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Method for prediction of level of efficiency of reduction of manifestation severity of atopic dermatitis

IPC classes for russian patent Method for prediction of level of efficiency of reduction of manifestation severity of atopic dermatitis (RU 2453851):
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FIELD: medicine.

SUBSTANCE: pre-therapy blood plasma is analysed for immunoglobulin E, adrenocorticotrophin and endorphin, the index SCORAD dynamics is determined by formula: Dsk=1.34147-0.000820741*IgE-0.00382642*ACTP+0.0209401*endorphin wherein IgE is the level of acute blood plasma immunoglobulin E mIU/ml; ACTP is the level of acute blood plasma adrenocorticotrophin ng/l. If observing the Dsk value exceeding 1.18, a prognosis of improving clinical dynamics of recovery is favourable; the conventional therapy is considered to be sufficient. The Dsk value being equal to 1.18 or less, the improving clinical dynamics of recovery is unfavourable, the intensified therapeutic scheme for atopic dermatitis is considered to be preferential.

EFFECT: higher prediction accuracy.

 

The invention relates to medicine, namely to dermatology, and can be used to predict the effectiveness of reducing the severity of atopic dermatitis according to the index SCORED.

There is a method of forecasting of severe atopic dermatitis at the level of specific IGG-antibodies in children older than 3 years [application EN 2009130183 from 06.08.2009].

A method for predicting severity of atopic dermatitis is carried out by assessing the level of specific antibodies of class G tissue protein keratin in the serum by a highly sensitive enzyme immunoassay and additional evaluation of the severity of the disease in children aged more than 3 years, characterized in that when the initial level of antibodies to keratin more 333,68 IU/ml severe persistent atopic dermatitis in 6 months. takes place in 91,0%, and the concentration of these antibodies is more 354.5 TWh excluding IU/ml severe disease recorded in 100% of cases.

The disadvantages of the method: is based on only one indicator, not a high degree of differences between persistent and severe course of illness.

There is a method of predicting the course of atopic dermatitis [U.S. Pat. EN 2310195], which consists in the fact that at the same time distinguish the epithelial cells in the brush-biopsies of the mucosa of the oropharynx - mA is eriala the integral assessment of the resistance of the microorganism of the patient for indicators, characterizing the microbiocenosis and morphofunctional state of the mucous membrane, determine the electrokinetic activity of the nuclei of buccal epitheliocytes (ELA), the index of infection (AI), the index of adhesion (IA) and take swabs from the affected skin area of 2 cm2in which determine the number of colony forming units (CFU) S.aureus/cm2. When the value of the index infection >70%, the index of adhesion >100-150 microbial cells of S.aureus to epitheliocyte, SOME of > 200/cm2and al < 20% at primary inspection predict severe atopic dermatitis when the value of the index infection <30%, the index of adhesion <50 microbial cells S.aureus / epitheliocyte, SOME < 50/cm2and ELA>30% in the initial examination predict a mild case. The method improves the accuracy and expressnet prediction of the clinical course of atopic dermatitis.

The disadvantages of the method: time-consuming calculation part is quite complicated.

There is a method of predicting the course of atopic dermatitis in adults [application for a patent RU №95104770 from 03.04.1995]. The authors propose to conduct clinical-anamnestic and immunological examination, Allergy testing, calculation of risk factors using the results of the discriminant analysis on the proposed formulas. Determine prognostic CoE who ficiency F1 and F2 separately for men and women and when the value of F1 is greater than or equal to F2 predict adverse atopic dermatitis.

The disadvantages of the method: cumbersome calculation apparatus is difficult to use.

The purpose of the invention is to develop a method for predicting the effectiveness of reducing the severity of atopic dermatitis based on the results of routine laboratory studies, allowing a high degree of accuracy to predict the effectiveness of the dynamics of the manifestations of the disease, according to the index SCORAD (SCORAD).

The technical result is achieved by research in the acute period of the disease, immunological and hormonal status of patients with atopic dermatitis with determining the level of adrenocorticotropic hormone (ACTH), endorphin, immunoglobulin class E (IgE), interferons, interleukins, the severity of the disease according to the index SCORAD [Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis // Dermatology. - 1993; 186(1): 23-31].

After the course of treatment, including medication and laser irradiation of the skin, re-assess indicators of hormonal, immunological status and degree of severity of the disease according to the index SCORED. Assess changes in clinical manifestations: the area affected of the skin, the intensity of the manifestations of these lesions, subjective symptoms. Estimate the dynamics of the index SCORED in percent as the ratio in the guises of this indicator after treatment to its value in the period of exacerbation.

We studied the dynamics of the index SCORAD, hormonal, immunological status, symptoms of anxiety and depression 122 patients with atopic dermatitis in the acute period of the disease and after treatment. Traditional treatment of 63 patients were included: sodium tiosulphate 30% 10 ml/day 14 injections; claritin 10 mg 1 time a day, " filtrum 2 tablets 3 times a day during meals, novopassit three times a day, one tablet, ointment advantan all lesions - treatment for 14 days. The second group of 59 patients in addition to conventional treatment had been Deltaran and laser irradiation of lesions. Before using 0.3 mg of Deltaran was dissolved in 0.5 ml of saline and injected endonasal in each nostril 1-2 drops of intervals per minute for 5-10 minutes, 2 times a day - morning and evening. Dose rate was on average from 6 to 12 mg for a period of 10 days.

Using as a tool of analysis, multiple regression, where the dependent measure were the dynamics of the index SCORED, as affecting all other above-mentioned indicators. It was found that the greatest degree of influence on the dynamics of the index SCORAD have a level of ACTH, endorphin, IgE. It was obtained the following regression equation:

Dsk=1,34147-0,000820741*IgE-0,00382642*ACTH+0,0209401* endorphin,

where the sk- dynamics of the index SCORAD,

IgE level of immunoglobulin E in blood plasma in the acute period mIU/ml;

ACTH - levels of adrenocorticotropic hormone in the blood plasma ng/l in the acute period;

endorphins - the level of endorphins in the blood plasma ng/l in the acute period.

For the control group consisted of 24 healthy person without atopic dermatitis, the average proposed index Dskaccording to the results of a single study, blood was 1.74±0,07. For patients with atopic dermatitis treated with traditional treatment, clinical dynamics improvement which amounted to more than 80% and rated as good, average index value of Dskmade up 1.27±0,09. Patients in this group of 23 people, the dynamics of clinical recovery are assessed as weak, amounting to no more than 30% of the level before treatment, the average value of Dskamounted to 0.94±0,08. In patients with atopic dermatitis in the amount of 5 people, in addition to receiving traditional therapy Deltaran, lasaraleen, dynamics of clinical recovery are assessed as weak, amounting to no more than 30% of the level before treatment, the average value of Dskstood at 0.98±0,07. The patients of this group, whose dynamics improve the clinical condition of more than 80%, Dskmade 1,31±0,09.

Thus, use as a forecasting tool offered us the formulas to evaluate the dynamics of the index SCORAD allows already at the initial reception from the results of measurements of immunoglobulin class E, ACTH and endorphin in patients with atopic dermatitis to determine the speed of the dynamics of recovery and assign traditional or strict regimen.

So, if Dskmore 1,18, it is sufficient for the purpose of traditional therapy; if Dskequal to or less 1,18 preferably assignment enhanced scheme of treatment of atopic dermatitis.

A method for predicting the effectiveness of reducing the severity of atopic dermatitis with determination before treatment level in the blood plasma immunoglobulin class E, ACTH and endorphin, characterized in that determine the dynamics of the index SCORED by the formula: Dsk=1,34147-0,000820741·IgE-0,00382642·ACTH+0,0209401·endorphin, where IgE level of immunoglobulin E in blood plasma in the acute period, mIU/ml; ACTH - levels of adrenocorticotropic hormone in the blood plasma ng/l in the acute period; if Dskmore 1,18, the forecast improvement in the clinical dynamics of recovery are favorable, fairly traditional destination therapy; if Dskequal to or less than 1.18 forecast improve clinical dynamics of recovery adverse, preferably assignment strenuously the scheme of treatment of atopic dermatitis.

 

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