Method of predicting post-infarction remodelling of left ventricle myocardium in patinets with myocardial infarction

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to cardiology. In order to predict post-infarction remodeling of left ventricle (LV) myocardium in patients with myocardial infarction (MI) laboratory blood parameters in said category of patients are analysed. In particular, estimated are levels of N-terminal brain natriuretic peptide precursor (NTproBNP), pg/ml, matrix metalproteinase 9 (MMP9), ng/ml, highly-sensitive C-reactive protein (hs CRP), mg/l, metalproteinase 1 precursor (proMMPI), ng/l and content, %. All parameters are analysed on 3-5 day of disease and remodeling of LV myocardium in patients with MI is predicted by formula: K=0.009×MMP9+0.00032×NTproBNP+0.15×m+0.03×proMMPI+0.08×hsCRP-5.4, where K is prognostic index of post-infarction remodeling of LV myocardium. If value K>-0.85, high risk of post-infarction remodelling of LV myocardium in patients with MI is predicted.

EFFECT: method increases accuracy of prediction of post-infarction remodelling of LV myocardium in patients with MI after three months after disease beginning due to correlation analysis between levels of MMP9, proMMPl, hsCRP, NTproBNP and monocytes.

1 tbl, 3 ex

 

The invention relates to medicine, namely cardiology, and can be used to predict post-infarction remodeling of the myocardium of the left ventricle (LV) in patients with myocardial infarction (mi).

Prediction of post-infarction remodeling in patients is an important clinical task, given the high incidence of heart failure (HF) in the post-infarction remodeling, which leads to reduced quality of life of patients, the increase in the number of hospitalizations and increased risk of sudden cardiac death. In recent years, there have been numerous studies aimed at identifying the most important indicators to assess the risk of SN as a clinical investigation of the remodelling process, and the actual remodeling of the myocardium assessed according to clinical and instrumental examination. The most commonly known methods of forecasting remodeling include a number of enzymes, electrocardiographic and, first of all, echocardiography, including tissue Doppler indices.

So one of the proposed methods for predicting post-infarction remodeling of the myocardium of the left ventricle in patients after mi with ST-segment elevation (Bershtein L.L. Prediction of post-infarction remodeling of the left who ludacka. / Bershtein L.L., Novikov V., Wisniewski, A., Grishkin YU. // Cardiology No. 3. - 2011. - P.17-23), based on the analysis of the combination of a number of enzyme (maximum activity of creatine kinase and its MB fraction), electrocardiographic (localization THEM, the presence of a Q wave, the total and maximum lift of the ST segment and others) and echocardiographic indices (index of local contractility, end-diastolic and end-systolic LV volumes and others).

The authors of this method say that it cannot be used in cases of poor visualization of the cavities of the heart by echocardiography (ECHOCG), registering a total blockade of the left bundle branch on electrocardiogram (ECG), in the presence of hemodynamically significant valvular heart disease. In addition, the exclusion criteria were: cardiogenic shock, the presence of contraindications to systemic thrombolysis. During the development of this method in the study did not include patients after percutaneous interventions (however, it is now known that patients with mi with ST-segment elevation necessary to perform diagnostic coronary angiography for deciding on possible methods and timing of coronary revascularization).

The authors of another method was proposed to predict the SN on the results of determination of lactate and the activity of myeloperoxidase lei is acetow (RF patent No. 2166758, 2001.05.10). To do this, postinfarction patients spend biochemical analysis of blood, plasma determine the concentration of lactate and myeloperoxidase activity of leukocytes. When activity of myeloperoxidase from 115,0 μm/g of protein per minute up to 200.0 μm/g of protein per minute and, accordingly, the level of lactate from 6.0 μm/ml to 10.0 μm/ml predict SN.

The disadvantage of this analogue, according to the authors of the proposed method is that patients at the time of the study had symptoms of severe myocardial dysfunction (which does not always correspond with the subjective manifestations), and is described in this situation, the change in the level of lactate and myeloperoxidase activity of leukocytes does not indicate the possibility of forecasting CM, a about existing pathologies, and is not specific to SN.

A method for predicting the development of postinfarction remodeling of the myocardium of the left ventricle in patients after acute coronary syndrome (ACS), was also described Hyungseop Kirn and co-authors (Hyungseop Kim, the Incremental Prognostic Value of C-Reactive Protein and N-Terminal ProB-Type Natriuretic Peptide in Acute Coronary Syndrome // Circ J. - 2006. - 70. - P.1379-1384).

This method is based on determining the levels of N-terminal predecessor natriuretic peptide (NTproBNP), high-sensitivity C-reactive protein (hsCRP) and Troponin I in the blood at the time of admission of patient with THEM. Patients with ur what vname hsCRP> 3.5 mg/l and NTproBNP>PG/ml were included in the high-risk group for the development of CH and other serious adverse outcomes.

The lack of similar, from the point of view of the authors of the proposed method is the lack of sensitivity of the method for predicting post-infarction remodeling of the myocardium, as assessed combined endpoint including cardiac death, including re, hospitalization for unstable angina, occurrence or progression of HF.

In addition, the results of myocardium was estimated at an average of 1 year from inclusion in the study. The NTproBNP levels and hsCRP, used for carrying out the forecast was assessed at admission patients with ACS and in this moment reflected the acute process of remodeling associated with ischemia, injury and expansion of the myocardium.

As a prototype, the closest technical nature, we have chosen a method for predicting post-infarction remodeling of the myocardium of the left ventricle, the proposed Dominic Kelly et al. (Dominic Kelly. Plasma tissue inhibitor of metalloproteinase-1 and matrix metalloproteinase-9: novel indicators of left ventricular remodeling and prognosis after acute myocardial infarction/Dominic Kelly et al. // European Heart Journal. - 2008. - Vol.29. - No. 17. - P.2116-2124).

The authors of the prototype, we analyzed the relationship between the parameters of ECHOCARDIOGRAPHY (ejection fraction (EF) of the left ventricle, the change in end-diastolic (BWW) and of course-Sisto is systematic volume (CSR) LV, movement of the free wall of the left ventricle during ECHOCARDIOGRAPHY during hospitalization and in the dynamics after 6 months), outcomes for THEM and the levels of tissue inhibitor of matrix metalloproteinase-1 (TMR), matrix metalloproteinase 9 (MMR), comparing them with the level of NTproBNP. Predictive model showed an independent prognostic value for LVEF during hospitalization levels TMR, MMR, NTproBNP and LVEF after 6 months - only levels TMR and NTproBNP. In patients with levels of TIMP-1 over 135 ng/ml or NTproBNP more 1472 fmol/ml was high risk endpoints. The sensitivity of the prototype to predict the primary endpoint was to TMR - 39% and for NTproBNP - 34%; specificity TMR - 97% and NTproBNP - 93%; the accuracy of the method for predicting the occurrence of the primary endpoint (including not only hospitalizations with progression of HF due to post-infarction remodeling, and death) subject NTproBNP amounted to 83.7%, TIMP-1 - 88,1%. We calculated the results presented data the forecasting accuracy CH amounted to 64.7% and 69.9 per cent respectively.

The disadvantages of the method, we have chosen as a prototype, is its low accuracy for predicting CH. When conducting correlation analysis the correlation coefficient between the levels of TIMP1, MMR, NTproBNP and ECHOCG parameters that assess remodeling, the most cases was less than 0.25, indicating a weak correlation. When statistical analysis was not taken into account the actual values of the concentrations of TIMP1, MMR, NTproBNP, and their decimal logarithms. Also during the development of this method in the study group did not include patients undergoing primary percutaneous intervention with the aim coronary revascularization, which limits its use.

The technical result of the invention is to improve the effectiveness of forecasting postinfarction remodeling of the myocardium of the left ventricle in patients with THEM by increasing the accuracy of the method, as well as an assessment of the forecast postinfarction remodeling of the myocardium of the left ventricle 3 months after the onset of the disease.

The technical result of the invention is achieved by the fact that within 3-5 days THEY patients are conducting a study of blood and assess laboratory values of NTproBNP level, PG/ml, MR, ng/ml, and hsCRP, mg/l, the precursor of matrix metalloproteinase 1 (proMMPl), ng/ml, the content of monocytes, %, and predict post-infarction remodeling of the myocardium of the left ventricle in patients with THEM according to the formula: K=0,009×MR+0,00032×NTproBNP+0,15×m+0,03×proMMP1+0,08×hsCRP is 5.4, which is a prognostic index postinfarction remodeling of the myocardium of the left ventricle, MMR - level matrix metalloproteinase 9, ng/ml, NTproBNP level N-terminal precursor of brain natriuretic peptide, n is/ml, proMMP1 - level predecessor matrix metalloproteinases 1, ng/ml hsCRP level of high-sensitivity C-reactive protein, mg/l, CH - contents monocytes,%. When K>-0,85 predict a high risk post-infarction remodeling of the myocardium of the left ventricle in patients with THEM.

The main features of the proposed method are:

- patients THEY carry out a further assessment of the values of hsCRP, mg/l, lomr-1, ng/ml, and the content of monocytes, %;

- assessment of all laboratory parameters, i.e. NTproBNP levels, PG/ml) hsCRP, mg/l, MMP-9, ng/ml, lomr-1, ng/ml, and the content of monocytes, %, estimated at 3-5 days of illness.

- predict the risk of post-infarction remodeling of the myocardium of the left ventricle in patients with THEM according to the formula: K=0,009×MR+0,00032×NTproBNP+0,15×m+0,03×proMMP1+0,08 × hsCRP and 5.4, where K is a prognostic index postinfarction remodeling of the myocardium of the left ventricle, MMR - level matrix metalloproteinase 9, ng/ml, NTproBNP level N-terminal precursor of brain natriuretic peptide, PG/ml, proMMP1 - level predecessor matrix metalloproteinases 1, ng/ml hsCRP level of high-sensitivity C-reactive protein, mg/l, m - the content of monocytes, %;

when K>-0,85 predict a high risk of development of post-infarction remodeling of the myocardium of the left ventricle in patients with THEM.

The method is as follows.

Within 3-5 days And the patient collect 8 ml of venous blood. Definition of levels proMMP1, MMR and TIMP-1 is performed using the standard method immunofermentnogo analysis (BIO-RAD 680) using standard enzyme immunoassay systems eBioscience" (MMP-9 and TIMP-1) and R&D Systems (lomr-1). The content of NTproBNP define a standard method electrochemiluminescent immunoassay (automatic analyzer Elecsys 2010), using the test-systems "Roshe". The level of hsCRP define a standard immunoturbidimetric method with latex amplification of the particles (the instrument COBAS INTEGRA 400 plus) using a set of reagents firm "Roshe". The count of monocytes conduct when performing clinical blood analysis (auto Hematology analyzer LH 500 company Beckman Coulter).

With these results, calculate the coefficient according to the formula K=0,009×MR+0,00032×NTproBNP+0,15×m+0,03×proMMP1+0,08×hsCRP and 5.4, where K is a prognostic index postinfarction remodeling of the myocardium of the left ventricle in patients with THEM, MMR - level matrix metalloproteinase 9, ng/ml, NTproBNP level N-terminal precursor of brain natriuretic peptide, PG/ml, proMMP1 - level predecessor matrix metalloproteinases 1, ng/ml hsCRP level of high-sensitivity C-reactive protein, mg/l, m - content of monocytes,%. When the value of the coefficient K>-0,85 predict a high risk post-infarction remodeling of the myocardium of the left ventricle in patients with THEM.

ricino-effect relationship between salient characteristics and achieve the result

In response to the loss of muscle mass with THEM on the remaining cardiomyocytes decreases increasing the load, resulting in developing their compensatory hypertrophy (Rumberger JA. Ventricular dilatation and remodeling after myocardial infarction / Rumberger JA et al. // Mayo Clin Proc. - 1994. - Jul. No. 69(7). - P. 664-74). Muscle mass of the left ventricle increases without increasing the number of myocardial cells. While other cells are able to share in response to molecular signals caused by adverse factors, the myocytes are capable of responding only hypertrophy. The volume of myocytes after THEM is significantly increased compared to baseline. After myocardial damage amplification processes of apoptosis, and in the initial stages it is the starting point of hypertrophy. Triggers apoptosis are cytokines, especially tumor necrosis factor-alpha and interleukins), oxidative stress and damage to the mitochondria (Necasova T.A. Remodeling of the left ventricle: pathogenesis and evaluation methods. /Tasedunova, Youraba, Niyazmatov. // Medical news. - 2008. No. 11. - P.7-13). To maintain the pumping function of the myocardium in terms of weight reducing, decreasing myocardial stretch of viable myocardium and increase the LV cavity, its adaptive Tonawanda dilatation and eccentric hypertrophy of the myocardium. The increase in MLC leads to the progression of the races is Irene cavity of the left ventricle. Over time, compensatory ability of the myocardium to overcome the growing loads exhausted, and a significant portion of patients Tonawanda dilation is transformed into a progressive myogenic, resulting in change of the geometrical shape of the left ventricle, a sharp increase in the voltage of its walls, and, as a consequence, the decrease of pump function. The increase in diameter (due to pererasseyaniya walls) and pressure in the left ventricle during the reconstruction after THEM lead to increased concentrations of natriuretic peptides. Despite the increase in NTproBNP, in the further course of the remodeling of the myocardium may be different, with a favorable or unfavorable outcome.

The rate of progression of postinfarction LV dilatation depends not only on the size of THEM, localization, volume of viable myocardium, the severity of hypertrophy of cardiomyocytes, but also on the state of the extracellular matrix (ECM). ECM takes up 25% of the mass of the entire LV and consists of collagen fibers (1, 3, 4 types), glycoproteinoses and signaling molecules in the norm provides a holistic and coordinated contraction of the myocardium (kapelko VI Remodeling of the myocardium: role of matrix metalloproteinases. /Vigarello // Cardiology. - 2001. No. 6. 49 - 55). On the degradation of collagen is affected by various factors, but their action is mediated through the system matrix of metallopro eines (MMP) and their inhibitors (TIMP). (F.G. Spinale Myocardial Matrix Remodeling and the Matrix Metalloproteinases: Influence on Cardiac Form and Function / F.G. Spinale // Physiol Rev. - 2007. - October. No. 1. - Vol.87(4). - P. 1285 - 1342). Proinflammatory cytokines, such as interleukin-1, -6, transforming growth factor, tumor necrosis factor - alpha, and others, can stimulate the synthesis of MMP (Creemers HER. Matrix metalloproteinase inhibition after myocardial infarction: a new approach to prevent heart failure?/Creemers EE, Cleutjens JP, Smits JF, Daemen MJ // Circ Res. - 2001. - Aug 3. - Vol.89(3). - P. 201-210.; Martinez Rosas M. Cardiac remodeling and inflammation/Martinez Rosas M. // Arch Cardiol Mex. - 2006. Oct - Dec. - No. 76. - Suppl 4. - P.58-66). Currently known about 26 types of DFID, which, depending on destructible-type of collagen, divided into 4 types: collagenase (MMP-1, 8,13), stromelysin (MMD-3, 7, 10, 11), gelatinase (MMP-2, 9) and membrane-type MMP, which are secreted active and localized on the cell membrane. Other MMP are secreted in an inactive form in the extracellular space, they will be detected as proenzymes (pro-MMPs) and are activated by a cascade of specific biochemical reactions ("cysteine switch") (Malemud CJ. Matrix metalloproteinases (MMPs) in health and disease: an overview/Malemud CJ. // Front Biosci. - 2006. - May. No. 1 (11). - P.1696-1701). The main MMP involved in the destruction ECM attack, according to many studies (F.G. Spinale Myocardial Matrix Remodeling and the Matrix Metalloproteinases: Influence on Cardiac Form and Function/F.G. Spinale // Physiol Rev. - 2007. - October. No. 1. - Vol.87(4). - P.1285-1342), are MMP - 1, 2, 9. Active MMP can be deprived of their proteolytic activity of PU is eat decontamination using TIMP. Identified 4 main types of TIMP, the most studied of which are the TIMP-1 and TIMP-2 and TIMP-1 is a universal inhibitor of most MMP.

In the early stages to THEM the destruction of collagen facilitates the implementation of inflammatory cells and fibroblasts in the damage zone. Subsequently, the newly formed ECM provides in the infarction zone linking viable bundles of myocytes and creates a structure that can ensure the rigidity and elasticity of the myocardium during contraction of the left ventricle. Violation patterns ECM leads to thinning of the LV wall and the "slippage" of the muscle fibers during contraction, and, consequently, to its dilatation and dysfunction, the clinical manifestations of CH. Conducted studies on the dynamics of changes in the levels of MMP, which showed that the concentration MMR and proMMPl reach a second peak at 3-5 days (F.G. Spinale Myocardial Matrix Remodeling and the Matrix Metalloproteinases: Influence on Cardiac Form and Function/F.G. Spinale // Physiol Rev. - 2007. - October. No. 1. - Vol.87(4). - P.1285-1342). Also several studies have noted a relationship between high levels MMR, TIMP-1 and increased end-diastolic dimension (CRA), a decrease in LVEF after 6 months in patients after THEM. (Kelly D. Plasma matrix metalloproteinase-9 and left ventricular remodelling after acute myocardial infarction in man: a prospective cohort study /Kelly D, et al. // Eur Heart J. - 2007. - Mar. No. 28 (6). - P.711-718).

In the present method as a final point chosen in fact p is sweetie postinfarction remodeling of the myocardium of the left ventricle, confirmed clinical and ECHOCARDIOGRAPHY data, which is a significant difference from other methods of forecasting that takes into account the combined endpoint, including not only the development of remodeling of the myocardium of the left ventricle and the appearance of clinical signs SN, but also cases of cardiac death, re-NAMED, hospitalizations due to worsening of angina, which undoubtedly reduces the accuracy of the prediction remodeling. In addition, when developing ways analogues in the study group did not include patients undergoing primary percutaneous intervention with the aim coronary revascularization, which limits their application. The use of prototype and analogues as predictors of post-infarction remodeling of the myocardium of the left ventricle in patients NAMED individual indicators (only NTproBNP or hsCRP, MMP9), apparently also reduced the overall accuracy of the prediction results. In the inventive method of improving the accuracy of the forecast is ensured by a comprehensive approach to its evaluation.

The essential distinguishing features is new and allows, in comparison with the prototype, to improve the effectiveness of forecasting the development of postinfarction remodeling of the myocardium of the left ventricle in patients with THEM by increasing the accuracy of the method and evaluation of forecast h is RES 3 months after you moved THEM.

Examples from clinical practice

Example 1

Patient, 56 years, and/b 14913

Hospitalized in connection with the development of the debut of coronary artery disease in acute myocardial infarction of the anterior-lateral wall of LV 01.10.09 was Done systemic thrombolysis in the first hours THEY are not effective on the EKG. 01.10.09, the patient fulfilled the diagnostic coronary angiography (CAG), which revealed occlusion of a blood clot prednamerennoe artery (LAD) in the proximal third, other artery - without hemodynamically significant stenosis. Simultaneously performed angioplasty and stenting of the LAD, in the area of stenosis of the implanted stent "Zeta" 3,0*13 mm In the control of CAG no injuries, standing stent is correct, the flow TIMI-III.

According to ECHOCARDIOGRAPHY on the 5th day THEY (the apparatus Phillips Sonos 5500) revealed moderate dilatation of the LV cavity (index CRA LV (ICDR) 33 mm/m2index BWW (ICDO) 69,7 ml/m2), akinesia front of the interventricular septum, akinesia tops with elements dyskinesia, PV=55%, Ve/Va=0,8, diastolic dysfunction on the rigid type. In the future for THEM without complications, angina syndrome not had anticipated, the effects of CH on level 1 functional class (FC). The patient for further rehabilitation on the 14th day of the disease transferred in cardiological sanatorium.

Identified markers of remodeling on the 4th day of the disease. Level lomr 1 is left 14.2 ng/ml, MMR - 403,5 ng/ml, NTproBNP - 1903 PG/ml hsCRP - are 11.62 mg/l, monocytes - 12.7%), and TIMP-1 - 632,26 ng/ml.

When calculating the developed formula K=0,009×MR+0,00032×NTproBNP+0,15×m+0,03×proMMPI+0,08×hsCRP-5,4 K=2,14, which indicates a high risk post-infarction remodeling of the myocardium in this patient 3 months after transferred.

In the method prototype for this patient is at high risk of developing post-infarction remodeling of the myocardium of the left ventricle in 6 months, since the level of TIMP-1>135 ng/ml.

When re-examination after 3 months in a patient taking the recommended corresponding to modern standards of therapy clinically progression phenomena SN up to level 2 FC, anginal attacks have been noted. When performing ECHOCARDIOGRAPHY in the dynamics (apparatus Phillips Sonos 5500) progression of myocardium of the left ventricle (ICDR=36 mm/m2ICDO=78 ml/m2akinesia front of the interventricular septum and apex of LV, PV=43%, Ve/Va=1,2, diastolic dysfunction on pseudonormal type).

This example shows that the inventive method allows to predict high-risk post-infarction remodeling of the myocardium of the left ventricle after 3 months the patient to THEM.

Example 2

Patient K., 38, and/b 12559

Hospitalized in the clinic of cardiology with a diagnosis of penetrating myocardial infarction of posterior-lateral wall of LV from 26.08.09, urgently whom the order is made systemic thrombolysis, which was not effectively carried out "rescue" angioplasty and stenting infektsionnoi artery (right coronary artery). For THEM without complications. According to ECHOCARDIOGRAPHY (apparatus Phillips Sonos 5500) on the 5th day of the disease: ICT=24 mm/m2ICDO=65 ml/m2, hypokinesia bottom-side wall, PV=70%, Ve/Va=0.7 and diastolic dysfunction in the rigid type.

Plasma indicators on the 4th day of the disease: proMMP-1 - of 10.9 ng/ml, MMR - 426,1 ng/ml, NTproBNP - 634,2 PG/ml hsCRP - 22,48 mg/l, monocytes - 7,9%, TIMP-1 - 675,57 ng/ml.

On the 13th day of the disease the patient was transferred for further treatment in cardiology resort. Recommended therapy consistent with contemporary standards.

The coefficient is calculated according to the formula: K=0,009×MR+0,00032×NTproBNP+0,15×m+0,03×proMMP1+0,08×hsCRP is 5.4. K=1,95, which indicates a high risk post-infarction remodeling of the myocardium of the left ventricle in the patient 3 months after transferred.

The Outlook on the way the prototype: this patient is a high risk post-infarction remodeling of the myocardium after 6 months, since the level of TIMP-1>135 ng/ml.

In the dynamics after 3 months when performing ECHOCARDIOGRAPHY (apparatus Phillips Sonos 5500) noted the growing phenomena of LV remodeling (ICDR=27 mm/m2ICDO=77 ml/m2akinesia front of the interventricular septum and apex of LV, PV=56%, Ve/Va=1,1, diastolic dysfunctio pseudonormal type).

This example shows that the inventive method allows to predict high-risk post-infarction remodeling of the myocardium of the left ventricle in 3 months after you moved THEM.

Example 3

Patient L., 41, and/b 2925

Hospitalized urgently diagnosed with Q - myocardial infarction of the anterior-lateral wall of the left ventricle from 16.11.10, In the first 24 hours performed coronary angiography, which revealed subocclusive LAD in the middle third. Simultaneously performed angioplasty and stenting of the LAD, in a zone of subocclusive implanted stent Liberte 2,5*20 mm Liberte 3.5*12.0 performed balloon angioplasty mouth of the diagonal branch. When the control koronaroangiografii standing stents correct, no damage, blood TM-III.

According to ECHOCARDIOGRAPHY on the 5th day of the disease (apparatus Phillips Sonos 5500) identified akinesia the apex of the left ventricle, the heart cavity is not expanded, significant intracardiac hemodynamics is not revealed (ICDR=23 mm/m2ICDO=57 ml/m2, PV=62%, Ve/Va=0.7)and diastolic dysfunction of LV on the rigid type.

Plasma indicators on the 4th day of the disease: proMMPI and 2.9 ng/ml, MMP-9 - 297,4 ng/ml, NTproBNP - 866 PG/ml hsCRP - 10,34 mg/l, monocytes and 4.4%, TIMP-1 - 1019,52 ng/ml.

The coefficient is calculated according to the formula K=0,009×MR+0,00032×NTproBNP+0,15×m+0,03×proMMP1+0,08×hsCRP is 5.4. K=-0,87, which is less than the threshold value and indicates a low risk of adverse remodeling of myocardium

The Outlook on the way the prototype for this patient at high risk post-infarction remodeling of the myocardium of the left ventricle, since the level of TIMP-1>135 ng/ml.

Further on the background of the recommended therapy of angina pain not had anticipated, the effects of CH on level 1 FC.

In the dynamics after 3 months and again after 6 months) health without degradation. According to ECHOCARDIOGRAPHY (apparatus Phillips Sonos 5500): ICT=23 mm/m2ICDO=54 ml/m2, PV=69%, Ve/Va=0,83, diastolic dysfunction on the rigid type, small hypokinesia apex of the left ventricle.

This example shows that patients with low-risk post-infarction remodeling of the myocardium of the left ventricle, with the re-examination after 3 months marked devolution ECHOCARDIOGRAPHY-remodeling confirmed after 6 months. The data obtained in the calculation of risk using the prototype had a false value as the expected development of postinfarction remodeling of the myocardium in this case was not observed, and, in addition, was marked regression phenomena remodeling of the left ventricle.

Prediction of post-infarction remodeling of the myocardium of the left ventricle in patients THEY performed taking into account the developed prognostic factor. Predictive model development evaluation of myocardium in patients with MI (p=0,0004) was built when carrying out step-by-step discriminan the aqueous analysis. In the course of its implementation were evaluated as potential influence on the process of myocardium the extent of the damage (Troponin T, MB fraction of creatine phosphokinase), the severity of the inflammatory response (levels of leukocytes, monocytes, hsCRP), system activity of MMP and their inhibitors (proMMP1, MMP9, TIMP-1), NTproBNP.

When testing a predictor postinfarction remodeling of the myocardium of the left ventricle in patients with THEM in control group was included 136 patients with mi admitted to the clinic of cardiology. Of these 111 men, 25 women. The average age of the patients was 56,7±8,0 years. In 92 patients were diagnosed with Q-THEM. The study did not include patients older than 75 years, patients with current severe comorbidity that could affect the levels of the investigated markers (renal, hepatic, respiratory failure, cancer, acute inflammation, autoimmune diseases, allergic reaction, the presence of cardiomyopathy neishemicescoy Genesis, valvular heart disease), acute or chronic exogenous intoxication, refused to participate in the study.

In all patients, the prediction of post-infarction remodeling of the myocardium of the left ventricle was conducted on the present method and according to the prototype.

By the present method is a high risk of postinfarction remodelers is of the LV myocardium 3 months after transferred was estimated at 121 patient with THEM (89%) of all examined patients, and low risk in 15 (11%). The prediction was confirmed in 106 patients, the accuracy of the prediction was 78.0%.

According to the prototype based on the obtained values of NTproBNP high risk post-infarction remodeling of the myocardium of the left ventricle was predicted in 2 patients (1.5%)and low risk of myocardium LV - 134 (98.5 per cent). The prediction was confirmed in 26 patients, the accuracy of the prediction is 19.1%.

According to the prototype based on the obtained levels TMR high risk post-infarction remodeling of the myocardium of the left ventricle was predicted in 130 patients (95,6%), and lowest in 6 patients (4.4 per cent). The prediction was confirmed in 91 patients, the accuracy of the prediction - 66,9%.

Thus, the claimed method for predicting post-infarction remodeling of the myocardium of the left ventricle in patients with THEM improves the accuracy of the forecast, compared with the method prototype, 58.9% (compared taking into account only the values of NTproBNP) and 11.1% (compared with only values TMR).

The inventive method allows to predict the development of post-infarction LV remodeling after 3 months after you moved THEM, unlike 6-12 months in the prototype and equivalents.

A brief comparative description of the described methods for predicting post-infarction remodeling of the myocardium of the left ventricle (according to the authors of the prototype, analogues and the proposed method) are presented in the Table.

As follows from the table, Appl is radiated to the invention, compared with the prototype, as well as analogs, increases the efficiency of the method for predicting the development of postinfarction remodeling of the myocardium of the left ventricle in patients with THEM by increasing the accuracy of the method and evaluation of forecast 3 months after transferred.

Comparative characteristics of the described methods for predicting post-infarction remodeling of the myocardium of the left ventricle in patients of THEM (according to the authors of the prototype, analogues and the proposed method)
The method of forecastingThe number of patientsPredictorThe method and timing of the evaluation remodeling and endpointAccuracy
The inventive method136NTproBNP, hsCRP, proMMP-1, MMP-9, monocytesClinical assessment+ECHOCARDIOGRAPHY in 3-month Remodeling of myocardium78%
Dominic Kelly et al. (prototype)404NTproBNP, TIMP1, MMP9Clinical assessment+ECHOCARDIOGRAPHY 6 months Combined pointNTproBNP is 6.7% TMR - 69,9%
Bernstein L.L. (similar)187The combination of enzymatic, ECG and ECHOCG-criteriaClinical assessment+ECHOCARDIOGRAPHY in 6-12 months Remodeling of myocardiumThe accuracy of the predictive model as a whole is not specified
Milasinovic SI et al.(similar)no dataThe concentration of lactate in plasma and the activity of myeloperoxidaseClinical evaluation Method evaluates the severity of HF, and not forecastNo data
Hyung-seop Kirn et al. (similar)215NTproBNP, hsCRP, Troponin IECHOCARDIOGRAPHY 12 months Combined pointhsCRP - 65.6% of NTproBNP to 58.6%

A method for predicting post-infarction remodeling of the myocardium of the left ventricle (LV) in patients with myocardial infarction (mi) by examining the blood in these patients, and the subsequent evaluation of laboratory performance level N-terminal precursor of brain natriuretic peptide (NTproBNP), PG/ml, matrix metalloproteinase 9 (MMR), ng/ml, characterized in that additionally the preliminary assessment of the level of high-sensitivity C-reactive protein (hsCRP), mg/l, the precursor of matrix metalloproteinase 1 (proMMPl), ng/ml, the content of monocytes, %, all the indicators analyzed within 3-5 days of illness and predict remodeling of the myocardium of the left ventricle in patients with THEM according to the formula: K=0,009·MMP9+0,00032·NTproBNP+0,15·m+0,03·proMMPI+0,08·hsCRP is 5.4, where K is a prognostic index postinfarction remodeling of the myocardium of the left ventricle, MMR - level matrix metalloproteinase 9, ng/ml, NTproBNP level N-terminal precursor of brain natriuretic peptide, PG/ml, proMMPI - level predecessor matrix metalloproteinases 1, ng/ml hsCRP level of high-sensitivity C-reactive protein, mg/l, m - contents Manolov, %, and when set To>-0,85 predict a high risk post-infarction remodeling of the myocardium of the left ventricle in patients with THEM.



 

Same patents:

FIELD: medicine.

SUBSTANCE: life-time differential diagnostic technique for Ascaris lumbricoides and Ascaris suum involves ascarid egg sampling on a slide, clearing in the mixture of 98.5% glycerol of density 1.256 and 40% lactic acid taken in proportions 1:1 then the eggs are covered with a cover slip and examined under the microscope at magnifications: 600 and 900 under immersion; for the purpose of diagnosing, the microstructural differences of eggs are determined, and ascarid types are differentiated by the following signs: Ascaris lumbricoides in the 1-st version: has a stylette on one pole; and on the other one: a cone-shaped metallic cap embraced by microstructure ends extending from the 2-nd shell from the opposite pole; the 2-nd shell: on one side - erased pimples; on the other side - flat, leaflike ones; in the 2-nd version: the cap is brush-shaped with its thin leg connected to an embryo through a gap drawn apart and a lifter hook-like gate of the 2-nd shell, in a basal portion - yellowish-white: a tooth-like plate; on the other one: a hole is open on the pole; the 3-rd shell functions as a plug; has 3 pimples; the 2-nd shell: 2 coupled ovals, fringed borders and grooved pimples; Ascaris suum the 1-st version: has the cap with 2 pimples on an apex on one of the poles and 3 tooth-like projections in the basal portion; on the other one: a slightly pointed pole; the 2-nd version: the 2-nd shell, the embryo: an evident pimpling; one pole is densely covered with large pimples; on the other one, the stylette with the microstructure in the form of a predatory animal head coupled with the 2-nd dense shell.

EFFECT: technique provides life-time ascarid differentiation by egg microstructure to type: Ascaris lumbricoides and Ascaris suum.

1 ex, 8 dwg

FIELD: medicine.

SUBSTANCE: technique involves whipworm egg sampling on a slide, clearing in the mixture of 98.5% glycerol of density 1.256 and 40% lactic acid taken in proportions 1:1 then the eggs are covered with a cover slip and examined under the microscope at magnifications 600, 1200 and 900 under immersion. The microstructural differences of eggs are determined, and whipworms are differentiated by the following signs: Trichocephalus trichiurus have high, thin-neck and wide-cap plugs on sharp-pointed egg poles; the 1-st external transparent cover encloses the whole egg and is visible close to the poles in the form of a transparent disk, or on the plug caps; the plug necks are helically-formed and has 4 rings; the 3-rd ring counting from an apical ring is dome-shaped thereby differing from the previous 2 rings; the 4-th ring can be transparent, or keratised: function as a linker between a base of the plug neck and the 4-th embryo shell; there are spines visible on the 2-nd keratised shell; the egg poles comprise: platelike spines of various configurations; Trichocephalus suis has short-neck and cap plugs not projecting from an egg surface; on the egg poles, the 1-st transparent shell is visible in the form of a fountain of transparent microstructures extending from the eggs; the helically-formed plug neck with 4 rings; the 4-th ring is dome-shaped and fastens the base of the plug neck to an internal embryo shell; it has: spines on the 2-nd shell, platelike spines and a stylette on the plugs.

EFFECT: technique provides the life-time differentiation of whipworms to types: Trichocephalus trichiums and Trichocephalus suis zoonosis by egg microstructure.

1 ex, 10 dwg

FIELD: medicine.

SUBSTANCE: method for assessing morphofunctional activity of eosinophils in helminthosis involves the determination of eosinophil count, an eosinophil index and an allergisation index with the additional determination of a degree of change of size and functional activity of eosinophils that is followed by the assessment of morphofunctional activity of eosinophils according to a level of specific antibody titre with the absolute eosinophil count calculated by formula wherein N is the eosinophil count calculated in a Fuchs-Rosenthal count chamber; 10 is a potency; 3.2 is the Fuchs-Rosenthal count chamber volume, the eosinophil index (EI) is calculated by formula: wherein Stab.% is a percentage of stab neutrophils; Neutr.% is a percentage of segmented neutrophils; Eos.% is a percentage of eosinophils, the assessment of a degree of allergisation in peripheral blood is calculated by the allergisation index (AI) by formula: wherein Lymph.% is a percentage of lymphocytes; Eos.% is a percentage of eosinophils; Neutr.% is a percentage of neutrophils; Mon.% is a percentage of monocytes; Bas.% is a percentage of basophils, while the degree of change of size and functional activity of eosinophils is stated by a cell contour height, increase of the relative eosinophil count, increase of the absolute eosinophil count, decrease of the specific optical density by red component and decrease of the average eosinophil diametre with a risk of helminthosis stated by increase of the cell contour height more than 400*10-9 m - +4.3, increase of the relative eosinophil count more than 10 - +3.5, increase of the absolute eosinophil count more than 400* 106/l - +3.3, decrease of the specific optical density by red component less than 0.270 - +3.3, decrease of the average eosinophil diametre less than 13.5 mcm - +2.9 and the level of specific antibody titre less than 1:800.

EFFECT: more accurate assessment of morphofunctional activity of eosinophils in helminthosis.

6 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely transfusiology and surgery, and concerns the assessment of the patient's state following packed red blood cell transfusion in critical conditions. For this purpose packed red blood cell transfusion is followed by blood sampling and preparing of a patient's blood serum sample for wedge degradation test. If observing a tongue-like structure in a fascia edge, the further progression of the patient's state is stated to be favourable, while the absence shows the unfavourable state up to lethal outcome.

EFFECT: method provides obtaining reliable information on the patient's state with no other laboratory studies required.

2 ex, 2 dwg

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to oncology. To diagnose cancer and potential resistance of malignant cells to hypoxia, prepared is cell imprint or suspension of cells, for which conditions of hypoxia are created and spectro-flowmetric analysis of said cells in dynamics of development of process of photodestruction of NAD(P)H fluorescence is performed. Conclusion about presence of tumour cells and their potential resistance to hypoxia is made by increase of NAD(P)H fluorescence intensity in conditions of darkness. Conditions of hypoxia are created by placement of cell suspension or cell imprint between two glasses for cytologic analysis. Spectro-flowmetric analysis is carried out in the range 440-470 nm, with length of excitation wave 365-370 nm.

EFFECT: method makes it possible to diagnose cancer and potential resistance of malignant cells to hypoxia.

3 cl, 6 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of sports medicine, namely to methods of laboratory diagnostics. In order to carry out laboratory diagnostics of physical activity level on organism of badminton player athlete, content of calcium and phosphorus in mouth fluid before and after physical activity is determined. If content of calcium and phosphorus before and after physical activity changes by value exceeding 9.0 and 42.9% respectively, high level of physical activity is determined; by value lower than 4.6 and 22.5 respectively, optimal level of physical activity is determined.

EFFECT: method makes it possible to carry out non-invasive laboratory diagnostics of physical activity level on organism of badminton player athlete.

1 dwg, 5 tbl

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to pediatrics. In order to diagnose biliary tract dysfunction in children acetic and propionic acids are determined in blood and saliva by gas-chromatographic method. If concentration of any of two acids in blood: acetic in the range more than 0.3264 to 1.1000 mmol/l, propionic in the range more than 0.0274 to 0.0990 mmol/l and/or if concentration of any of two acids in saliva: acetic in the range more than 0.0683 to 0.5900 mmol/l, propionic in the range more than 0.0066 to 0.0430 mmol/l, biliary tract dysfunction is diagnosed.

EFFECT: method makes it possible to diagnose biliary tract dysfunction in children.

3 ex, 3 tbl

FIELD: medicine.

SUBSTANCE: invention relates to medicine and deals with method of controlling check meter of glucose. Method can be realised in stages, which consist in storing multitude of indices of glucose in memory of check meter, each of glucose indices containing time mark and order code with time mark containing date and time of glucose index registration and order code showing order, in which multitude of glucose indices is stored in memory of check meter; determination whether successively stored glucose indices contain time marks in chronological order, corresponding to order code; and showing that setting of date and time in check meter is not exact, if there exist successively stored glucose indices, which contain time marks, which do not correspond to order index.

EFFECT: invention ensures higher accuracy with minimal complexity.

25 cl, 9 dwg

FIELD: medicine.

SUBSTANCE: method involves preparation of a patient's blood serum sample by drying, grinding and suspending in Vaseline oil; then the sample is examined by infrared spectroscopy in 1200-1000 cm-1 to determine a peak height of absorption bands with maximums 1150, 1130, 1125 cm-1 that is followed by the calculation of the relation of the peak heights with maximum 1150 cm-1 to the peak height with maximum 1130 cm-1 in males and the relation of the peak height with maximum 1150 cm-1 to the peak height with maximum 1125 cm-1 in females. The blood serum sample immediately follows the performed growth surgery, and thereafter in progression, preferentially monthly. If observing increase of the relation of the peak height with maximum 1150 cm-1 to the peak height with maximum 1130 cm-1 in a male patient and the relation of the peak height with maximum 1150 cm-1 to the peak height with maximum 1125 cm-1 in a female patient by the value of 0.5±0.015 as compared to the relation value derived from the previous sample examination, the recurrent cerebral malignant growth is stated.

EFFECT: use of the method enables stating the postoperative recurrent cerebral malignant growth at the early stages.

2 cl, 3 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: method involves preparation of a patient's blood serum sample by drying, grinding and suspending in Vaseline oil; then the sample is examined by infrared spectroscopy in 1200-1000 cm-1 to determine a peak height of absorption bands with maximums 1150, 1130, 1125 cm-1 that is followed by the calculation of the relation of the peak heights with maximum 1150 cm-1 to the peak height with maximum 1130 cm-1 in males and the relation of the peak height with maximum 1150 cm-1 to the peak height with maximum 1125 cm-1 in females. The blood serum sample immediately follows the performed growth surgery, and thereafter in progression, preferentially monthly. If observing increase of the relation of the peak height with maximum 1150 cm-1 to the peak height with maximum 1130 cm-1 in a male patient and the relation of the peak height with maximum 1150 cm-1 to the peak height with maximum 1125 cm-1 in a female patient by the value of 0.5±0.015 as compared to the relation value derived from the previous sample examination, the recurrent cerebral malignant growth is stated.

EFFECT: use of the method enables stating the postoperative recurrent cerebral malignant growth at the early stages.

2 cl, 3 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to functional diagnostics, and can be used in outpatient clinics, centres of preventive medicine, sanatoria, as well as in rooms of rehabilitation medicine in form of computer programme for diagnostics. Estimation of parameters characterising functional state of cardiovascular system, physical state, biochemical status, psychological state, as well as health self-estimation is performed. Values of each parameter, corresponding to the norm, are converted into a single ten-point four-level scale. After that, obtained individual values of each parameter are converted into ten-point scale. On the basis of obtained for each individual parameter values, determined is integral index of: health self-estimation, functional state of cardio-vascular system, physical state, biochemical status, psychological state. Obtained in ten-point scale values of integral indices, which characterise functional state of human body: health self-estimation, functional state of cardio-vascular system, physical state, biochemical status, psychological state are compared with the intervals. Conclusion about their unsatisfactory, satisfactory, good or excellent state is made.

EFFECT: method makes it possible to give quantitative estimation of functional reserves in single integral four-level scale, quantitatively estimate risks of somatic disease development, form conclusion with recommendations on health improvement for people of risk groups and prevention of respective diseases.

1 tbl, 3 dwg

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to oncology. To diagnose cancer and potential resistance of malignant cells to hypoxia, prepared is cell imprint or suspension of cells, for which conditions of hypoxia are created and spectro-flowmetric analysis of said cells in dynamics of development of process of photodestruction of NAD(P)H fluorescence is performed. Conclusion about presence of tumour cells and their potential resistance to hypoxia is made by increase of NAD(P)H fluorescence intensity in conditions of darkness. Conditions of hypoxia are created by placement of cell suspension or cell imprint between two glasses for cytologic analysis. Spectro-flowmetric analysis is carried out in the range 440-470 nm, with length of excitation wave 365-370 nm.

EFFECT: method makes it possible to diagnose cancer and potential resistance of malignant cells to hypoxia.

3 cl, 6 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of sports medicine, namely to methods of laboratory diagnostics. In order to carry out laboratory diagnostics of physical activity level on organism of badminton player athlete, content of calcium and phosphorus in mouth fluid before and after physical activity is determined. If content of calcium and phosphorus before and after physical activity changes by value exceeding 9.0 and 42.9% respectively, high level of physical activity is determined; by value lower than 4.6 and 22.5 respectively, optimal level of physical activity is determined.

EFFECT: method makes it possible to carry out non-invasive laboratory diagnostics of physical activity level on organism of badminton player athlete.

1 dwg, 5 tbl

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to pediatrics. In order to diagnose biliary tract dysfunction in children acetic and propionic acids are determined in blood and saliva by gas-chromatographic method. If concentration of any of two acids in blood: acetic in the range more than 0.3264 to 1.1000 mmol/l, propionic in the range more than 0.0274 to 0.0990 mmol/l and/or if concentration of any of two acids in saliva: acetic in the range more than 0.0683 to 0.5900 mmol/l, propionic in the range more than 0.0066 to 0.0430 mmol/l, biliary tract dysfunction is diagnosed.

EFFECT: method makes it possible to diagnose biliary tract dysfunction in children.

3 ex, 3 tbl

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to dentistry and is intended for estimation of esthetic results of dental treatment. Essential esthetic face characteristics: symmetry of features (S), state of teeth in esthetically important zone (ST), naturalness of mimics (M) and smile (S) are estimated before and after treatment by formula: Ie=(S+ST+M+S):4, where Ie is index of total esthetic result of dental treatment. Estimation in points of each face characteristics is performed on the basis of bilateral contact expertise by scheme "doctor-patient". Quantity of points of each essential face characteristics - feature symmetry, state of teeth in esthetically important zone of oral cavity, mimics naturalness, smile naturalness is determined on the basis of reduction of possible highest mark in 100 points, where one point corresponds to one percent. Total esthetic result is estimated as good, when Ie equals 95-100 points, as satisfactory - from 90 to 94 points and Ie is considered to be unsatisfactory if Ie is less than 90 points.

EFFECT: method makes it possible to increase accuracy of estimation of dental treatment results due to bilateral contact expertise by scheme "doctor-patient" and system of calculation of value of estimation of each essential face characteristics.

3 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. In order to estimate intensity of destructive processes in case of knee joint traumatic injury and prediction of development of post-traumatic arthrosis, content of oxyprolene in determined in rats after modelling of knee joint trauma. Content of protein-bounded oxyprolene in plasma higher than 75 mcmol/l with simultaneous increase of free fraction of oxyprolene higher than 16 mcmol/l testified to active reparation at the background of continuing intensive destruction of collagen structures resulting in deforming osteoarthrosis.

EFFECT: method increases accuracy of estimation of destructive processes intensity in case of traumatic injury of knee joint and prediction of development of post-traumatic arthrosis due to determination of quantitative and fractional content of oxyprolene.

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be used for examination and diagnostics of biological object or its part. Method of examination and diagnostics includes the following stages: image of biological object is obtained, obtained image is calibrated and standardised, computed morphodensitometric analysis is performed. For this purpose zones of interest are identified on obtained image, required ranges of charcteristics of signal intensity are determined by fixed distribution of characteristics of irradiation interaction with substance on image, graphic presentation of distribution of intensities of image elements is formed with possibility of superposition of graphic presentation on image. After that, morphometric and densitometric parameters of image are determined, said parameters of examined object are compared with analogous parameters of reference group and decision about condition of examined object is taken on the basis of comparison results. When image of biological object is obtained, shooting of examined object is performed with additional application of illuminator with changeable emission spectrum. Source of illumination is moved on circumference around object of examination and angle of ray incidence is changed discretely at each following circle due to movement of illuminator, shooting is performed and series of object images in different spectrums of illumination for each position of illumination source is obtained, calibration of light intensity is performed in different spectrums of illumination. After that, several pictures of image are accumulated with further obtaining by said pictures average image for each version of illuminator spectrum separately, graphic presentation of distribution of intensities of image elements is performed in form of histogram. Histogram is performed with possibility of linearise and expanding in automatic, interactive modes.

EFFECT: application of claimed invention will make it possible to increase accuracy and hardness of obtained images of examined objects, and due to it obtain more objective picture of changes in biological object at the level of its structure.

7 cl

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to phthisiology. In order to carry out differential diagnostics X-ray examination of patient's lungs and laboratory test of blood parameters are performed. In case if inhomogeneous and highly-intensive infiltration of lung tissue is detected, level of cortisol in blood serum is additionally determined, and if its value is from 808 nmol/l to 2500 nmol/l, caseous pneumonia is diagnosed, if value is from 159 nmol/l to 718 nmol/l, infiltrative tuberculosis of lungs is diagnosed.

EFFECT: method increases accuracy of differential diagnostics of caseous pneumonia due to determination of level of cortisol in blood serum.

2 ex

FIELD: medicine.

SUBSTANCE: stage of atopic dermatitis in children is diagnosed by immunobiological assay of patient's peripheral blood. A degree of lymphocyte expression of CD95+ markers is evaluated. If the CD95+ value exceeds 60.09% enables diagnosing an acute stage of the disease, while the CD95+ values 20.33% to 60.09% shows a chronic stage.

EFFECT: well-timed prediction of the clinical course ensured by accuracy and acceleration of dianosis of transmission of the acute stage of atopic dermatitis in children into the chronic stage.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely endocrinology and diabetology. The clinical course of diabetes mellitus is predicted by evaluating the following risk factors: tongue rolling, myopia, jug ears, joint hypermobility, platypodia, astenic body, diagonal fold of the earlobe, high skin elasticity, varicosity, visceroptosia, height/span > 1.1, clinodactyly, mitral valve prolapse, renal cysts, Gothic palate, chest distortion, biliary tract deformation, arachnodactylia, false left-ventricular chordas. If the patients suffering type 1 diabetes mellitus shows 5 or more indicators, a high risk of developing diabetic nephropathy and arterial hypertension is predicted. If the patients suffering type 2 diabetes mellitus shows 5 or more indicators, a high risk of developing ischemic cardiac disease is predicted. If observing 4 or less indicators in the patients suffering types 1 and 2 diabetes mellitus, a minimum risk of the unfavourable clinical course of diabetes mellitus is predicted.

EFFECT: method enables predicting the clinical course of diabetes mellitus in the patients with types 1 and 2 diabetes mellitus on the basis of the indicators of increased dysplastic stigmation.

3 ex

FIELD: medicine, clinical toxicology.

SUBSTANCE: at patient's hospitalization one should gather the data of clinical and laboratory values: on the type of chemical substance, patient's age, data of clinical survey and laboratory values: body temperature, the presence or absence of dysphonia, oliguria being below 30 ml/h, hemoglobinuria, erythrocytic hemolysis, exotoxic shock, glucose level in blood, fibrinogen and creatinine concentration in blood serum, general bilirubin, prothrombin index (PTI), Ph-plasma, the state of blood clotting system. The state of every sign should be evaluated in points to be then summed up and at exceeding the sum of points being above "+20" one should predict unfavorable result. At the sum of "-13" prediction should be stated upon as favorable and at "-13" up to "+20" - prediction is considered to be doubtful.

EFFECT: higher accuracy of prediction.

2 ex, 3 tbl

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