Method of laboratory diagnostics of early disorders of liver functional state

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine. For laboratory diagnostics of early disorders of liver functional state activity of ALT, AST, LDH, GGT, ALP, total bilirubin are measured. Additionally carried out is 3-minute long occlusion of shoulder vessels - "cuff test" (CT) to create short-timer hypoxia. Indices of liver functional activity are determined by the following formulas: ALT index=((ALT after CT - ALT before CT)/ALT before CT)*100%; AST index=((AST after CT - AST before CT/AST before CT)*100%; LDH tot = ((LDH after CT - LDH before CT)/LDH before CT)*100%; ALP index=((ALP after CT - ALP before CT)/ALP before CT)*100%; GGT index=((GGT after CT - GGT before CT)GGT before CT)*100%; Bilirubin index=((Bilirubin after CT - Bilirubin before CT)/Bilirubin before CT)*100%. If said indices increase by more than 10%, early disorder of liver functional state is diagnosed.

EFFECT: method increases diagnostics efficiency due to early detection of liver functional state disorders, preceding registered by laboratory methods changes in its functioning.

2 ex, 4 tbl

 

The invention relates to medicine, namely to methods of determining violations of the functional state of the liver.

There is a method of use of the "cuff" of the sample (MP) to assess atrombogennoe endothelial function and hematopathology interactions (Method of Balady MV), based on short-term occlusion of vessels shoulder overlay cuff sphygomanometer. In the body of information about the response of cells of various organs and tissues to any changes in living conditions is passed through various blood components and using the cells of the vascular wall. When this tissue cells "respond" release of certain biochemical substances depending on their functional state. The thrust of these changes is determined and at short-term change in living conditions (such as short-term ischemia or hypoxia - in this case, MP).

It is known that under the influence of intermittent hypoxia occurs metabolic response, which is not only in the physiological reactions of the organism, but also in a change of biochemical parameters of blood (Tkachuk E.N., Lyapkov astray freight, Tsvetkova A.M. "Metabolic response to short-term hypoxia in young, healthy volunteers" // Hyp. Med. J. 1994. Vol.2. # 4. C). Closest to the invention is the manual evaluation of the functional state of the liver in patients with chronic hepatitis and cirrhosis of the liver" (D2: EN 2194280 C2 from 10.12.2002,), in which considered hypoxia as a test stimulus of hemostasis", to confirm the degree of decompensation processes in the liver, when it is already known clinical and laboratory violation of its functioning (cirrhosis and hepatitis).

On the other hand, closest to the invention is an accepted method for laboratory diagnosis of disorders of the functional state of the liver by measuring the activity of the enzymes ALT, AST, LDH, GGT, alkaline phosphatase, and total bilirubin (Ayacuchano, Viewcom, VOB, WAV, Yevgani. The textbook "Clinical Biochemistry", publishing house "Fact" of 2005 and other textbooks on the wedge. Biochemistry).

However, this method finds a violation of the functional state of the liver only when it is determined a significant increase of these parameters in the blood.

The authors of the present invention found that the use MP for early diagnosis of functional disorders of the liver. Was first used MP not only as a functional assay for the study of endothelial function and as a test stimulus of hemostasis", but also to create short-term hypoxia, under the influence of which is metabolic response, i.e. the change of a number of biochemical parameters of blood (ALT, AST, LDH, GGT, alkaline phosphatase, total bilirubin, reflecting/characterizing (donnaslut) the functional state of the liver.

The technical result of the invention is to improve the efficiency of diagnosis through early detection of violations of the functional state of the liver, previous laboratory registered the change of its functioning (i.e. increase of the indicators listed above), as well as clinical manifestations of disturbances. This allows you to start timely and adequate medical prevention, aimed at restoring the normal functioning of the liver.

The method consists in the following.

Perform quantitative evaluation of the activity of liver enzymes ALT, AST, total LDH, alkaline phosphatase, GGT, and bilirubin before and after MT. MP - three-minute occlusion of the vessels of the shoulder caused by the imposition of the cuff of sphygomanometer on the shoulder of the subject. Determine the indices of functional activity, which shows the relationship of these indicators before and after MT. The indexes are calculated by the following formulas:

Index ALT = ((ALT after MP - ALT to MP)/ALT to MP)·100%.

Index ACT = ((ACT after MP - ACT to MP)/AST to MP)·100%.

The index of total LDH = ((LDH after MP - LDH to MP)/LDH to MP)·100%.

The alkaline phosphatase index = ((alkaline phosphatase after MP - alkaline phosphatase to MP)/alkaline phosphatase to MP)·100%.

Index GGT = ((HPT after MP - GGT to MP)/GGT to MP)·100%.

Index Bellyrub. = ((Bilirubin after MP - Bilirubin up to MP)/Bilirubin up to MP)·100%.

So conduct a quantitative assessment of the degree above the FL-defined indicators. In normal (healthy individuals) indices do not exceed 5%. Indices of six parameters compared with the same indices in healthy persons. When it detects an increase of more than 10% of diagnosed disorders of the functional state of the liver.

The rate of change of indicators does not occur or does not exceed 5%. It was investigated and evaluated in 44 healthy persons.

The proposed method is examined 154 people, including 110 patients with different pathologies and 44 healthy persons. 72 people were established by the claimed method for the diagnosis of functional disorder of the liver.

Example 1

Patient L., age 79. Entered NCN RAMS with Acute ischemic stroke in the left middle cerebral artery with the formation of a heart attack. The study proposed method on the day of receipt.

Table 1 presents the data and the percentage change before and after MP.

Table 1
ALT%ACT%Alkaline phosphatase%LDH%GGT%Bilirubin %
1923151.942674828.97
25At 31.582821.74176.4216.1130714.9528.333.0714.06

A comparative analysis of the obtained values with the same name in healthy individuals showed that the patient L. there is a violation of the functional state of the liver.

Along with the main course of treatment was recommended additional therapeutic correction of hepatic within 1 month. After 1 month, a repeat survey was conducted in this way. Table 2 presents the data and the percentage change before and after MP.

Table 2
ALT %ACT%Alkaline phosphatase%LDH%GGT%Bilirubin%
1519170.153784012.7
166.6190.00175.643.24016.0412.513.45.5

Comparative analysis of the obtained values with those in healthy individuals showed that almost all values were in the normal range, and when comparing the data with the values from the previous analysis identified the improvement of the functional state of the liver, which confirmed the effectiveness of the conducted terapeuticas the second correction.

Example 2

Patient K., 49 years. Entered NCN RAMS with acute violation of cerebral circulation with the development of myocardial infarction in the deep sections of the right hemisphere of the brain. The study proposed method on the day of receipt. Table 3 presents the data and the percentage change before and after MP.

Table 3
ALT%ACT%Alkaline phosphatase%LDH%GGT%Bilirubin%
3525206.183603115.1
4220.03124.0248.7320.6 43420.53616.117.415.2

A comparative analysis of the obtained values with the same name in healthy individuals showed that the patient had To. there is a violation of the functional state of the liver.

Along with the main course of treatment was not carried out additional therapeutic correction of the control.

After 1 month, a repeat survey was conducted in this way. Table 4 presents the data and the percentage change before and after MP.

Table 4
ALT%ACT%Alkaline phosphatase%LDH%GGT%Bilirubin%
4837257.1535244 17.8
60254521.6304.6418.547735.55218.122.425.8

Results were compared with those in healthy individuals showed that the patient had To. an infringement of the functional state of the liver. Thus, there is a deterioration in functional status compared with the primary survey of the proposed method, which is manifested not only increased the indices of the studied parameters during cuff samples, but also increase their initial level (before cuff samples) above normal, which is a direct sign of the functional state of the liver.

From the two examples above, reveals medical and clinical effectiveness of the proposed method lies in the possibility of holding early diagnosis of functional disorders of the liver, prior to the development of clinical manifestations of impaired its functioning. Early diagnosis of disorders functioning the project for a liver in this way allows you to assign and to spend adequate therapeutic treatment by hepatic and, possibly prevent further deterioration of its functioning (as in example 1).

Way early laboratory diagnosis of disorders of the functional state of the liver by measuring the activity of the enzymes ALT, AST, LDH, GGT, alkaline phosphatase, total bilirubin, characterized in that it further conduct a three-minute occlusion of the vessels of the shoulder - "cuff test" (MP) to create short-term hypoxia, under the influence of which is metabolic response, and determine the indices of the functional activity of the liver, which shows the relationship of these indicators before and after the implementation of the MP by the following formulas:
Index ALT = ((ALT after MP - ALT to MP)/ALT to MP)·100%
Index AST = ((AST after MP - ACT to MP)/AST to MP)·100%
The index of total LDH = ((LDH after MP - LDH to MP)/LDH to MP)·100%
The alkaline phosphatase index = ((alkaline phosphatase after MP - alkaline phosphatase to MP)/alkaline phosphatase to MP)·100%
Index GGT = ((HPT after MP - GGT to MP)/GGT to MP)·100%
Index Bellyrub. = ((Bilirubin after MP - Bilirubin up to MP)/Bilirubin up to MP)·100%,
upon detection of the increase of these indices by more than 10% can be diagnosed early violation of the functional state of the liver.



 

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