Method of diagnosing impairment of vegetative regulation in children with tuberculosis

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pediatrics. In children of pre-school age with tuberculosis of intrathotacic lymph nodes indices of heart rhythm variability are determined: rhythmograms - interinterval differences RMSSD (ms), coefficient of variability CV (%), spectrograms - total spectrum power TR (ms2), very low frequency waves of spectrum VLF (ms2), low frequency waves of spectrum LF (ms2), high frequency waves of spectrum HF (ms2). If their values equal: interinterval differences RMSSD - 76.8±3.92, coefficient of variability CV - 9.9±0.50, total spectrum power TR - 3437±175.3, very low frequency waves of spectrum VLF - 1067±54.4, low frequency waves of spectrum LF - 1003±51.2, high frequency waves of spectrum HF - 1900.2±96,9 vegetative dysfunction is diagnosed.

EFFECT: method increases reliability of diagnostics of impairment of vegetative regulation in children with tuberculosis.

1 tbl, 1 ex

 

The invention relates to medicine, namely to Pediatrics.

In recent years there has been an increase in the incidence of tuberculosis of the child population. The peak incidence of TB in children, as well as primary infection with Mycobacterium tuberculosis (MBT), accounted for preschool age children. In the structure of the forms of the disease in children of preschool age dominated by tuberculosis of intrathoracic lymph nodes (TGLU).

There are known: a method for early diagnosis of tuberculosis infection in children, when determining the level of lymphocyte proliferation in microculture whole blood by the reaction of blast transformation of lymphocytes (EN 2315315 C2, 20.01.2008), the method for diagnosis of active tuberculosis of the respiratory system in children with calcitonin in the lung tissue and intrathoracic lymph nodes on the results sonoluminescence analysis portion of blood plasma (EN 2219547 C2, 10.06.2003), a method for the diagnosis of tuberculosis of intrathoracic lymph nodes paraaortal group with complex laboratory and radiological examinations (EN 2339041 C2, 20.11.2008).

An important role in the response to chronic infection plays an autonomic nervous system (ANS). In this regard, it is important to develop criteria for diagnosing autonomic disorders for assessment of functional state of organism of the child and contact the Olya for treatment.

As a prototype of the chosen method of assessment of the VNS in patients with tuberculosis teenagers method kardiointervalografii (Tohtohodjaeva BORN, Aibekova M.K. Characteristic of the autonomic nervous system in adolescents with destructive pulmonary tuberculosis and its influence on the course of tuberculosis /TB in Russia. Year 2007: proceedings of the VIII Russian Congress of TB. - M.: OOO "Idea", 2007. - S-264). The authors examined adolescents with infiltrative, disseminated and cavernous tuberculosis of the lungs, and has determined that the surveyed children in the original vegetative tone prevailed hypersympathicotonia (45% of children with infiltrative form, 60% for disseminated tuberculosis of the lungs, from 100% at the cavernous form) and Hyper sympathicotonic autonomic reactivity (80%, 70% and 100% of children, respectively). Identified vegetative disturbances, according to the authors, contributed to the formation of resistant to therapy forms, marked symptoms of intoxication, both lungs, a large percentage of complications, long-term patients. Vagotonic the process was slow, kept the symptoms of intoxication, was not closed cavity decay. At the same time normotonikov studied destructive forms proceeded steadily and well managed specific therapy.

However, this with the royals has some disadvantages, as applied to characterize the autonomic nervous system and predicting the course of disease in children in the older age groups - teenagers, with destructive forms of pulmonary tuberculosis. Assessment of autonomic regulation carried out only by a method of kardiointervalografii, which makes it impossible to evaluate the spectral and biorhythm data of heart rate variability (HRV) and more fully assess the functional state of the organism.

The objective of the invention is to increase the reliability of diagnosis of autonomic dysfunction in patients with pre-school children with tuberculosis of intrathoracic lymph nodes.

The result of the development of the method is to increase the informativeness of the study of the ANS and the use of indicators of heart rate variability in children of preschool age with tuberculosis of non-invasive studies with simultaneous simplicity of violations through the use of known devices, the ability to assess the effectiveness of treatment of sick children, as well as prenosological diagnostics in children at increased risk of TB, as in hospital, tuberculosis hospital and sanatorium.

The task and its result is achieved by the fact that in the method for the diagnosis of disorders of the autonomic re is ulali children TB patients, including a study of clinical manifestations and data kardiointervalografii with the definition of autonomic reactivity, according to the invention in preschool children with tuberculosis of intrathoracic lymph nodes further define the parameters of heart rate variability: ramagrama - mediterannee differences RMSSD (MS), the coefficient of variation CV (%), spectrogram - total spectral power (TP MS2very low wave VLF spectrum (MS2), low wave spectrum LF (MS2), high waves HF spectrum (MS2), and when the following values:

- mediterannee differences RMSSD - 76,8±3,92;

the coefficient of variation CV - 9,9±0,50;

- total spectral power (TP - 3437±175,3;

- very low wave spectrum of VLF - 1067±54,4;

- low wave spectrum LF - 1003±51,2;

- high wave spectrum HF - 1900,2±96,9, diagnosed with autonomic dysfunction. In children of preschool age with tuberculosis of intrathoracic lymph nodes mainly determined asimpatikotonia autonomic reactivity.

The introduction of new indicators of heart rate variability in the diagnosis of impaired autonomic regulation in children of preschool age with tuberculosis of intrathoracic lymph nodes associated with the frequent use of spectral and biorhythm features and advantages of the IR HRV in pediatric practice in recent years, that allows one to determine precisely simpato-parasympathetic changes in the autonomic nervous system and impaired functional status of the organism. The studies were conducted in children's tuberculosis sanatorium. Of all indices of HRV presents reliable, which differ significantly from healthy children of the same age. In addition, the functional studies in children of preschool age with tuberculosis of intrathoracic lymph nodes is shown to clarify the clinical autonomic changes (weakness, fatigue, tachycardia), which have much in common with symptoms of chronic tubercular intoxication. Changes in autonomic regulation during treatment of children with tuberculosis of intrathoracic lymph nodes will help to evaluate its effectiveness.

The heart rate variability were studied using the ANS-spectrograph using vegetotester program Polyspectra" company "Neurosoft" (Russia). Were recorded from 300 to 500 cardiocycle with parallel recording of the piezosensor pneumogram to determine the contribution of vagusnye activation of respiration in simpato-parasympathetic balance. Estimated initial autonomic tone indicators ramagrama: mediterannee differences RMSSD (MS), the coefficient of variation CV (%); Spectro the scheme: total spectral power (TP MS 2very low wave VLF spectrum (MS2), low wave spectrum LF (MS2), high waves HF spectrum (MS2).

Statistical data processing included the following methods: determination of numerical characteristics (descriptive statistics), to check if the distribution of sample indices to the normal law on the characteristics of the skewness, the kurtosis and test of Lilliefors, testing statistical hypotheses for the one-dimensional samples was carried out by nonparametric Wilcoxon criterion, the method univariate univariate analysis implemented in two variants - parametric (ANOVA) and nonparametric Kruskal the Valls (Well-Walls), the level of significance was determined at p<0,05.

During processing of the material used personal computer Intel Pentium II using software packages Excel, Matlab 6,5" with the expansion pack Statistic Toolbox. The statistical study showed no normal distribution of parameters of heart rate variability, and therefore the processing of data was performed by non-parametric methods with the definition of a Chi-square (table 1).

A method for the diagnosis of impaired autonomic regulation in children TB patients is illustrated by the following examples.

Results were examined in 58 children aged 4-7 years, including in the study group included 26 de is her patients with tuberculosis of intrathoracic lymph nodes. 32 healthy child with the natural flow of the post-vaccination process was the control group. The survey was conducted for all children in the first half of the day, between 9 a.m. till 12 hours a day, no earlier than 2 hours after a meal, in the same setting.

A feature of the clinical picture in preschool children, the sick, TUGLU, was the presence of fatigue (34,6%), weakness (26,9%), fever (23,1%), cough (19,2%) and dyspnea on exertion (26,9%), pallor (46,2%), insufficient development of the subcutaneous fat layer (46,2%), the presence of abnormalities in physical development due to the shortage of length (19,2%) or body mass (19,2%), tachycardia (26,9%), generalized lymphoadenopathy (100%) with photoelasticity (92,3%), painless on palpation (65,4%) lymph nodes, and phenomena of periadenitis (26,9%), and data from x-ray studies, which verify the diagnosis of tuberculosis of intrathoracic lymph nodes in the phase of infiltration (73,1%), in the phase of consolidation and calcined (19,2%) or in the phase of resorption (7,7%). In all cases of tuberculous process was characterized by the absence of selection office (BC-). In most patients, TUGLU noted Mantoux test medium intensity (61,5%), giperergicakie sample was 26.9%.

When conducting cardiointervals the guide is installed, that children TUGLU, in the original vegetative tone dominates sympathicotonia, which was detected in 61.5% of children in this group, which is 4 times the frequency sympathicotonia orientation initial autonomic tone in the control group (15,6%, p<0,001). When determining autonomic reactivity (AutoProbe) 69,2% of TB cases in children was registered simpaticotonici option autonomic reactivity, which is 2.5 times higher compared with healthy preschool children (28,1%, p<0,05).

Table 1 presents significantly different indices of HRV in children 2 groups.

Table 1
Indices of HRV in children of preschool age (M±m)
OptionsGroups of children:p
Patients TUGLU (n=26)Healthy (n=32)
RMSSD, MS76,8±3,92124,0±5,33p<0,05
CV %9,9±0,5016,1±0,69TP, MS23437,0±175,298076,0±347,27p<0,05
VLF, MS21067,0±54,423217,0±138,33p<0,05
LF, MS21003,0±51,152304,6±99,10p<0,05
HF, MC21900,2±96,904124,1±177,33p<0,05
Note: p - significance of differences between 2 groups.

As can be seen from table 1, in the group of patients with tuberculosis in children has decreased parameters characterizing the parasympathetic activity: indicator magisterially differences (RMSSD) - 38.1% and the coefficient of variation of RR interval (CV) - 38.5%). In addition, it was found a decrease of all parameters characterizing the power spectrum in the high frequency range (HF) - by 53.9%, low frequency range (LF) - 56.5%, very low frequencies of the spectrum, characterizing the activity of the humoral channel regulation (VLF) - by 66.9%to the data group of healthy children. Accordingly, the total capacity of the JV is CTR (TP) in the group of patients with tuberculosis was by 57.4% less than in the control, which was confirmed by high sympathetic activity in children TUGLU.

Thus, in children of preschool age with TUGLU revealed characteristics of HRV, which is characterized by increased sympathetic with the decline of parasympathetic activity of the ANS, which allows us to diagnose autonomic dysfunction.

The patterns formed the basis of the developed method for the diagnosis of impaired autonomic regulation, ensuring the adequacy of adaptive reactions in children of preschool age with tuberculosis intrathoracic lymph nodes. Its essence consists in the following: chronic TB infection invariably, even on the background of therapy, resulting in reduced vegetative protection of the child's body in her asthenia.

Clinical example.

Nastya K., 5 years, 9 months. (No. East. 07495). Diagnosis: Tuberculosis of intrathoracic lymph nodes in the phase of infiltration, MBT(-). Comorbidities: timomegalia, anemia of mixed Genesis mild.

Girl from unidentified contact on TB, from a second pregnancy occurring with toxemia of the first half and anemia in the second degree, the second term birth by caesarean section, vaccinated with BCG vaccine in the hospital (hem 8 mm), the second is months of life on artificial feeding, refers to a group of sickly children are infected with the office more than one year, within two months receives standard therapy for the disease in the hospital.

Clinically, the girl was showing signs of chronic intoxication (weakness, fatigue, periorbital shadows, retarded physical development, deficiency of subcutaneous fat, anemia mild tachycardia, systolic murmur functional character over heart area), expressed lymphoproliferative syndrome, objective symptoms of disorders of the respiratory system.

Data ANS spectrometry: RMSSD - 74 MS; CV - 10,1%; TP - 3521 MS2; VLF - 1023 MS2; LF - 988 MS2; HF - 1810 MS2- indicate the depletion of adaptive regulatory mechanisms, that is, in this patient there is a dysfunction of the autonomic nervous system.

The proposed method for the diagnosis of impaired autonomic regulation in children of preschool age with tuberculosis of intrathoracic lymph nodes, confirmed the objective nature of the performance, highly informative, non-invasive examination, the technical simplicity of studies using well known and widely used devices for ECG, assessment of effectiveness (token) in the treatment of tuberculosis, prenosological diagnostics in children of high-risk groups sableman the I TB use of the method in terms of primary health care, TB dispensary, hospital, preschools and schools. The obtained criteria to establish the presence or absence of the functional reserve of adaptation.

In the present invention is undergoing clinical trials.

1. A method for the diagnosis of impaired autonomic regulation in children, TB patients, including a study of clinical manifestations and data kardiointervalografii with the definition of autonomic reactivity, characterized in that preschool children with tuberculosis of intrathoracic lymph nodes further define the parameters of heart rate variability: ramagrama - mediterannee differences RMSSD (MS), the coefficient of variation CV (%), spectrogram - total power spectrum TR (MS2very low wave VLF spectrum (MS2), low wave spectrum LF (MS2), high waves HF spectrum (MS2), and when the following values:
- mediterannee differences RMSSD - 76,8±3,92
the coefficient of variation CV - 9,9±0,50
- total power spectrum TR - 3437±175,3
- very low wave spectrum of VLF - 1067±54,4
- low wave spectrum LF - 1003±51,2
- high wave spectrum HF - 1900,2±96,9
diagnosed with autonomic dysfunction.

2. The diagnostic method according to claim 1, characterized in, h what about the children of preschool age with tuberculosis of intrathoracic lymph nodes mainly determined asimpatikotonia autonomic reactivity.



 

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EFFECT: accelerated noninvasive method.

1 tbl

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