Method for prediction of gastric ulcer cicatrisation rate

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to gastroenterology and therapy, can be used to update a prediction of clinical course of the gastric ulcer (GU). It involves the evaluation of an ulcer defect, Helicobacter infection content, and hemolytic resistance parametres. An individual dynamics of ulcer defect cicatrisation of a wall of stomach is calculated by formula: Cicatrisation dynamics = 0.139831+0.853145·S_prior - 0.0000181334· tlat-0.0221184· Kmax - 0.000185502·HP, where S_prior is the defect area prior to the initiation of treatment, Kmax is a maximum erythrocyte hemolysis rate constant, tlat is latent hemolysis time, HP is the Helicobacter infection content. And if the derived coefficient is equal to or less than 0.6, ulcer healing within a therapeutic standard time limit is predicted, if it exceeds 0.6, prolonged gastric ulcer healing is supposed.

EFFECT: method allows to estimate the ulcer defect cicatrisation dynamics even prior to the initiation of treatment that in turn allows to optimise drug therapy.

1 tbl, 1 dwg

 

The invention relates to medicine, in particular to a gastroenterologist and therapy, can be used to Refine the prognosis of gastric ulcer (GU).

There is a METHOD of PREDICTING the COURSE of GASTRIC ULCER AND DUODENAL ULCER (patent No. 2246731 (RU) from 2005.02.20). The authors conduct a diagnostic study, with 5-6 days from the beginning of exacerbation of peptic ulcer of stomach and duodenum determine the content of serotonin, histamine and acetylcholine in the blood, then in 2-3 weeks conduct drug therapy and again determine the level of serotonin, histamine and acetylcholine in the blood and when the content of serotonin in 2-3 times above the norm, histamine 1.15-1.4 times higher than normal, and acetylcholine - 20-45% below normal forecast for gastric ulcer and duodenal ulcer as not cicatrizing ulcers.

The disadvantages of the method is the high cost due to the use of specific reagents and equipment for determining serotonin, histamine and acetylcholine.

There is a METHOD of PREDICTING the course of GASTRIC ULCERS AND DUODENAL ULCERS ASSOCIATED WITH HELICOBACTER PYLORI (patent No. 2269132 (RU) from 2006.01.27). The essence of the method is that carried out the biochemical analysis of blood, determine the titer of antibodies to Helicobacter pylori class IgG and IgA, and when the title to the each of them is 1:200 and more forecast for gastric ulcer and duodenal ulcer, associated with Helicobacter pylori, with exacerbations. The technical result is to increase the accuracy of the prognosis of the disease.

The disadvantages of the method: diagnosis and prediction is done using only one clinical symptom - titer antibodies to Helicobacter pylori, not taking into account the peculiarities and possibilities of their own systems of an organism of the patient.

Closest to the claimed method is a method of DIAGNOSING PATHOLOGIES of the GASTROINTESTINAL TRACT of the PATIENT (patent No. 2098819 (RU) from 1997.12.10). The method includes determining the phase currents of the gastro-intestinal tract, including peptic ulcer disease, and assessment of individual sensitivity of the patient to the development of peptic ulcer. The patient carry out blood collection, separation and its control sample in saline to a reference concentration of red blood cells, the effect on samples with hydrochloric acid, followed by determining at set intervals of values of optical density study and control samples, which make the conclusion about the percentage concentration of red blood cells, separated by a characteristic group resistance to the hemolytic effects of hydrochloric acid: value added, demoted-, rednisone, and it is judged on the condition of the gastrointestinal tract, before exposure to blood samples with hydrochloric acid to produce their incubation with lekti the AMI in doses threshold concentration, not cause agglutination of red blood cells, and the condition of the gastrointestinal tract of the patient is judged as follows: increase percent concentration povsemestnij erythrocytes indicates early signs of ulcer and erosive lesions of the mucous membrane, the increase in the percentage concentration pangenetic erythrocytes indicates remission of the disease.

The drawbacks of the invention: the complexity of calculating portion for identifying group affiliation resistance of erythrocytes; no justification of the boundaries of the partition coefficients in groups of resistance.

The purpose of the invention is development of a method of predicting the course of GU, allowing to assess the dynamics of cicatrization of the ulcer before treatment, which, in turn, will allow to optimize drug therapy.

This goal is achieved by the fact that at the preliminary stage conducted a study of the osmotic properties of red blood cells obtained from the blood of patients with SUD. We have studied clinical and laboratory dynamics of the disease in 12 patients with SUD. Used automatic registration method acid and osmotic erythrogram on the installation, with the following blocks:

1) optical (photoelectrocolorimeter FEC-56M with built-in differential amplifier or CPK-2MP);

2) recording (two-Regis is combined with LCD-003 and digital voltmeter type B7-20);

3) thermostatic (ultraharmonic UTU-6).

Hemolysis of erythrocytes was performed in a thermostatted cells with outer dimensions of 20×40×10 mm and a working volume of 4 ml measurement of the values of transmittance was carried out at a wavelength of λ=490 nm, since in this region of the spectrum, the molar extinction coefficient of aqueous solutions of oxyhemoglobin minimum. Thus, the application of a spectrophotometric method for recording the intensity of the parallel light fluxes that have passed through the control and working of the cell, allows you to test not only the release of hemoglobin into the environment of incubation, and the intensity of light scattering suspensions of erythrocytes, the value of which is proportional to the volume of erythrocyte cells and the number of them in the environment.

When conducting hemolysis of red blood cells in one cell installation registers the S-shaped cumulative curve whose shape reflects the total change of the magnitude of light scattering (τ %) in the studied solution in time.

The registration method of the kinetic curves allows to assess the structural condition of erythrocytes by the following parameters:

tlatthe latent time period of hemolysis (s, min);

t50the time half of hemolysis (s, min);

Tomax- constant maximum rate of hemolysis (Rel. units);

GSFthe relative number of spherocytes (%);

G - Rel the relative number of hemolyzed cells (%).

The kinetics of the acid hemolysis was detected after adding in the working cell with 5 ml of the suspension of erythrocytes 100 μl of acid (Hcl 0.1 N.). The choice of Hcl due to its stability during storage, and the presence of both ions (H+and CL-in plasma.

At admission and after standard treatment for SUD compared the dynamics of scarring ulcers of the stomach wall, the duration of treatment, hemoglobin, presence of Helicobacter pylori (HP).

A fragment of the table containing the studied parameters below.

The performance of some patients with FBG
tlat(s)Kmax(atmospheric air)b (g/l)HPThe size of the ulcer (cm)Bed-day
before the treatmentafter the treatment
3203,2118+0,6 x 0,8016
3102,25 120+0,5×1,1021
1803,40135+of 0.5 and 0.6017
2252,39121++0,6×1,0022
1751.25108+++1,0×1,50,3×0,429
195of 2.51140+++1,5×1,8of 0.5 and 0.630
1732.421431,5×1,90,6 x 0,632

The main parameter characterizing the resistance of cells to acid, is the value of tlatthe time latentes the period of hemolysis, the value of Kmax- constant describing the maximum rate of hemolysis of erythrocytes.

We calculated the dependence of the dynamics of scarring ulcers, defined as the difference of the square of the defect before treatment and after treatment has been studied clinical and laboratory criteria based on multiple regression analysis. It was found that the greatest contribution to the dynamics of scarring make settings such as the area of the defect before treatment (S_), the constant maximum speed of hemolysis of erythrocytes (Kmax), the latent time period of hemolysis (tlat), infection of Helicobacter (HP).

The regression equation is as follows:

Dynamics rubs.=0,139831+0,853145·S_-0,0000181334·tlat-0,0221184·Kmax-0,000185502·HP.

Further mathematical processing showed that the duration of treatment is statistically significant relationships with those calculated using equation coefficient dynamics of scarring (see drawing). Moreover, the average values of this coefficient is calculated for a group of patients who have had complete scarring, 0.6; for a group of patients who have had partial scarring, and 2.1, the differences between groups on this topic were statistically significant. As a practical guidance on the use of our method can be applied in dagiti the following algorithm individual forecast speed scarring ulcers: if the ratio of dynamics, calculated by the proposed formula, 0.6 or less, the healing of ulcers will be provided in the standard treatment time, if the ratio is more than 0.6, expected long-term healing of stomach ulcers.

Thus, the proposed formula for calculating the coefficient of the dynamics of scarring using the area of the ulcer of the stomach wall before treatment, a constant maximum rate of hemolysis of erythrocytes, the latent time period of hemolysis and the degree of H. pylori colonization is easy to use, does not require the Clinician complex calculations, allows to reliably differentiate each patient individually according to the intensity of ulcer healing. For this differentiation, in turn, will allow the doctor to prescribe the best course of treatment, standard or enhanced, will reduce the time and increase the effectiveness of treatment.

A method for predicting the course of gastric ulcer, including determining the size of the ulcer, colonization of H. pylori infection, the parameters of resistance to hemolytic effect, characterized in that the dynamics of individual cicatrization of the ulcer of the stomach wall calculated by the formula: Dynamics rubs.=0,139831+0,853145·S_ - 0,0000181334·tlat- 0,0221184·Kmax- 0,000185502·HP
where S_ - the area of the defect is cured before the I; Kmax- constant maximum rate of hemolysis of erythrocytes; tlatthe latent time period of hemolysis; HP - infection of H. pylori infection, if the ratio is equal to or less than 0.6, predict healing of ulcers in the stipulated standard of treatment time, if more than 0.6 - expected long-term healing of stomach ulcers.



 

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2 ex, 3 tbl

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