Diagnostic technique for desynchronosis of hypophysial thyroid system in patients with severe bronchial asthma, previously not taking glucocorticoid therapy |
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IPC classes for russian patent Diagnostic technique for desynchronosis of hypophysial thyroid system in patients with severe bronchial asthma, previously not taking glucocorticoid therapy (RU 2382366):
       
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Method for predicting fetoplacental insufficiency in pregnant women with thyroid diseases / 2263919
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FIELD: medicine. SUBSTANCE: diagnostic technique for desynchronosis of hypophysial thyroid system in the patients with severe bronchial asthma refers to medicine. Substance consists that blood of the patients is radioimmunoassayed for concentration of TSH, T3, T4 hormones. The obtained data are processed to draw a graphic curve of circadian rhythm for each hormone that provides a basis to determine individual acrophase and batiphase time. The acrophase (confidence interval) TSH development biorhythm 9 h 11 min (confidential interval 4 h 57 min to 13 h 26 min), T3 hormone - 15 h 01 min (confidential interval 8 h 05 min to 21 h 57 min) T4 hormone - 16 h 34 min (confidential interval 8 h 55 min to 24 h 13 min), and batiphase of circadian TSH secretion rhythm 21 h to 22 h, T3 - 2 h to 4 h, T4 4 h to 5 h ensure to diagnose apparent desynchronosis of hypophysial thyroid system. EFFECT: application of the method allows to detect desynchronosis of hypophysial thyroid system in the patients with severe bronchial asthma, previously not taking glucocorticoid therapy and thereby prescribing an individual regimen of chronotherapy, enabling monitoring during treatment for a complex estimate of clinical effectiveness, reducing frequency of collateral actions, ensuring earlier remission and reducing time of staying in hospital. 2 ex, 9 dwg
The invention relates to medicine, namely to therapy, and can be used to diagnose desynchronosis function of the pituitary-thyroid system in patients with bronchial asthma severe naïve glucocorticoid therapy. Known methods of diagnosis of circadian rhythms of endocrine systems in patients with bronchial asthma by examining hormonal patients [1]. Known methods of studying hormones TSH, T3T4[2]. However, for the diagnosis of desynchronosis the pituitary-thyroid system in patients with bronchial asthma severe naïve glucocorticoid therapy, these methods were not applied. The aim of the invention is the timely diagnosis of desynchronosis the function of the thyroid gland, which will allow you to assign and korrigirovat individual plan chronotherapy according to modern pathogenetic concepts. This goal is achieved by the systematic study of circadian rhythms of hormones TSH, T3T4in patients with bronchial asthma, according to which it will be possible to assign appropriate corrective therapy. The way to diagnose desynchronosis the pituitary-thyroid system in patients with bronchial asthma severe naïve glucocorticoid therapy, vklyuchyeniye hormones, characterized in that in the blood to determine the concentration of hormones TSH, T3T4radioimmunological method, processes the received data and build a graphical curve circadian rhythm for each hormone, on the basis of which the individual acrophase and motivasi, and when indicators of acrophase (confidence interval) biorhythm generation TSH 9 h 11 min (confidence interval with 4 h 57 min to 13 h 26 min) (figure 1), a hormone T3- 15 h 01 min (confidence interval with 8 h 05 min up to 21 h 57 min) (figure 2), hormone T4- 16 h 34 min (confidence interval with 8 h 55 min to 24 hours 13 min) (figure 3) and indicators motivasi akoloutheo rhythm of TSH secretion from 21 to 22 h (figure 1), T3- from 2 to 4 h (figure 2), T4- from 4 to 5 hours (figure 3) diagnose expressed desynchronosis the pituitary-thyroid system. Average sine wave circadian rhythm of TSH, T3T4in healthy and patients with bronchial asthma, severe, treated with maintenance doses of systemic glucocorticoids (BATT continuous), are presented respectively in figures 1, 2, 3, where the axis of ordinate is the concentration of hormones in blood plasma (in Miu/l for TSH, in nmol/l for T3T4), the axis of abscissa is time (in hours). Technical result is achieved by the systematic study of circadian rhythms of hormones TSH, T3T 4in patients with bronchial asthma, according to which it will be possible to assign appropriate corrective therapy. The method is as follows: blood samples are taken from the cubital vein in 6, 12, 18 and 24 hours two days in a row after admission to the clinic prior to the beginning of medical treatment and before discharge. The interval between blood sampling is 6 hours, as only four points not lying on one straight line, determine the cycle sine wave clearly. The first observation is performed immediately after waking up, the last - just before going to sleep. Awake patients is extremely undesirable because of the untimely awakening can desynchronizing work oscillators of the body and thereby to distort the assessment of the subject. Normal day shall not be violated, it is necessary only to avoid measurement earlier than 20-30 minutes after eating or coming from the street. Concentrations of hormones TSH, T3T4determined by radioimmunoassay method. Data processing is carried out according to the program Cosinor 2, 4 for Excel 2000/XP, the confidence level is 95%. For each patient based graphical curve circadian rhythm for each hormone, on the basis of which is determined by the individual acrophase (diagnostically more important) and motivasi. Conclusions are p and comparison of sinusoids of patients with asthma curves of healthy individuals (figure 1, 2, 3). In healthy individuals circadian rhythm of TSH secretion is characterized by the acrophase in the early night hours (23 hours 59 min) and motivate in the afternoon (from 12 to 13 hours). In patients with severe bronchial asthma confidence interval of acrophase shifted to the morning hours (9 h 11 min), and batituta recorded from 21 to 22 h, which is the result of the stress response of the pituitary gland at night asthma, typical for this category of patients (figure 1). The study of circadian rhythms of hormone T3in healthy individuals showed the presence of acrophase in the early night hours (1 hour 17 min) and motivasi - in day (from 13 to 14 hours). In patients with severe bronchial asthma confidence interval of acrophase shifted to daytime hours (15 h 01 min), and motivasi - up night massively parallel state (2 to 4 h) (figure 2). Circadian rhythms of hormone T4healthy people are acrophase in 6 hours and motivate from 16 to 20 hours. When disease progression occurs violation of circadian rhythms. The strongest shift acrophase occurs in patients with bronchial asthma severe course (16 hours 34 min), respectively, which occurs and the shift motivasi (batituta registers 4 to 5 hours) (figure 3). Changes in the circadian rhythms of hormones TSH, T3T4allow to conclude about the presence of exp is part of desynchronosis thyroid function in patients with bronchial asthma severe, naïve glucocorticoid therapy. The invention allows to detect desynchronize thyroid function in patients with bronchial asthma severe naïve glucocorticoid therapy, and thereby to assign individual scheme chronotherapy, to perform monitoring during treatment for a comprehensive assessment of the effectiveness of therapy, to reduce the frequency of side effects and complications during long-term systemic therapy with corticosteroids, to achieve early remission and reduce the time of stay of patients in hospital for 3-5 days. Example run 1 Lady patient, 51 years old, was admitted with a diagnosis of: Bronchial asthma, mixed, severe, worsening. Chronic simple bronchitis, exacerbation. Emphysema. Diffuse pneumosclerosis. HPS in senior compensation. NAM II Art. From the anamnesis it is known that earlier from hormone therapy, the patient refused, citing the effectiveness of methods of alternative medicine. The levels of hormones in the blood: TSH (6 hour - 2.8 Miu/l, 12 h - 2.9 Miu/l, 18 h - 2,65 honey/l, 24 hours - 2.7 Miu/l) T3(6 hours of 2.08 nmol/l, 12 h - 2.21 nmol/l, 18 h - 2,18 nmol/l, 24 hour -2,12 nmol/l) T4(6 hours 110,0 nmol/l, 12 h - 115,0 nmol/l, 18 hours 115,0 nmol/l, 24 hours 110,0 nmol/l) Results: individual chronogram TSH, T3T4the pain is Oh And presented respectively in figure 4, 5, 6. TSH - confidence interval of acrophase shifted to night-time (standard) up to the early hours of 9 h 36 min (5 h 10 min - 14 h 02 min), batituta registered 21-22 hours (figure 4). T3the acrophase (confidence interval) 15 h 01 min (8 h 05 min 21 h 57 min), batituta - 3-4 hours (figure 5). T4the acrophase (confidence interval) 16 h 51 min (9 h 04 min - 24 h 38 min), batituta - 4-5 hours (6). Conclusion: severe desynchronosis the pituitary-thyroid system. Example run 2 Patient C., 30 years old was admitted with a diagnosis of: Bronchial asthma, non-allergic form, easy persisting over, aggravation, day 0-I tbsp. The levels of hormones in the blood: TSH (6 hours - 3.5 Miu/l, 12 h - 3.0 Miu/l, 18 h - 3,4 honey/l, 24 hours - 3.9 Miu/l) T3(6 hours - 2.5 nmol/l, 12 h - 2.1 nmol/l, 18 h - 2.2 nmol/l, 24 h and 2.8 nmol/l) T4(6 hours 135,0 nmol/l, 12 h - 120,0 nmol/l, 18 h - 100.0 nmol/l, 24 hours 120,0 nmol/l) Results: individual chronogram TSH, T3T4patient Century is represented, respectively, 7, 8, 9. The levels of the studied hormones in the blood, as well as indicators of acrophase for TSH - 23 hours 56 min (23 h 54 min - 23 h 58 min) (7), for T3- 1 hour 27 min (0 h 47 min - 2 h 06 min) (Fig), for T4- 6 h 00 min (3 h 14 min - 8 h 46 min) (Fig.9) and motivasi for TTT - 12-13 hour (Fig.7), for T3- 13-14 hour (Fig), for T4- 16-20 hour (IG) had practically no significant difference (p< 0,05) with the control group, disorders of circadian rhythms TSH, T3T4not found. Conclusion: desynchronize the pituitary-thyroid system not found. Literature 1. Mishuk VP Chronobiological aspects of dishormonal disorders in patients with bronchial asthma and methods of their correction. - Diss.... Dr. the honey. Sciences: 14.00.43. - Blagoveshchensk, 2001. - Pp.109-115. 2. Tkachev GA, Balabolkin M.I., laricheva I.P. Radioimmunochemical research methods. The Handbook. - M.: Medicine, 1983 - S-156. The way to diagnose desynchronosis the pituitary-thyroid system in patients with bronchial asthma severe naïve glucocorticoid therapy, including the definition of hormones, characterized in that in the blood to determine the concentration of hormones TSH, T3T4radioimmunological method, processes the received data and build a graphical curve circadian rhythm for each hormone, on the basis of which the individual acrophase and motivasi, and when indicators of acrophase (confidence interval) biorhythm generation TSH 9 h 11 min (confidence interval with 4 h 57 min to 13 h 26 min), hormone T3- 15 h 01 min (confidence interval with 8 h 05 min up to 21 h 57 min), hormone T4- 16 h 34 min (confidence interval with 8 h 55 min to 24 hours 13 min) and indicators bativa the s akoloutheo rhythm of TSH secretion from 21 to 22 h, T3- from 2 to 4 h, T4- from 4 to 5 hours, diagnose expressed desynchronosis the pituitary-thyroid system.
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