - constants; a1 - the level of vitamin C in blood; a2 - δ-index by EEG; a3 - atherogenicity index; a4 - the level of α-proteides in blood; a5 - scale 3 value by SMIL; a6 - scale K value by SMIL; a7 - scale 5 value by SMIL; a8 - scale 7 value by SMIL; a9 - the level of volumetric cerebral circulation; a10 - the value of linear circulatory rate along total carotid artery, a11 - the value of resistive index along total carotid artery; a12 - the value for the tonicity of cerebral vessels at carrying out hypercapnic sampling by REG; a13 - the value for the intensity of cerebral circulation in frontal-mastoid deviation by REG. At F value being above the constant one should diagnose toxic encephalopathy, at F value being below the constant - discirculatory encephalopathy due to applying informative values.

EFFECT: higher accuracy of diagnostics.

6 ex, 1 tbl

 

The present invention relates to the field of medicine, namely, neurology and occupational pathology, and can be used for differential diagnosis of toxic and dyscirculatory encephalopathy.

So far not developed accurate methods for differential diagnosis of toxic encephalopathy and dyscirculatory encephalopathy. There are methods of differential diagnosis of toxic encephalopathy, including clinical neurological examination, ultrasound dopplerography (USDG) main arteries of the head, electroencephalography, rheoencephalography not (REG), a psychological study of the emotional-volitional and mnestic-intellectual spheres, biochemical study of the processes of lipid metabolism [3, 4]. However, these techniques are not high enough accuracy for the differential diagnosis of toxic encephalopathy at the fire and dyscirculatory encephalopathy.

The objective of the invention is the most accurate differential diagnosis toxic and dyscirculatory encephalopathy.

The problem is solved by holding the patient biochemical blood tests and electroencephalography, or test SMIL, or ultrasonic dopplerography of the main arteries of the head and rheoencephalography with the definition of the volume of the mA of cerebral blood flow and holding hypercapnic load and calculated diagnostic factor F for specific methods of examination, by the formulas:

Fb/e=6,3-0,16·a1+0,12·A2-1·A3+0,2·A4,

or FSMIL=9,6+0,16·a5-0,11·A6-0,14·A7+0,07·a8

or Fheme=48,6-0,04·A9+0,15·a10+13,7·a11-0,02·a12+24,7·a13

where Fb/ediagnostic factor for biochemical studies of blood and EEG;

FSMILdiagnostic factor for the test SMIL;

Fhemediagnostic factor for hemodynamic studies of the brain when performing USDG and REG;

6,3; 9.6 48.6 per - constant;

digital indicators are discriminatory factors,

a1,2...13 - numeric values surveys (a1 - levels of vitamin C in the blood, A2 - δ-index as EEG, A3 - atherogenic index, A4 - level α-lipoproteins in the blood; a5 is an indicator of the scale 3 on SMIL, A6 - indicator scale To SMIL, A7 - indicator scale 5 SMIL, A8 - indicator scale 7 on SMIL; A9 - level volumetric cerebral blood flow, a10 - value of the linear velocity of blood flow in the common carotid artery, a11 - the value of resistive index in the common carotid artery in USDG, a12 - indicator tone of cerebral vessels when conducting hypercapnic samples on the REG, a13 - intensity value of cerebral blood flow in fronto-mastoidal lead on REG);

and when the value of F more constants diagnose toxic ence is halopathy, when the value of F is less than the constant - dyscirculatory encephalopathy.

Comparative analysis of the proposed solutions to the prototype [2] shows that the proposed method differs in that the diagnostic expect the coefficients of F on the proposed formulas. The resulting value is compared with a constant, when the value of F more const diagnosed with toxic encephalopathy, when the value of F is less than const - dyscirculatory encephalopathy. In addition, unlike the prototype of our system is focused on an objective clinical, physiological and biochemical parameters, so the results of differential diagnosis does not depend on the competence of physicians in the area of occupational pathology. Thus, the proposed solution meets the criteria of the invention of "novelty."

The analysis of patent and literature the authors found that the proposed solution has features that distinguish it not only from the prototype, but also on other technical solutions in this and related fields. There are a predictor of ischemic stroke in patients with dyscirculatory encephalopathy hypertensive Genesis performed using the discriminant equation, where informative signs are risk factors [5]. The method of differential diagnosis of toxic the tion and dyscirculatory encephalopathy, including differential diagnosis of toxic encephalopathy in the set of proposed indicators, available literature is not revealed. Offer options allow you to differentiate toxic encephalopathy at the fire with a high degree of accuracy (85.7 percent). Thus, the proposed method meets the criterion of "inventive step".

The developed method is simple to use and can be used by doctors in polyclinics and hospitals that meets the criterion of "industrial applicability".

The method is as follows.

The patient or biochemical blood analysis (determination of vitamin C in the blood, α-lipoproteins and atherogenic index) and electroencephalography, or test SMIL, or ultrasonic dopplerography of the main arteries of the head, rheoencephalography not with determining the amount of cerebral blood flow and hypercapnic load, and determine their values.

Then calculate diagnostic factors F by the formulas:

Fb/e=6,3-0,16·a1+0,12·A2-1·A3+0,2·A4,

FSMIL=9,6+0,16·A5-0,11·A6-0,14·A7+0,07·a8

Fheme=48,6-0,04·A9+0,15·a10+13,7·a11-0,02·a12+24,7·a13

where Fb/ediagnostic factor for biochemical studies of blood and EEG;

FSMILdi is the Gnostic coefficient for the test SMIL;

Fhemediagnostic factor for hemodynamic studies of the brain when performing USDG and REG;

6,3; 9.6 48.6 per - Constanta;

digital indicators are discriminatory factors;

a1,2...13 - numeric values surveys (a1 - levels of vitamin C in the blood, A2 - δ-index as EEG, A3 - atherogenic index, A4 - level α-lipoproteins in the blood; a5 is an indicator of the scale 3 on SMIL, A6 - indicator scale To SMIL, A7 - indicator scale 5 SMIL, a8 - indicator scale 7 on SMIL; A9 - level volumetric cerebral blood flow, a10 - value of the linear velocity of blood flow in the common carotid artery, a11 - the value of resistive index in the common carotid artery in USDG, a12 - indicator tone of cerebral vessels when conducting hypercapnic samples on the REG, a13 - intensity value of cerebral blood flow in fronto-mastoidal lead on REG);

when the value of F more constants diagnosed with toxic encephalopathy, when the value of F is less than the constant - dyscirculatory encephalopathy.

Diagnostic ratios Fb/e; FSMILand Fhemeobtained by subtracting the discriminators toxic and dyscirculatory encephalopathy for sootvetstvujushij performance (F1B/e-F2B/e; FSMIL-FSMILand FGem-FHe the ):

F1B/e=- 17, 3C+0,14·a1+0,22·A2+2,1·A3+0,6·A4

F2B/e=-23,6+0,3·a1+0,1·A2+3,1·A3+0,4·A4

FSMIL=-39,6+0,5·A5+0,3·A6+0,4·A7+0,2·a8

FSMIL=-49,2+0,34·A5+0,41·A6+0,54·A7+0,13·a8

FGem=-331,8+0,74·A9+0,88·a10+99,0·a11+0,12·a12+95,0·a13

FGem=-380,4+0,78·A9+0,73·a10+85,3·a11+0,14·a12+70,3·a13

Discriminant analysis was conducted in the group of patients with dyscirculatory and toxic encephalopathy. Patients with toxic encephalopathy were firefighters exposed to complex toxic substances (vinyl chloride, sulfur dioxide, hydrogen fluoride, dioxins, furans, carbon monoxide and other toxic gases) [1]. The reliability of the received informative parameters in the discriminant analysis are presented in table 1.

Table 1

Informative indicators discriminant analysis of patients with toxic and dyscirculatory encephalopathy
No.IndicatorsF enablep
a1The content of vitamin C in the blood (μm/l)13,50,0007
A2Delta index on EEG (%) 9,60,003
A3The atherogenic index (units)7,80,008
A4Content α-lipoproteins in the blood (%)6,50,014
A5The volume of cerebral blood flow by REG (ml/min)42,40,000000
A6LCS in GSM (cm/s)16,90,00008
A7AIC WASPthe 13.40,0004
a8The tone of cerebral vessels in hypercapnic test (/A) (%) a 3.90,05
A9The intensity of the cerebral circulation (a) REG (Ohms)the 3.80,05
a10Figure 3 scale SMIL (T-scores)126,90,000000
a11The indicator scale in SMIL (T-scores)to 12.00,0008
a12Figure 5 scale SMIL (T-scores)6,60,011
a13Figure 7 scale SMIL (T-scores)the 5.70,018

Example 1.

Patient A., party fire suppression, conducted biochemical examination and EEG, identified by their numeric values:

a1 - the level of vitamin C in the blood is 29 μm/l;

A2 - is δ-index for EEG - 12%;

A3 - atherogenic index equal to 3.2;

A4 - level α-lipoproteins in the blood - 35%;

Fb/e=6,3-0,16·29+0,12·12-1·3,2+0,2·35=6,9

The resulting value of 6.9>6,3. Conclusion: A. patient is toxic encephalopathy.

Example 2.

Patient D., participated in the liquidation of numerous fires, conducted biochemical examination and EEG, identified by their numeric values:

a1 - the level of vitamin C in the blood is 32 μm/l;

A2 - is δ-index for EEG - 20%;

A3 - atherogenic index equal to 3.8;

A4 - level α-lipoproteins in the blood - 23%;

Fb/e=6,3-0,16·32+0,12·20-1·3,8+0,2·23=of 4.38

The resulting value of 4.38<6,3. Conclusion: the Patient suffers D. dyscirculatory encephalopathy.

Example 3.

Patient K. (fire) performed a psychological evaluation test SMIL and determined the numerical values of the test:

A5 - indicator dial 3 for SMIL equal to 75 points;

A6 - indicator scale To SMIL equal to 44 points;

A7 - indicator scale 5 on SMIL equal to 38 points;

a8 - indicator scale 7 on SMIL equal to 73 points;

FSMIL=9,6+0,16·5-0,11· 44-0,14·38+0,07·73=16,55

The resulting value 16,55>9,6. Conclusion: patient K. is toxic encephalopathy.

Example 4.

Patient R., party extinguish fires, performed a psychological evaluation test SMIL and determined the numerical values of the test:

A5 - indicator dial 3 for SMIL equal to 58 points;

A6 - indicator scale To SMIL equal to 35 points;

A7 - indicator scale 5 on SMIL equal to 62 points;

a8 - indicator scale 7 on SMIL equal to 41 points;

FSMIL=9,6+0,16·58-0,11·35-0,14·62+0,07·41=9,3

The resulting value of 9.3<a 9.6. Conclusion: the patient P. suffers dyscirculatory encephalopathy.

Example 5.

Patient K., party extinguish fires, held Doppler ultrasound of the extracranial vessels and rheoencephalography in fronto-mastoidal lead with hypercapnic stress and defined their numeric values:

A9 - level volume cerebral blood flow - 762 ml/min;

a10 - level linear velocity of blood flow in the common carotid artery - 35 cm/s;

a11 - value of resistive index in the common carotid artery in USDG=0,6;

A12 - indicator tone of cerebral vessels when conducting hypercapnic samples on REG=60;

a13 - intensity value of cerebral blood flow in fronto-mastoidal lead on REG=0,8;

Fheme=48,6-0,04·762+0,15·35+13,7·0,6-0,02· 60+24,7·0,8=50,15.

The resulting value 50,15>48,6. Conclusion: in a patient K. has a toxic encephalopathy.

Example 6.

Patient S., participated in the liquidation of fire, held Doppler ultrasound of the extracranial vessels and rheoencephalography in fronto-mastoidal lead with hypercapnic stress and defined their numeric values:

A9 - level volume cerebral blood flow - 720 ml/min;

a10 - level linear velocity of blood flow in the common carotid artery - 28 cm/s;

a11 - value of resistive index in the common carotid artery in USDG=0,68;

a12 - indicator tone of cerebral vessels when conducting hypercapnic samples on REG=70,3;

a13 - intensity value of cerebral blood flow in fronto-mastoidal lead on REG=0,5;

Fheme=48,6-0,04·720+0,15·28+13,7·0,68-0,02·70,3+24,7·0,5=44,25.

The resulting value 44,25<48,6. Conclusion: the Patient With. ill dyscirculatory encephalopathy.

The results of discriminant analysis on biochemical and electroencephalographic parameters obtained optimal combination of four; psychological - four; hemodynamic - five signs in which the diagnostic accuracy was maximum. Therefore, for the differential diagnosis of toxic and dyscirculatory encephalopathy we used 13 read the technical indicators, above.

Evaluation of the effectiveness of the proposed method for differential diagnosis was performed in the training and control samples. In the training set (32) correct recognition was 83,3% for patients with toxic encephalopathy and 86.8% of the patients with dyscirculatory encephalopathy (30 people). In the control sample of 30 patients with toxic and 30 with dyscirculatory encephalopathy, with proper recognition of 85.5% and 92%, respectively.

The proposed method enables you to differentiate toxic encephalopathy when using the minimum number of the most informative diagnostic indicators, thereby reducing the amount of paraclinical studies. Informed us diagnostic method focuses on objective clinical, physiological and biochemical parameters, therefore, the diagnostic results are not dependent on the competence of physicians in the area of occupational pathology and angioneurology.

Literature:

1. Benemansky V.V. Influence biaxinorderbiaxin compounds on the body working /VV Benemansky, I. Giblets // research Report No. 02990004196. Angarsk, 1999.

2. Clinic, diagnostics, treatment and rehabilitation in the long term professional neurotoxicity at the fire /VG Kolesov, G.M. Bodienkova, O.L. Lakhman: Method, d is mendacii. Angarsk, 2002. - 26 S.

3. Long-term effects of chronic occupational neurotoxicity / V.N. Dumkin, MN. Ryzhkov, LE of Milkov: Method. recommendation No. 10-11/29. - M.: the USSR Ministry of health, 1987. - 28 S.

4. Tarasova L.A. Occupational diseases with a primary lesion of the nervous system: hands-ve edited by Izmerov NF: Occupational disease. - M.: Medicine, 1996. - S-200.

5. Sprach CENTURIES encephalopathy. - Irkutsk, 1997. - Ñ.38.

The method of differential diagnosis of toxic encephalopathy from exposure to complex toxic substances and dyscirculatory encephalopathy, including biochemical, instrumental or psychological research, characterized in that the analysis use the following formula :

Fb/e=6,3-0,16·a1+0,12·A2-1·A3+0,2·A4,

where Fb/ediagnostic factor for biochemical studies of blood and EEG;

6,3 - constant;

0,16; 0,12; 1; 0,2 - discriminatory factors;

a1 - the level of vitamin C in the blood;

A2 - δ-index of the EEG;

A3 - atherogenic index;

A4 - level α-lipoproteins in the blood;

or FSMIL=9,6+0,16·A5-0,11·a6-0,14·A7+0,07·A8

where FSMILdiagnostic factor for the test SMIL;

9,6 - constant;

0,16; 0,11; 0,14; 0,07 - discrim the discriminatory factors;

A5 - indicator dial 3 for SMIL;

A6 - indicator scale To SMIL;

A7 - indicator scale 5 on SMIL;

A8 - indicator scale 7 on SMIL;

or Fheme=48,6-0,04·A9+0,15·a10+13,7·a11-0,02·A12+24,7·A13,

where Fhemediagnostic factor for hemodynamic studies of the brain when performing USDG and REG;

48,6 - constant;

0,04; 0,15; 13,7; 0,02; 24,7 - discriminatory factors;

A9 - level volumetric cerebral blood flow;

a10 - value of the linear velocity of blood flow in the common carotid artery;

a11 - value of resistive index in the common carotid artery on the USDG,

A12 - indicator tone of cerebral vessels when conducting hypercapnic standard REG;

A13 - intensity value of cerebral blood flow in fronto-mastoidal lead on REG;

and when the value of F more constants diagnosed with toxic encephalopathy, when the value of F is less than the constant - dyscirculatory encephalopathy.



 

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