Method for predicting scoliotic vertebral column deformity in children and adolescents suffering from oxalate nephropathy

FIELD: medicine.

SUBSTANCE: method involves carrying out X-ray examination of the vertebral column and determining CrossLaps content in blood, oxalate calcium crystals available in urine and urine density. man. The value being equal to or less than 45%, external genital endometriosis diagnosis is to be set. Urine density being equal to 1018-1016, oxalate calcium crystals from 1 to 1.5 mg/kg of body mass and CrossLaps value being greater than 0.14 ng/ml, curvature angle is predicted not to be greater than 10°. Urine density being equal to 1015-1010, oxalate calcium crystals content being from 1.6 to 2.0 mg/kg of body mass and CrossLaps value being greater than 0.23 ng/ml, curvature angle is predicted to be from 11°.to 50°. Urine density being less than 1010, oxalate calcium crystals being greater than 2.0 mg/kg of body mass and CrossLaps value being greater than 0.61 ng/ml, curvature angle is predicted not to be greater than 51° with hard secondary transformations being developed.

EFFECT: high accuracy of prognosis.

1 tbl

 

The invention relates to Nephrology and vertebrology, in particular for the diagnosis of scoliotic spinal deformity in children and adolescents patients oxalate nephropathy (HE).

There are ways of predicting the course of scoliotic spinal deformity: clinical, laboratory, x-ray. These methods are based on:

1. Etiology, progression of the scoliotic spinal deformity in children is most dependent on etiology. Most are progressing scoliosis arising on the basis of neurofibromatosis, those of syringomyelia, isgrayscale status and myelodysplasia, among which heavy deformation amount of 80-95%. The progression of dysplastic scoliosis occurs less aggressive, but when combined with other signs in 20-30% of cases leads to the III-IV degree. Congenital scoliosis is not different rapid progression. However, while common anomalies, exciting the entire spine, compensatory arcs are absent or poorly expressed, which determines decompensated nature of scoliotic deformities. To slowly progressive include scoliosis occurring in children with congenital collagenoses - Marfan syndrome, Ehlers-Dunloe and others, as well as several forms of osteochondrodysplasia - pseudoachondroplasia, Larsen syndrome, degenerative dis is lazy and others, which are characterized by metabolic and hormonal disorders in the system of connective tissue. Dystrophic scoliosis, accompanied by osteochondropathy and similar dysontogenetic changes in vertebral segments, such as when youth osteochondrosis and others, are common, but progress and reach of III degree not more than 3-5% of children. In this form of scoliosis after apiservice of the vertebral bodies all the defects of the spine usually disappear scoliotic and kyphotic deformation decrease. Scoliotic spinal deformity arising due to poliomyelitis, encephalitis, meningitis, after birth injuries of the spine and spinal cord, injuries to the skull and brain, in the presence of spinal tumors or tumors of the spine, on the grounds of children's spinal paralysis, long lasting pain neuro-reflex installation, as well as developed after osteomyelitis, tuberculosis of the spine, ribs, sternum, empyema and other reasons, including iatrogenic, usually has no tendency to progression and depends on the underlying disease course.

2. Age of detecting deformation, the magnitude of the curvature of the spine, resulting in the progression of scoliosis by the end of skeletal growth, is directly dependent on what atrasta detection of scoliotic deformities or more precisely, the age, when there was the initial "push" of progression. Therefore, the possibility of disease progression and the more the worse than before clinically evident scoliosis. According to Ayisien et al. 1981, scoliosis, which is manifested to 10 years of age, 25.6% of cases progressing to the corner more than 50° - IV degree, the detection of deformation in age from 10 to 12 years curvature exceeds 50° 12, 1% of cases, at the age of 13-14 years - 8.3%. Those patients with scoliotic deformity appeared after 14 years, the curvature of the spine, as a rule, does not reach such a degree.

3. The age of puberty. After a period of uniform growth in healthy children, between 5 and 10 years in girls and between 5 and 12 years in boys occurs faster growth of the spine. According to different authors, the maximum growth occurs in an average of 12-15 months. before the first menstruation. Usually 2 years before menarche in girls appear the first signs of puberty secondary sexual characteristics. In this regard, patients with deformity in a period of rapid growth of the spine for scoliosis may decrease rapidly, the greater the likelihood of progression of existing scoliotic deformities to III-IV degree.

4. Localization of curvature, the most PLN is a quality progressive course is marked through localization of deformation, less pronounced when the thoracolumbar and even less in the lumbar curvature of the spine.

5. The maturity of the skeleton - test Risser, it is considered that the completion of ossification iliac bones coincides with the cessation of skeletal growth and is an indicator reduce the risk of progression of scoliotic spinal deformity. The complete absence of ossification in the appropriate age-period - on average, the appearance of nuclei of ossification iliac crests of bone is determined by the girls at 13, boys at the age of 14; the fusion of ossification in 18 years for girls and 19 boys, is one of the signs pointing to an unfavorable course of the pathological process and the possibility of progression of the scoliotic deformity.

6. Osteoporosis of the vertebral bodies on the convex side of the arc of curvature relative osteoporosis top-side segments of the vertebral bodies, a sign of Movshovich, as a result of asymmetric growth of the vertebrae described x-ray symptom is an adverse prognostic sign, which occurs only in those cases when the scoliotic spinal deformity steadily increased.

7. Metabolic disorders of connective tissue structures in the urine are determined oxoprolinuria, increased content is of hexoses of glycoproteins low - neuroamine acid and hexosamine in the blood are dissacharides, reduced levels of hyaluronic acid, the accumulation of chondroitin-4-sulfate, increased activity of hyaluronidase and reduced activity of cholinesterase and alkaline phosphatase. Depending on the severity of the results obtained lesion tissues and biological fluids in children with deformity of the spine can be judged on the future forecast of curvature.

8. Hormones, in the study of the hormonal status of patients with dysplastic scoliosis elevated blood levels of androgens and earlier activation of the gonadotropic pituitary function, and the severity of hormonal shifts correlate with the severity of the strain.

The closest analogue, the prototype, is the prediction of the progression of scoliotic deformities by determining the level of calcitonin, somatotropin, parathyrin, cortisol in the blood, and with the increase of calcitonin in the blood >4,14 PG/ml, somatotropin >of 4.45 ng/ml; and lowering parathyrin <18,64 ng/ml, cortisol <352,97 nmol/l predict a strengthening of the scoliotic spinal deformity [Tsykunov MB, Ermoshkin M.A. // prognosis of scoliotic spinal deformity // Kleene is a mini medicine. - 2001. No. 1. - P.21-24].

The disadvantage of these methods is that researchers use methods of statistical approach to the description of an already existing changes. The prognosis for children and adolescents is built on account of the manifest already shown signs of scoliosis. Estimated progression of spinal deformity already with rough changes, i.e. in the period of the swing. Proof of this is belated identification of the etiology, the purpose of laboratory and x-ray examinations, for example: use test Risser - which reflects the cessation of progression of scoliosis with the completion of ossification apofisu crests of the iliac bones, some of them, at present, are more of historical interest, although used in practice - the definition of the zone of stability Harrington, sign Mehta and others [Ulrich EV the Mushkin, A. // in Such terms, figures, drawings // St. Petersburg. - 2002. - P.67-70.]. X-ray examination carried out only during adolescence, when there is a striking clinical manifestations of the disease and underwent irreversible changes of the skeleton. Not detected scoliosis in children and adolescents, patients, HE is not assigned x-ray and clinical examination is not assigned to early treatment, and especially not build a forecast of the likely prospect is dressirovannye scoliotic spinal deformity, and scoliosis in children and adolescents treated very seriously. The research described in the literature dedicated to the diagnosis and prognosis of scoliotic spinal deformity in children and adolescents, patients with HE, we have not met.

Object of the invention is the early determination of the probability of development, and if available, the probabilities of progression of the scoliotic spinal deformity in children and adolescents, patients with HE.

The technical result of the proposed method is to improve the accuracy of determining the likelihood of progression of scoliotic spinal deformity in children and adolescents, patients with HE.

The technical result is achieved by the fact that children and adolescents with hyperoxaluria and oxalate-calcium crystalluria (COC), as well as with the characteristic external signs produce x-ray examination of the spine - cervical, thoracic and lumbar spine, sacrum and coccyx. Determine the type of scoliosis or postural disorders, the detection of changes in the height, shape, structure of the vertebrae, the angles of arrangement of the trabeculae, the distance between them, the thickness of the cortical reflex records, on one side or the other, to reduce the height of intervertebral disks, changing their shape; determine the density of the urine and the JCC in daily urine; examine crosslaps in blood - With-therm the national telopeptide, designed for the quantitative determination of degradation products of type I collagen; then spend the correlation between radiological signs, the density of the urine and the OCC, content crosslaps in the blood and predict the likely progression of the scoliotic spinal deformity. When the density of urine 1018-1016, VBEs from 1 to 1.5 mg/kg of body weight, the content of crosslaps more than 0.14 ng/ml predict the angle of curvature is not more than 10°when the density of urine 1015-1010, VBEs from 1.6 to 2.0 mg/kg of body weight, the content of crosslaps more than 0.23 ng/ml predict the angle of curvature from 11° to 50°when the density of urine less 1010, VBEs more than 2.0 mg/kg of body weight, the content of crosslaps more 0.61 ng/ml predict the angle of curvature of more than 51° with the development of coarse secondary changes.

Table
The density of the urineOxalate-calcium crystalluria mg/kg of body weightCrosslaps ng/mlThe probability of progression, the angle of curvature
1018-1016From 1 to 1.5More 0,14No more than 10°
1015-1010From 1.6 to 2.0More 0,2311° to 50°
Less than 1010More than 2.0More 0,61 More than 51°

The advantage of this method is to improve the accuracy of determining the likelihood of progression of scoliotic spinal deformity in children and adolescents, patients with HE, at the stage of formation of the skeleton in the age between 3-th year of life and the beginning of puberty until the age of 12-14, when you can still affect metabolic processes and therefore timely to prescribe an adequate treatment that will slow the progression of scoliosis.

Example No. 1.

Patient L. 18 years living in Khabarovsk, was admitted to the Nephrology Department KKB No. 1 in 2001 with a diagnosis of interstitial nephritis, dysmetabolic nephropathy associated spondylopathy. During examination in Nephrology unit was diagnosed with dysmetabolic interstitial nephritis with oxalate-calcium crystalluria, "S"-shaped scoliosis nizhnegrudnogo spine of the I degree. Crosslaps 0.17 ng/ml, the density of the urine 1016 and oxalate-calcium crystalluria 1.4 mg/kg of body weight, when conducting x-ray examinations of the spine was determined by the angle of curvature on Kobu - 8 degrees. In addition, there was a decrease in height of intervertebral disks Th 7-8, Th 9-10, Th 10-11 with the formation of hernias, Smile.

Prediction: in 3 years the angle of curvature will be up to 10°.

In 2004, crosslaps 0.14 ng/ml urine density 1016 and oxalate-calcium crystalluria of 1.34 mg/kg of body weight, when conducting x-ray examinations of the spine was determined by the angle of curvature on Kobu - 9°.

Example No. 2.

Patient D. 17 years old, living in Khabarovsk, was admitted to the Nephrology Department KKB No. 1 in 2001 with a diagnosis of dysmetabolic nephropathy associated spondylopathy. During examination in Nephrology unit was diagnosed with dysmetabolic interstitial nephritis with oxalate-calcium crystalluria, "S"-shaped scoliosis srednekamennogo spine of the I degree. Crosslaps of 0.34 ng/ml, the density of the urine 1015 and oxalate-calcium crystalluria 1.8 mg/kg of body weight, when conducting x-ray examinations of the spine was determined by the angle of curvature on Kobu - 7°. In addition, there is a decrease in height of intervertebral disks Th 5-6, Th 6-7, Th 7-8 with the formation of hernias, Smile.

Prediction: in 3 years the angle of curvature will be from 11° to 50°.

In 2004, crosslaps of 0.44 ng/ml, the density of the urine 1015 and oxalate-calcium crystalluria of 1.84 mg/kg of body weight, when conducting x-ray examinations of the spine was determined by the angle of curvature on Kobu - 17°.

Example No. 3.

Sick Days 12 years living in Khabarovsk, was admitted to the Nephrology Department of the CST in 2000 with a diagnosis of dysmetabolic nephropathy, "S"-shaped scoliosis of II century When bobsled is the training in Nephrology unit, was diagnosed with dysmetabolic interstitial nephritis with oxalate-calcium crystalluria, "S"-shaped scoliosis srednekamennogo spine of the II degree. Crosslaps of 0.56 ng/ml, the density of the urine 1012 and oxalate-calcium crystalluria 1.8 mg/kg of body weight, when conducting x-ray examinations of the spine was determined by the angle of curvature on Kobu - 14°. In addition, there is a decrease in height of intervertebral disks Th 4-5, Th 5-6, Th 6-7 with the formation of hernias, Smile.

Prediction: in 3 years the angle of curvature will be from 11° to 50°.

In 2004, crosslaps 0.58 ng/ml, the density of the urine 1011 and oxalate-calcium crystalluria of 1.84 mg/kg of body weight, when conducting x-ray examinations of the spine was determined by the angle of curvature on Kobu - 25°.

Example No. 4. A. 3 years living in the Khabarovsk district, village Forest, was admitted to the Nephrology Department of the CST in 2000 with a diagnosis of dysmetabolic nephropathy, "S"-shaped scoliosis of II century During the examination in Nephrology Department, was diagnosed with dysmetabolic interstitial nephritis with oxalate-calcium crystalluria, "S" shaped scoliosis nizhnegrudnogo spine of the II degree. Crosslaps 0.65 ng/ml, the density of the urine 1010 and oxalate-calcium crystalluria 2.8 mg/kg of body weight, when carrying out x-ray research is to improve his spine was determined by the angle of curvature on Kobu - 17°. In addition, there was a decrease in height of intervertebral disks, Th 5-6, Th 6-7, Th 7-8 with the formation of hernias, Smile.

Prediction: in 3 years the angle of curvature ranges from 51° and more.

Adequate treatment was absent in 2004 crosslaps of 0.87 ng/ml, the density of the urine 1009 and oxalate-calcium crystalluria of 3.57 mg/kg of body weight, when conducting x-ray examinations of the spine was determined by the angle of curvature on Kobu - 54°.

The method is convenient and can be used in practical health care even at the level of the clinic.

A method for predicting the scoliotic spinal deformity in children and adolescents, patients oxalate nephropathy, including x-ray examination of the spine, the definition of the type of scoliosis, biochemical analysis of blood, characterized in that determine the content of crosslaps in the blood, oxalate-calcium crystalluria (COC) and the density of the urine and density of urine 1018-1016, CUC - 1 to 1.5 mg/kg of body weight, the content of crosslaps more than 0.14 ng/ml predict the angle of curvature is not more than 10°when the density of urine 1015-1010, VBEs from 1.6 to 2.0 mg/kg of body weight, the content crosslaps more than 0.23 ng/ml predict the angle of curvature of from 11 to 50°when the density of urine less 1010, VBEs more than 2.0 mg/kg of body weight, the content of crosslaps more 0.61 ng/ml predict the angle iskrev who deposits more than 51° with the development of coarse secondary changes.



 

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