Diagnostic technique for vibration sickness

FIELD: medicine.

SUBSTANCE: venous blood is taken from a worker exposed to vibration action to analyse a neuron-specific enolase (NSE) level by immune-enzyme assay (IEA). If the NSE concentration is less than 20 ng/ml, the absence of vibration sickness in the person being tested is stated, the NSE level being within 20 to 30 ng/ml shows the presence of degree 1 vibration sickness, while the NSE level exceeding 30 ng/ml indicates degree 2 vibration sickness.

EFFECT: simplified diagnosing of vibration sickness and evaluation of a manifestation degree of vibration sickness.

1 tbl, 3 ex

 

The present invention relates to medicine, namely, neurology and pathology, and is intended for diagnostics of vibration disease (WB).

A known method for the diagnosis of WB (Lyubimova R.P. "the Dynamics of clinical and electrophysiological changes in the neuromuscular system of patients with vibration disease", journal of Neuropathology and psychiatry, 1991, No. 9, s-17), based on the collection of complaints, the investigation of neurological status, biochemical blood analysis (including determination of calcium content), identifying angiospastic disorders, disorders of pain and vibration sensitivity, needle electromyography (EMG). To substantiate the diagnosis WB Replusive recommends that in the analysis of EMG to estimate the duration of motor unit potentials (PDE), maximum and average amplitude of PDE, the degree of deviation of the characteristics of the histogram of biopotentials from age norms, the severity fibrillyatsy and fasciculations.

Closest to the present invention is a method for the diagnosis of vibration disease (Occupational diseases. A guide for physicians. M: Medicine. 1996 edited Nefazodone, in 2 volumes. Volume 2, Chapter 7. Vibration disease. S-162.), based on a comprehensive examination of the patient, including complaints, clinical and laboratory data, as well as functional is s research methods (cold test, skin thermometry, altimetry, the determination of the threshold sensitivity vibration, dynamometry, rheovasography, stimulation electroneuromyography, electroencephalography), aimed at identifying the major syndromes WB - peripheral angiopathies syndrome (white finger) and syndrome of vegetative-sensory polyneuropathy, which are found in patients with WB, both the first and second degrees, only more pronounced (Occupational diseases. A guide for physicians. M: Medicine. 1996 edited Nefazodone, in 2 volumes. Volume 2, Chapter 7. Vibration disease. P.146-147). A disadvantage of the known methods of diagnosis WB is a subjective approach to the refinement stage of development of the WB to the patient due to the lack of precise quantitative criteria; it is a costly and time-consuming procedure involving the use of a large number of different methods.

The objective of the invention is a simplified method for the diagnosis of vibration disease without reducing the quality of diagnosis, quantifying the severity of vibration disease.

The task is solved in that in the method for the diagnosis of vibration disease, including assessment of clinical signs, carry out the determination of the level neurospecific enolase (NSE) in serum by the method of immunopharm what these assay (ELISA), and when the content of NSE less than 20 ng/ml make a conclusion about the absence of the subject of vibration disease, when NSE from 20 to 30 ng/ml - about the presence of vibration disease first-degree gravity, with NSE more than 30 ng/ml - second vibration disease severity.

In the clinic, Yekaterinburg medical research center surveyed 167 miners vibration threatening professions, whose average age was 45.6±0,6 years, the average work experience is 19.2±0.8 years. For the purpose of diagnosis of vibration disease all work the survey was conducted according to the standard technique (Occupational diseases. A guide for physicians. M: Medicine. 1996 edited Nefazodone, in 2 volumes. Volume 2, Chapter 7. Vibration disease. S-156), and determined the content of NSE in serum by ELISA.

After the inspection and identify the business objective changes (symptom PAL, a symptom of "white spots", gipestesia), and data of instrumental study (conducted: palleschisommese to determine threshold sensitivity vibration; electroneuromyography (ENMG) of the upper extremities with the speed of conduction of the impulse (IPN) touch (Spies) and motor (Sleep) the median and ulnar nerves, and terminal latency (TL) and the amplitude of the M-response of the same nerves; according to the days (RVG) of the forearms and wrists were analyzed pulse volume (RI) vessels and the coefficient asymmetry blood; all work is remodels cold test), decisions of the expert Commission on the communication of disease and occupation of the surveyed workers were divided into 3 groups: the first group - patients with vibration disease first severity (VB) - 47 (28%), work experience with Vibroscreen - 23,0±0.6 years; the second group included patients with vibration disease in the second degree of severity (VB) - 62 (37%), work experience - 23,9±0.5 years. The third group was made up of working groups risk for the development of vibration disease (58 people, 35% of those surveyed), the average length of which was 6.0±0.5 years. All examined patients WB was diagnosed with the syndrome of vegetative-sensory polyneuropathy of upper extremities.

Comparison of two methods to assess the severity of the manifestations of vibration disease (as defined by the level of NSE and generally accepted criteria for the diagnosis of vibration disease using instrumental methods) showed that the claimed method is not inferior to the prototype for the quality assessment of the extent WB (table 1).

The data obtained showed that the performance of instrumental methods of research workers risk group did not differ from those of healthy persons diagnosed only (p<0.001) and the asymmetry of the pulse of the blood vessels of the hands. The level of concentration of NSE in serum CROs and the average for the group amounted to 13,0±6,6 ng/ml and did not differ from that of healthy persons.

Patients VB was registered slow SLEEP (p<0,001), both sensory and motor fibers of the median and ulnar nerves and increase terminal latency (in comparison with the group of healthy individuals), indicating that the development of autonomic-sensory polyneuropathy of upper extremities. According to the RVG marked tendency to decrease and the asymmetry of the pulse of the blood vessels of the hands. The threshold vibration sensitivity was significantly (p<0,001) higher than in healthy persons. in Addition, all indicators analyzed in patients VB significantly (p<0.001) and differed from those of workers at risk. The concentration of NSE in serum of patients VB 23.4±4.5 ng/ml and was significantly higher (p<0,001) indicators, as healthy individuals, and workers at risk.

Indicators ENMG (Spies, Sleep, TL, both the median and ulnar nerves) in patients VB, as well as in patients VB, had no significant difference (p<0,001) with the same values in healthy persons In the study of vibration sensitivity registered an increase (p<0,001) threshold sensitivity vibration. At the same time, according to ENMG we did not reveal significant differences between groups of patients VB and VB marked only the tendency to slow down Spies and increase t as the middle is my, and ulnar nerves. The concentration of NSE in serum was 44.5±8.7 ng/ml and was significantly (p<0.001) above indicators as healthy individuals and patients VB.

The authors believe that NSE is a highly specific marker of neurons that perform multiple functions, including those involved in myelinopathy [Poletaev A.B. Meshoperations group proteins S-100, their endogenous acceptors and ligands and the regulation of metabolic processes in the nervous tissue: author. Diss. ... Prof. The honey. Sciences. - M., 1987. - P.20-23.; Abramov V.V. Integration of immune and nervous systems // Novosibirsk: Nauka, Siberian branch, 1991. - 168 C.]. There are many works devoted to the role neurospecific proteins in neurodegenerative diseases of the CNS [Belyaev I.A. Neurospecific proteins in blood and spinal fluid with tick-borne CNS (clinical, diagnostic and prognostic aspects): author. discard. the honey. Sciences. - M., 1995. - 22 S.; Nagdyman N., Grimmer I., Scholz T. Predictiv value of brain-specific proteins in serum for neurodevelopmental outcome after birth asphyxia // Pediatr. Res. - 2003. - Vol.54(2). - P.270-275.). Obtained data show that in vibration disease level of NSE in serum significantly increased, therefore, the NSE can be considered a marker of disorders of the peripheral nervous system.

The method is as follows.

The worker exposed to in the brazii, take blood from a vein and determine the level of NSE enzyme-linked immunosorbent assay (ELISA) using kits "MAGIWEL (USA) according to the following scheme: dispense 25 ál of NSE standards and patient samples in cells in duplicate, make 100 μl incubation solution in each cell, without touching the surface of the liquid; incubate 1 hour at room temperature (20-28°C) with constant stirring die on the shaker for microplates, after incubation, remove the liquid and wash each strip 5 times, making each cell 100 ál of enzyme, incubated 60 minutes at room temperature, remove the mixture and washed 5 times with buffer, incubated for 30 minutes at room temperature with constant stirring die on the shaker, avoiding direct sunlight. The optical density immediately measured on a plate reader at 450 nm. Each measurement standards and patient samples are carried out in two takes. Before using all samples and reagents are brought to room temperature (24,3±3°C). Then largest NSE determine the severity of vibration disease: when the content NSE less than 20 ng/ml make a conclusion about the absence of the subject of vibration disease, NSE from 20 to 30 ng/ml - about the presence of vibration disease first-degree gravity, with NSE more than 30 ng/ml - second vibration disease severity.

Example No. 1. Patient I., miner, St the W work with Vibroscreen 23 years. Was admitted to the neurology clinic with complaints of numbness, sensitivity to cold and paresthesias in the hands, whitening of the terminal phalanges 4 and 5 fingers on the cold, convulsive tightening and reduction of strength in the hands, sleep disturbance because of aching pain in the hands, shortness of breath, fatigue, irritability.

Objective examination: tenderness to palpation of namyslow shoulders and shoulder-beam muscles, especially in the middle third. Brush bluish-hypermonogenic, wet, reduced ripple on a.radialis with two sides, a symptom of "white spots" 7 seconds symptom PAL positive from both sides. Hypoesthesia on the hands on polyneuritic type. Tendon reflexes of the upper and lower extremities symmetric, quickened. According to ENMG upper limbs showed signs of polyneuropathy: a decrease in the rate of impulses in sensory (List) fibers of the median nerve (45 m/s), amplitude of the M-response (5,9 MB) and a slow terminal (TL) latency (3 msec). In the study of the ulnar nerve Spies was 45 m/sec, Sleep - 56 m/s, the amplitude of the M-response - to 5.4 mV, t is 2.5 msec. The threshold of occurrence of the M-response was 7 mA. The initial skin temperature in the area of the nail phalanx of the third finger of the right hand was 30,9°C, after the cold test and 22.8°C (test positive). On RVG upper extremities reported to decrease blood (RI - 1,02$) and signs of increasing vascular tone hands. The threshold vibration sensitivity was increased and amounted to 118%. On radiographs of the elbow and shoulder joints, osteo-articular pathology was not detected. On the basis of complaints, physical examination data, and instrumental methods of examination, was diagnosed with vibration disease first the severity of the syndrome of vegetative-sensory polyneuropathy of upper extremities. The concentration of NSE in serum was registered at the level of 24.7 ng/ml, which confirms the above diagnosis in a given patient.

Example No. 2. The patient Including, the drifter, the experience of working with Vibroscreen 25 years. Was admitted with complaints of pain and convulsive contraction in the hands, pain in the shoulder and elbow joints, numbness of the fingers, "whitening" of the fingers, sleep disturbance, fatigue, pain in the cervical spine.

At objective examination: the brush of cool, wet, cyanotic, the symptom of "white spots" 8 seconds, reduced pulsation of the radial artery on both sides, hypesthesia on polyneuritic type type high glove to the level of the middle third of the forearm. Sharp pain on palpation of external namyslow shoulders. According to ENMG showed signs of polyneuropathy: a List of the median nerve was 45 m/s, the List of the ulnar nerve - 46 m/s. The temperature of the third finger on the right hand corresponded to 23.2°C, POS is f cold test - 23,5°C (sample indifferent). On RVG - pulse blood vessels in the area of the brushes significantly reduced (RI $ 0,68). On the basis of complaints, physical examination data, and instrumental methods of examination, diagnosis: second vibration disease severity, symptoms of autonomic-sensory polyneuropathy of upper extremities with angiospazmam fingers, outer and inner epicondyles shoulders, periastron shoulder joints. The concentration of NSE in serum was registered at the level of 67 ng/l, which confirms the above diagnosis in a given patient.

Example No. 3. Patient K., drifter, experience with Vibroscreen 10 years. Upon admission to the clinic complained of numbness and paresthesias of the tips of the fingers of the hands. At objective examination: the skin of normal color, hypesthesia on the fingers. According to RVG - pulse blood pressure forearm moderately reduced (RI - 0,75 USD), the asymmetry of the pulse of the blood vessels of the arms (28%). The temperature of the third finger brush 30°, after cold test - 28,7° (test positive). When ENMG of the median nerve Sleep was 55 m/sec (normal), List - 54 m/sec (normal), and in the study of the ulnar nerve - Sleep - 58 m/s, Spies - 51 m/s (in the range of normal values). When setting the threshold sensitivity vibration is not what Yavlena deviations from the norm. On radiographs of the cervical spine revealed a marginal osteophytes2-C4and the reduction of height of intervertebral discs. After the survey was diagnosed with osteochondrosis of the cervical spine. The concentration of NSE in serum registered at the level of 6.5 ng/l, which confirms the absence of the examined miner vibration disease.

The advantages of the proposed method for the diagnosis of vibration disease should include: a simplified method for the diagnosis of diseases and objective quantitative assessment of the identified changes.

A method for the diagnosis of vibration disease, including assessment of clinical signs, characterized in that they determine the level of neuron-specific enolase (NSE) in serum enzyme-linked immunosorbent assay and content NSE less than 20 ng/ml make a conclusion about the absence of the subject of vibration disease, NSE from 20 to 30 ng/ml - about the presence of vibration disease first-degree gravity, with NSE more than 30 ng/ml - second vibration disease severity.



 

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