Method for determining probability of preserving myocardium following infarction in patients with acute coronary syndrome

FIELD: medicine.

SUBSTANCE: invention represents a method for determining a probability of preserving the myocardium following infarction by creating an admission examination-based data array of 7 peripheral blood parameters, 11 biochemical analysis parameters and 6 parameters of standard 12-lead electrocardiogram in 200 patients with the Q-myocardial infarction and 200 patients without the myocardial infarction. The parameters are stratified with respect to 7 intervals, wherein values related to the probability of preserving the myocardium following infarction are derived by calculating a ratio of the patients without myocardial infarction to all the patients with acute coronary syndrome. The probability is evaluated in a specific patient by analysing the above parameters, searching the respective intervals and values related to the probability of preserving the myocardium in the data array. Summing up the derived values enables calculating an integrated index, which is normalised, and a dimension from 0 to 100% is reduced.

EFFECT: invention enables increasing the prediction accuracy of preserving the myocardium in the patients with acute coronary syndrome.

1 tbl, 2 ex

 

The invention relates to medicine, namely to cardiology.

The known method of determining low risk of myocardial infarction in unstable angina (Shamsiev M. R., Z. G. Bondarev, E. A. Aronov, etc. Acute coronary syndrome: diagnostic and prognostic value of troponin I and cardiac enzymes. Cell cycle No. 3(109), 2003) registration of troponin I level below 2 ng/ml. The disadvantage of this method is the lack of numerical information about risk value of infarct damage that makes it difficult to develop a proper treatment strategy.

Also known method for predicting complications of the patient with myocardial infarction (patent RF №2197173), which according to the first day of occurrence of myocardial infarction based on the most unfavourable sign, arterial hypotension, and stroke in anamnesis of dyspnea in 1 day when the respiratory rate to 2 per min, less than or more than 26 breaths per minute, with the development of complete atrioventricular and intraventricular block in the 1st day of myocardial infarction, the average ST-segment elevation after thrombolytic therapy and the value of the constant of the regression equation member of the analysis on a personal computer. Moreover, if the solution of the obtained discriminant equations, the accuracy or the overall percentage of correctness comp�fork of 95.6%, the value of the first equation for surviving patients is higher, then the probability of 96.8% is determined that the patient survives the acute phase of the disease, and if there be more than the value of the second equation, then with probability at 78.6 predict that lethal outcome in the acute period of myocardial infarction. The disadvantages of this method are the difficulty and the lack of accuracy of diagnosis of myocardial infarction in the first day of observation, and equalization of all patients on the probability of a favorable outcome in the case of exceeding the values of the first equation above the value of the second, which complicates the selection of medical tactics.

Also known method for the diagnosis in individuals with coronary heart disease possible (subclinical) myocardial infarction or commitment to him (patent RF №2004134078/14). They are using anamnestic size, expressed in points, and is calculated diagnostic index, based on the 20 variables. When the value of the diagnostic indicator equal to 1 or less than 1, is judged on the absence of myocardial infarction and the absence of possible prospects of its development in the near future. The disadvantage of this method is the equation for the probability of preservation of the heart wall from infarct damage to all patients with diagnostic indicator of less than 1 and equal to 1 which makes the decision about hospitalization in the cardiology Department at dynamic observation of patients.

As a prototype, the authors propose a method for determining the risk of myocardial infarction in patients with acute coronary syndrome (RF patent No. 2488111), in which patients with acute coronary syndrome in the study of the 7 parameters of peripheral blood, 11 of biochemical parameters of blood and 6 of a standard 12-channel electrocardiogram using databases find the value associated with the risk of myocardial infarction. Further, summing the values associated with the risk, calculate the integral indicator. Integral indicator normalize, result in dimension from 0 to 100%.

The disadvantage of the prototype is the lack of duplicate prognostic system, prove or disprove the received forecast.

The authors propose a method of determining the probability of preservation of the myocardium from infarction damage in patients with acute coronary syndrome based on the definition 7 of peripheral blood: hemoglobin concentration, the content of leukocytes, band neutrophils, segmented neutrophils, lymphocytes and monocytes in 1 mm3the erythrocyte sedimentation rate, 11 parameters of biochemical analysis: activity aspartataminotranferase and activity alanineaminotransferase, prothrombin index, content in plasma bilirubin, urine�ins, creatinine, β-lipoprotein, total protein, fibrinogen, total cholesterol, glucose, and 6 indicators standard 12-channel electrocardiogram: the difference between the squares of the maximum and minimum RR intervals, the angle alpha, the duration of the P wave, the duration of the PQ interval, the duration of the QRS complex, the duration of the QT interval.

The methodology of the study: to determine the level of hemoglobin is hemichromis method for Navel, V. I. et al. (1998); determination of the number of cells per unit volume of peripheral blood - unified method of counting in the automatic counter, speed of subsidence of erythrocytes - capillary unified microtechnique (ers) (1972). The methodology of the study: the study of the morphological composition of the blood produced by microscopic examination of smears stained by Romanovsky-Giemsa; the determination of the number of stab, segmented neutrophils, lymphocytes and monocytes in the leukocyte count by Garkavi L. H. et al. (1999). Determination of the concentration of bilirubin in serum was performed by colorimetric method with diazoreagent. To determine the activity aspartataminotranferase and alanineaminotransferase used colorimetric dinitrophenylhydrazine method of research activity aminotransferase in serum CRO�and (Reitman, Frenkel, 1957). Determination of the concentration of urea and creatinine in the serum was performed by a color reaction with diacetylmonooxime and color Jaffe reaction (method of Popper et al., 1937), respectively (1972), the content of total protein by colorimetric method with biuret reagent. The level of total cholesterol in serum was determined using a unified method Ilko by reaction with acetic anhydride (reaction Liebermann-of Burkhard), the content of β-lipoprotein - when the electrophoretic separation of lipoproteins of serum in agar gel using electrophoresis systems and sets of reagents company "Karma". Fibrinogen concentration was determined by the gravimetric method according to Rutberg (1974). The concentration of blood glucose was determined by glucose oxydase unified method for the oxidation of tolidine (1974), prothrombin index - Quick. The determination of indicators of 12-lead ECG was performed at the time of registration on hardware-software complex "KAD-03" ("DNA", Tver).

With the PC retrospective analysis subjected 7 parameters of clinical blood analysis, 11 biochemical parameters and 6 parameters of the standard 12-channel electrocardiogram (ECG) on admission in 400 patients with acute coronary syndrome (ACS), 200 of which are in the follow-up in techenieto weeks, the diagnosis of Q-wave myocardial infarction, and other 200 - myocardial infarction did not develop and diagnosed with progressive angina. For each parameter, the performance of patients with myocardial infarction (mi) and indicators in patients with unstable angina (UA) are combined in a single numerical series. Combined numerical rows are sorted, they determine the maximum and minimum numeric value and difference between them. By dividing the obtained difference by the number 4 counting the steps of stratification for each parameter. By successive summation with the minimum numeric value or one, or two, or three steps stratification expect the initial boundary separating the first, second, third and fourth initial intervals for each parameter. The step size stratification divided by the number 4. By calculating the difference between initial boundaries with one-fourth of the stratification step, and of calculating the amount of the initial border of a fourth step of stratification count 6 of the final boundaries of each parameter, separating the first, second, third, fourth, fifth, sixth and seventh final intervals of the parameters, including also the boundary separating the minimum value of the range. The number of patients NS patients with ACS who did not develop THEM) are found, respectively, to the initial interval, divided by the number of patients with acute coronary syndrome�m (the sum of patients with ua and MI), found in the corresponding interval. The result of the division designated by the term "value associated with the probability of surviving from myocardial infarct damage in patients with ACS" (value connected with probability SMIP). In the first, third, fifth and seventh final interval value associated with the probability SMIP, equate respectively to those in the first, second, third and fourth primary intervals. In the second and final interval value associated with the probability SMIP, calculated as average arithmetic value of the first and second start intervals, the fourth final - as the arithmetic average of the second and third primary intervals, in the sixth and final - third and fourth elementary intervals. Thereby form a "database" for a specific region. "Database" for the city of Tver, i.e. the boundaries of the intervals and values within intervals associated with the probability SMIP presented in table 1.

In the "database" of all 400 patients with ACS regardless of his transformation, total quantities related to the probability SMIP, i.e., the integral indicators of probability. Determine the maximum and minimum values of the integral indicator. The maximum value of the integral indicator, found in the "database," 12,996; minim�diesel - 9,063.

The calculation of the probability of SMIP build on tracking the proportion of cases in which not developed infarct damage to the heart wall for 2 weeks, among ACS patients with similar symptoms. Because the accumulation of information about saving from myocardial infarction among similar lesions on symptoms of ACS patients is associated with considerable difficulties, for the calculation of the probability is used the summation of the proportion of cases identified based on a comparison of the number of patients who did not develop THEM, to all patients with ACS within the interval parameter. Thus was achieved the emergence of the law of large numbers and the appearance of a logical value from a summation of a large number of random variables.

Therefore, the algorithm for determining the probability of SMIP a particular patient in the method consists in the following steps. First, determine the values associated with the probability SMIP, i.e. on the basis of clinical and biochemical blood analysis, standard 12-lead ECG in a certain patient searches the "database" of the corresponding interval and the corresponding numerical values associated with probability SMIP. Secondly, carry out the summation of the values associated with probability SMIP, and defining a summation of the integral indicator. Thirdly, the implementation�give the normalization of the integral index, i.e. the translation of the measurement scale from 0% to 100%, based on maximum permitted medical error of 5%. Consider that the minimum value of the integral indicator corresponding to 5% probability, and the maximum value is 95% probability. A numeric array is between 5% and 95% risk is used as the evaluation scale of probability, and 1% probability corresponds to the value 1:

where max is the maximum value of the integral indicator in the "database", a min - the minimum value.

To translate the values of the integral indicator of the probability of preservation of the myocardium in a specific patient with ACS will use the formula 2:

where max is the maximum value of the integral indicator in the "database", min - minimal value, the probability - the probability of SMIP a particular patient, and int. Gen. - the numerical value of the integral indicator of an individual patient.

If it is impossible for any research, for example in the absence of reagents, "database" reduce, i.e. named, unfulfilled research all quantities related to the probability SMIP, equate to zero. Then in the reduced "database" find the maximum and minimum values of the integral indicator. For example, if it is impossible studies�the study prothrombin index maximum value of the integral index in the reduced "database" is 12,488, the minimum value 8,555. If it is impossible to study the levels of β-lipoprotein in serum, the maximum value of the integral index in the reduced "database" is 12,451, the minimum value is 8,569. Found in the reduced "database" maximum and minimum values of the integral indicator and a reduced specific integral index patient is substituted into the formula 2, wherein the calculation result in reduced "database" slightly, within a 5% error, is different from the result of calculation on the full "database".

The study in patients who subsequently developed myocardial infarction (the first group), the average value of the probability SLIP at the time of admission amounted to the value 79,7±0,69%, in patients who developed myocardial infarction (the second group), the average probability SMIP amounted to the value of 56.7±1,15% (when compared with the first group t=17,1). In the first group of 114 patients (57% of the members of the group) the value of the probability SMIP was greater than or equal to 80%), in the second group, only 11 patients (5.5% of the members of the group) probability SMIP was greater than or equal to 80%).

Next, conduct a comparison of the probability SMIP and mi risk, as determined by the algorithm of patent No. 2488111, and if the probability of SLIP defined�was reduced by "database", then reduce and "database" from the patent 2488111, find the maximum and minimum values of the integral indicator of the reduced database and used to calculate the formula 2 of the invention. For comparison initially summarize the value of the probability SMIP and risk to THEM. Next, calculate the difference of the sum from 100%. If the difference is less than 5%, magnitude error, the maximum allowed in medicine, the value of probability SMIP can be left unchanged. If the difference is 5 percent or more, we calculated the average value of the probability SMIP and the result of calculating the difference between 100% and mi risk. The average value is subsequently used as the value of the adjusted forecast.

The final stage of the mapping aims to improve diagnostics. Increased risk of myocardial infarction with a reduction in the probability SMIP, in the proximity of their sum to 100% will be indirectly indicative of myocardial infarction. Reducing the risk of myocardial infarction with increasing probability SMIP in the proximity of their sum to 100%, will indirectly indicate unstable angina. At the same time, the simultaneous increase in mi risk and the probability SMIP or simultaneous decrease when the difference of the sum of 100% of the amount greater than 10%, can cause to doubt the correctness of diagnostic�and, in particular, question the diagnosis of re-analysis, and suggest the development of diseases of different nature, have similar acute coronary syndrome clinical picture, such as pericarditis, aortoarteriit or defeat of aortic atherosclerotic.

Example 1. Patient L., age 66. During a two-week observation and treatment in the cardiology Department of the patient revealed coronary artery disease: new-onset angina of SFC complicated by heart failure IIA degree

At the time of admission to the study:

the hemoglobin level of 70 g/l; interval 1; the value associated with probability SMIP - 0,5;

leucocytes - 4600 1 mm3; interval 1; the value associated with probability SMIP - 0,601;

the erythrocyte sedimentation rate 5 mm/h; interval 1; the value associated with probability SMIP - 0,57;

the content of band neutrophils - 230V 1 mm3; interval 3; the value associated with probability SMIP - 0,453;

the content of segmented neutrophils - 2484 1 mm3; interval 1; the value associated with probability SMIP - 0,7;

the content of lymphocytes - 1472 1 mm3; interval 2; the value associated with probability SMIP - 0,51;

monocytes - 368 1 mm3; interval 2; the value associated with probability SMIP - 0,5;

content in plasma total bilirubin 19 mg/l; interval 2; the value associated with probability SMIP - 0,492;

activity aspartataminotranferase - 0.33 mmol/h·l; interval 1; the value associated with probability SMIP - 0,635;

activity alanineaminotransferase - 0,41 mmol/h·l; interval 2; the value associated with probability SMIP - 0,586;

content in plasma urea - 5.6 mmol/l; interval 1; the value associated with probability SMIP - 0,515;

content in plasma creatinine - 102 µmol/l; interval 2; the value associated with probability SMIP - 0,501;

content in plasma β-lipoprotein - 2700 mg/l; interval 1; the value associated with probability SMIP - 0,5;

content in plasma protein 64 g/l; interval 3; the value associated with probability SMIP - 0,546;

prothrombin index - 84%; interval 5; value connected with probability SMIP - 0,529;

fibrinogen concentration 2 g/l; interval 1; the value associated with probability SMIP - 0,511;

the level of total cholesterol 5.1 mmol/l; interval 3; the value associated with probability SMIP - 0,483;

plasma concentration of blood glucose is 4 mmol/l; interval 1; the value associated with probability SMIP - 0,488;

the difference of the squares of the maximum and minimum RR-intervals with 02; interval 1; the value associated with probability SMIP - 0,567;

the angle alpha plus 58°; interval 5; value connected with probability SMIP to 0.99;

the duration of the P wave - 0.11; spacing 6; value connected with probability SMIP - 0,296;

the duration of the PQ interval 0.15 s; interval 3; the value associated with probability SMIP - 0,511;

the duration of the QRS complex - 0,09; interval 2; the value associated with probability SMIP - 0,507;

the duration of the QT interval to 0.39 s; interval 4; the value associated with probability SMIP - 0,511.

Integral index, the sum values associated with probability SMIP, patient L. is the value 12,604. Substituting the value of the integral indicator in the formula 2, we get the value of the probability SMIP within 2 weeks:

the probability=5+(12,604-9,063):(12,996-9,063)*90=86,0(%).

You will solve mi risk in a patient L., age 66 algorithm patent No. 2488111.

At the time of admission to the study:

the hemoglobin level of 70 g/l; interval 1; the value associated with the risk of mi - 0,5;

leucocytes - 4600 1 mm3; interval 1; the value associated with the risk of mi - 0,399;

the erythrocyte sedimentation rate 5 mm/h; interval 1; the value associated with the risk of mi - 0,425;

the content of band neutrophils - 230V 1 mm3; interval 1; the value associated with the risk of mi - 0,495;

the content of segmented neutrophils - 2484 1 mm3; interval 1; the value associated with the risk of mi - 0,3;

the content of the lymphocyte�in - 1472 1 mm3; interval 2; the value associated with the risk of mi - 0,479;

monocytes - 368 1 mm3; interval 2; the value associated with the risk of mi - 0,488;

content in plasma total bilirubin - 19 mmol/l; interval 1; the value associated with the risk of mi - 0,521;

activity aspartataminotranferase - 0.33 mmol/h·l; interval 1; the value associated with the risk of mi - 0,355;

activity alanineaminotransferase - 0,41 mmol/h·l; interval 1; the value associated with the risk of mi - 0,429;

content in plasma urea - 5.6 mmol/l; interval 1; the value associated with the risk of mi - 0,475;

content in plasma creatinine - 102 µmol/l; interval 2; the value associated with the risk of mi - 0,516;

content in plasma β-lipoprotein - 2700 mg/l; interval 1; the value associated with the risk of mi - 0,489;

content in plasma protein 64 g/l; interval 3; the value associated with the risk of mi to 0.448;

prothrombin index - 84%; interval 5; the value associated with the risk of mi - 0,462;

fibrinogen concentration 2 g/l; interval 1; the value associated with the risk of mi - 0,479;

the level of total cholesterol 5.1 mmol/l; interval 3; the value associated with the risk of mi - 0,497;

plasma concentration of blood glucose is 4 mmol/l; interval 1; the value associated with �claim development - 0,499;

the difference of the squares of the maximum and minimum RR-intervals with 02; interval 1; the value associated with the risk of mi - 0,458;

the angle alpha plus 58°; interval 5; the value associated with the risk of mi - 0,391;

the duration of the P wave - 0.11; spacing 6; the value associated with the risk of mi - read 0.699;

the duration of the PQ interval 0.15 s; interval 3; the value associated with the risk of mi - 0,476;

the duration of the QRS complex - 0,09; interval 2; the value associated with the risk of mi - 0,482;

the duration of the QT interval to 0.39 s; interval 4; the value associated with the risk of mi - 0,478.

The integral indicator, the sum of the quantities associated with the risk of mi, patient L. is the value 11,236. Substituting the value of the integral indicator in the formula patent No. 2488111, get the value of mi risk for 2 weeks:

Risk=5+(int. pok.-10,927)*23,112=5+(11,236-10,927)*23,112=12,1%.

Next, compare the probability of SLIP and the risk to THEM and summarize these quantities. 86 a+12.1=98,1%. The difference of the sum of 100% is 1.9% and less than 5%. Therefore, the probability value is SMIP leave without change, and it is 86%.

Suppose that the patient arose L. the impossibility of conducting research prothrombin index. Then the reduced integral indicator of the patient L. will be (see 5 interval PTY) 12,604-,529=12,075. Using equation 2 and substituting in it the values of the maximum and minimum values of the integral indicator of reduced "database" (12,488 and 8,555), get the value of the probability SMIP within 2 weeks, slightly different from the probabilities calculated for the full "database":

the probability=5+(12,075-8,555):(12,488-8,555)*90=85,5(%).

Similarly calculate the risk of developing THEM reduced from "database" patent No. 2488111. Using the formula 2 patents and substituting in it the values of the maximum and minimum values of the integral indicator of reduced "database" (14,371 and 10,389), get the value of the probability SMIP within 2 weeks, slightly different from the probabilities calculated for the full "database":

the risk=5+(10,774-10,389):(14,381-10,389)*90=13,7(%).

Next, compare the probability of SLIP and the risk to THEM and summarize these quantities. 85,5+13,7=99,2%. The difference of the sum of 100% is 0.8%, so use the probability value of SLIP equal to 85.5%.

At impossibility of carrying out research into the levels of β-lipoprotein in serum reduced integral indicator of the patient L. will be (see 1 interval for β-lipoprotein) 12,604-0,5=12,104. Using formula 2, get the value of the probability SMIP:

the probability=5+(12,104-8,569):(12,451-8,569)*90=87,0(%).

Similarly calculate the risk of mi from reduce�agreed "database" patent No. 2488111. Using the formula 2 of the patent, get the risk to THEM:

the risk=5+(10,747-10,432):(14,331-10,432)*90=13,3(%).

Next, compare the probability of SLIP and the risk to THEM and summarize these quantities. 87,0+13,3=100,3%. The difference of the sum of 100% is 0.3%, so use the probability value of SLIP equal 87,0%.

Patient L. comparison confirms the diagnosis of unstable angina.

Example 2. Patient C., 55 years old. During a two-week observation and treatment in the cardiology Department of the patient revealed a myocardial infarction Antero-septal region of the left ventricle with the transition to the apex of the heart, complicated heart failure 3 FC by Killip.

At the time of admission to the study:

the level of hemoglobin - 158 g/l; interval 6; value connected with probability SMIP - 0,472;

leucocytes - 19800 1 mm3; interval 7; value connected with probability SMIP - 0;

the erythrocyte sedimentation rate of 2 mm/h; interval 1; the value associated with probability SMIP - 0,57;

the content of band neutrophils - 990 1 mm3; interval 7; value connected with probability SMIP - 0;

the content of segmented neutrophils - 15642 1 mm3; interval 7; value connected with probability SMIP - 0,28;

the content of lymphocytes - 2178 1 mm3; interval 3; the value associated with probability SMIP - 0,482;

monocytes - 792 B1 mm 3; interval 4; the value associated with probability SMIP - 0,452;

content in plasma total bilirubin - 11 mmol/l; interval 2; the value associated with probability SMIP - 0,492;

activity aspartataminotranferase to 2.45 mmol/h·l; interval 7; value connected with probability SMIP - 0,125;

activity alanineaminotransferase - 1,44 mmol/h·l; interval 4; the value associated with probability SMIP - 0,275;

content in plasma urea - 11.3 mg/l; interval 2; the value associated with probability SMIP - 0,434;

content in plasma creatinine - 88 µmol/l; interval 2; the value associated with probability SMIP - 0,501;

content in plasma β-lipoprotein - 4400 mg/l; interval 2; the value associated with probability SMIP - 0,495;

content in plasma protein 71 g/l; interval 4; the value associated with probability SMIP - 0,494;

prothrombin index - 95%; spacing 6; value connected with probability SMIP - 0,491;

fibrinogen concentration of 5.75 g/l; interval 6; value connected with probability SMIP - 0,142;

total cholesterol of 6.2 mmol/l; interval 4; the value associated with probability SMIP - 0,522;

concentration in blood plasma glucose of 5 mmol/l; interval 1; the value associated with probability SMIP - 0,488;

the difference of the squares of the maximum and minimum RR-intervals 0,682 with2; interval 3;value, associated with probability SMIP - 0,182;

the angle alpha plus 30°; interval 4; the value associated with probability SMIP - 0,56;

the duration of the P wave is 0.08 seconds; interval 2; the value associated with probability SMIP - 0,474;

the duration of the PQ interval is 0.17 seconds; interval 4; the value associated with probability SMIP - 0,478;

the duration of the QRS complex - 0,09; interval 2; the value associated with probability SMIP - 0,507;

the duration of the QT interval to 0.39 s; interval 4; the value associated with probability SMIP - 0,511.

Integral index, the sum values associated with probability SMIP, the patient P is the magnitude of 9,427. Substituting the value of the integral indicator in the formula 2, we get the value of the probability SMIP within 2 weeks:

the probability=5+(9,427-9,063):(12,996-9,063)*90=13,3(%).

Then carry out the calculation in mi risk in a patient C., 55 years old according to the algorithm of patent No. 2488111.

At the time of admission to the study:

the level of hemoglobin - 158 g/l; interval 6; the value associated with the risk of mi - 0,534;

leucocytes - 19800 1 mm3; interval 7; the value associated with the risk of mi - 1;

the erythrocyte sedimentation rate of 2 mm/h; interval 1; the value associated with the risk of mi - 0,425;

the content of band neutrophils - 990 1 mm3; interval 1; the value associated with the risk of mi - 0,495;

the content SEG�neyadernykh neutrophils - 15642 1 mm3; interval 7; the value associated with the risk of mi - 0,711;

the content of lymphocytes - 2178 1 mm3; interval 3; the value associated with the risk of mi - 0,509;

monocytes - 792 1 mm3; interval 4; the value associated with the risk of mi - 0,538;

content in plasma total bilirubin - 11 mmol/l; interval 1; the value associated with the risk of mi - 0,521;

activity aspartataminotranferase to 2.45 mmol/h·l; interval 7; the value associated with the risk of mi - 0,875;

activity alanineaminotransferase - 1,44 mmol/h·l; interval 3; the value associated with the risk of mi - 0,845;

content in plasma urea - 11.3 mg/l; interval 2; the value associated with the risk of mi - 0,554;

content in plasma creatinine - 88 µmol/l; interval 1; the value associated with the risk of mi - 0,47;

content in plasma β-lipoprotein - 4400 mg/l; interval 2; the value associated with the risk of mi - 0,495;

content in plasma protein 71 g/l; interval 4; the value associated with the risk of mi - 0,496;

prothrombin index - 95%; spacing 6; the value associated with the risk of mi - 0,498;

fibrinogen concentration of 5.75 g/l; interval 6; the value associated with the risk of mi - 0,845;

total cholesterol of 6.2 mmol/l; interval 4; the value associated with the risk�m development - 0,468;

concentration in blood plasma glucose of 5 mmol/l; interval 1; the value associated with the risk of mi - 0,499;

the difference of the squares of the maximum and minimum RR-intervals 0,682 with2; interval 2; the value associated with the risk of mi was 0.608;

the angle alpha plus 30°; interval 4; the value associated with the risk of mi - 0,428;

the duration of the P wave is 0.08 seconds; interval 2; the value associated with the risk of mi - 0,511;

the duration of the PQ interval is 0.17 seconds; interval 4; the value associated with the risk of mi - 0,516;

the duration of the QRS complex - 0,09; interval 2; the value associated with the risk of mi - 0,482;

the duration of the QT interval to 0.39 s; interval 4; the value associated with the risk of mi - 0,478.

The integral indicator, the sum of the quantities associated with the risk of mi, the patient P is the value 13,801. Substituting the value of the integral indicator in the formula patent No. 2488111, get the value of mi risk for 2 weeks in a patient S.:

Risk=5+(int. pok.-10,927)*23,112=5+(13,801-10,927)*23,112=71,4%th

Next, compare the probability of SLIP and the risk to THEM, summarize the values indicated: 13,3+71,4=84,7%. Next, calculate the difference of the sum from 100%. The difference is in the patient P to 15.3% and more than 5%. Therefore, calculated the average value of the probability SMIP and the difference between 100% and mi risk: (13,3+100-71,4)/2=21,0%. Update online, work same�TES the value of the probability of preservation of the myocardium from infarction damage to the patient is S. 21%.

Suppose that the patient had C. have any inability to conduct the study prothrombin index. Then the reduced integral indicator of the patient P will be 9,427-0,491=8,936. Using equation 2 and substituting in it the values of the maximum and minimum values of the integral indicator of reduced "database" (12,488 and 8,555), get the value of the probability SMIP:

the probability=5+(8,936-8,555):(12,488-8,555)*90=13,7(%)

Similarly calculate the risk of developing THEM reduced from "database" patent No. 2488111. Using the formula 2 patents and substituting in it the values of the maximum and minimum values of the integral indicator of reduced "database" (14,371 and 10,389), get the value of mi risk:

the risk=5+(13,303-10,389):(14,381-10,389)*90=70,9(%).

Next, compare the probability of SLIP and the risk to THEM and summarize these quantities. 13,7+70,9=84,6%. The difference of the sum of 100% is 15.4%, so use the average value of the probability SMIP and difference of 100% and a risk to THEM, equal to 21.4%.

At impossibility of carrying out research into the levels of β-lipoprotein in serum reduced integral indicator of the patient P will be 9,427-0,495=8,932. Using formula 2, get the value of the probability SMIP:

the probability=5+(8,932-8,569):(12,451-8,569)*90=13,4(%).

Similarly calculate the risk of mi from the reduced "base d�granted" patent No. 2488111. Using the formula of a patent, get a risk to THEM:

the risk=5+(13,306-10,432):(14,331-10,432)*90=71,3(%)

Next, compare the probability of SLIP and the risk to THEM and summarize these quantities. 13,4+71,3=84,7%. The difference of the sum from 100% to 15.3%, so use the average value of the probability SMIP and the difference between 100% and risk THEM equal to 21.1 per cent.

Patient S. the diagnosis of myocardial infarction should be questioned and re-analysis.

Thus, compared with the prototype of the claimed method has the following advantages:

1. A comparison of the probability SMIP with the risk of myocardial infarction (patent No. 2488111) in the case of separately forming the "databases" helps to clarify the prognosis of ACS.

2. The method allows to calculate the probability of preservation of the myocardium from infarction damage in each patient with acute coronary syndrome and to monitor its dynamics even in case of impossibility of conducting patient research any parameter that is included in the "database".

Method of determining the probability of preservation of the myocardium from infarction damage in patients with acute coronary syndrome, including the formation of a "database" on the basis of a study in 200 patients with acute coronary syndrome who for two weeks had not happened� development infarct myocardial damage, and study in 200 patients with acute coronary syndrome, for transforming a two-week period in the Q-myocardial infarction, 7 of peripheral blood: hemoglobin concentration, the content of leukocytes, band neutrophils, segmented neutrophils, lymphocytes and monocytes in 1 mm3the erythrocyte sedimentation rate, 11 parameters of biochemical analysis: activity aspartataminotranferase and activity alanineaminotransferase, prothrombin index, content in plasma bilirubin, urea, creatinine, β-lipoprotein, total protein, fibrinogen, total cholesterol, glucose, and 6 indicators standard 12-channel electrocardiogram: the difference between the squares of the maximum and minimum RR intervals, the angle alpha, the duration of the P wave, the duration of the PQ interval, the duration of the QRS complex, the duration of the QT interval; stratification respectively 7 intervals and calculation of quantities related to the probability of surviving from myocardial infarction damage determination of the maximum and minimum values of the integral indicator in the "database", as well as finding the probability of preservation of myocardium in an individual patient with acute coronary syndrome, which examined the above 7 parameters of peripheral blood, 11 of biochemical parameters of blood and 6 parametersthat 12-channel electrocardiogram, define "database" value associated with the probability of saving the infarcted myocardium from damage, summarize them, i.e. calculate the integral indicator, and further normalize the integral index by calculating the sum of 5 and works 90 on the ratio of the difference of the integral indicator of a particular patient and its minimum values in the "database" to the difference of the maximum and minimum values of the integral indicator in "database"; characterized in that in order to stay within the ranges of values associated with the probability of saving the infarcted myocardium from damage, and calculate the ratio of patients included in the interval, who did not develop myocardial infarction, all patients with acute coronary syndrome within the interval; in case of impossibility of carrying out any research "database" reduce, that is, for unexplored parameters all quantities related to the probability of preservation of the myocardium, equate to zero, then in a reduced "database" find the maximum and minimum values of the integral index, which is used for normalization.



 

Same patents:

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, namely to immunology, and can be used in laboratory diagnostics, as a test system and a method for measuring interferon alpha (IFN-α) antiviral activity in human blood serum. The test system for measuring IFN-α activity in the human blood serum comprises diploid cells, a virus-containing fluid and standard human interferon-α (IFN-α). As the diploid cells, the test system comprises cells of the characterised line of the diploid cells - human M-20 fibroblasts at 20-33 passages cultured in the medium with added 10% fibrinolytically active plasma (FAP). As the virus, the system contains the A vesicular stomatitis virus (VSV) adapted to M-20 cells, the Indiana strain; the test system additionally contains a viral dye based on two fluorochromes - acriflavine and rhodamine C. The group of inventions also involves a method for measuring IFN-α activity in the human blood serum with the use of the developed system.

EFFECT: using the given inventions enables the quantitative good-reproducible measurement of IFN-α activity in the examined blood serum sampled by the luminescent microscopy of the vital preparations coloured in a fluorochrome-based vital dye.

3 cl, 4 dwg, 1 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: invention describes a diagnostic technique for infected pancreonecrosis with establishing the indications for a surgical intervention by examining a patient, wherein acetic, propionic, butyric and isovaleric acids are measured in the blood by gas chromatography, and if the acetic acid concentration is more than 0.11 mmole/l enables stating infected pancreonecrosis, and if the concentration of any of three acids: propionic more than 0.095 mmole/l, butyric more than 0.0035 mmole/l, isovaleric acid more than 0.0003 mmole/l enables stating infected pancreonecrosis with active development of an anaerobic infection requiring one of versions of the surgical intervention.

EFFECT: invention enables providing the objective and accurate diagnosing of pancreonecrosis transformation into the stage of infection by using the qualitative parameters with no undesired side effects.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to a method of predicting a probability of reduction of the glomerular filtration rate (GFR) after 3 months of observation after aortocoronary bypass surgery without artificial blood circulation (ACBS without ABC). The essence of the method consists in the fact that the concentration of a kidney injury molecule of type 1 (KIM-1) is determined in blood serum, the ratio of the biomarker KIM-1 concentrations in two time points after 48 hours and 7 days after the operation is calculated and if its value is higher than 1.5, a conclusion about the probability of (GFR) reduction in the remote period after ACBS without ABC is made.

EFFECT: application of the claimed method makes it possible to predict the probability of the glomerular filtration rate (GFR) reduction after 3 months of observation after aortocoronary bypass surgery without artificial blood circulation in an efficient and accurate way.

1 tbl, 1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: method includes determination of a titre of antibodies to cytomegalovirus, content of 2,3 DPG (2,3-diphosphoglycerate), and oxyhaemoglobin in erythrocytes. If the titre of the antibodies to cytomegalovirus increases to 1:1600, DPG increases to 6.7±0.3 mcmole/ml, content of HbO2 is 95.0±1.7%, with the reduction of the specific optical density of haemoglobin to 0.70±0.01, it is concluded that a threat of anaemia development is formed.

EFFECT: method makes it possible to study the character of haemoglobin oxygenation impairment by means of determination of the specific optical density.

FIELD: medicine.

SUBSTANCE: neurovisualisation examination of brain is carried out, Cirs comorbidity index and Kaplan-Feinstein comorbidity index are determined, cochleovestibular syndrome, eye-moving impairments, type of diabetes mellitus are identified. Value of discriminate function (D) is calculated. If D value is higher than zero, diagnosed are consequences of ischemic brain stroke (IBS) with hyperhomocysteinemia (HH), if D is lower than zero, consequences of IBS without HH are diagnosed.

EFFECT: method makes it possible to increase reliability of diagnostics of IBS consequences, which is achieved due to complex analysis of said parameters.

2 ex

FIELD: veterinary science.

SUBSTANCE: method includes detection of leukocytes, protein, haemoglobin in faeces, and PH-reaction of faeces. A sample of faeces is dissolved in distilled water and applied drop by drop onto appropriate test fields of a test strip designed for urine testing. By variation of colour within 1 minute the reaction is assumed as positive. If pH is less than 7.0 or more than 7.5, and faeces contain soluble protein, haemoglobin and leukocytes at the same time, availability of the inflammatory process in the intestines is confirmed.

EFFECT: invention makes it possible to quickly and accurately diagnose inflammatory process in intestines.

2 cl, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine and aims at diagnosing vaginitis in females of a reproductive age. Expression levels of mRNA of TNF, IL18, GATA3 and TLR4 genes are measured in vaginal smears. Expression levels of mRNA of TLR4/GATA3 and TNF/IL18 genes are related, and the derived threshold cycles are used to predict a probability of vaginitis by formula. If P≤57% for nonpregnant females or P≤68.5% for pregnant females, the absence of vaginitis is stated. If P≥57% for nonpregnant females or P≥68.5% for pregnant females, vaginitis is diagnosed.

EFFECT: invention provides the effective diagnosis of vaginitis in the females of a reproductive age.

3 tbl, 5 ex

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, namely to a method of analysing ex-vivo if a patient suffering a cancer is expected to respond therapeutically to a method of treating. To this purpose, a biological sample specified in a group consisting of total blood, plasma or serum samples is taken from the patient. The levels IL10 and IFNγ are measured in the above biological sample; the levels are determined with using the respective IL10 and INFγ specific antibodies. The IL10/IFNγ ratio is derived and compared to a threshold. If the IL10/IFNγ ratio of less than 4 shows that the patient is expected to develop the preventive or therapeutic response to the immunogenic composition. The group of inventions also refers to using IL10 and INFγ as biomarkers and a kit for analysing the above method.

EFFECT: using the given method enables predicting the sensitivity of the patient suffering cancer to the therapeutic treatment, as well as obtaining an algorithm for treatment modification for improving the patient's response to the treatment.

12 cl, 2 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention deals with early diagnostics of infectious complications in patients with acute lymphoblastic leukaemia (ALL), obtaining chemotherapy (CT). Claimed method consists in the following: concentration of fibrinogen, time of XIIa-dependent euglobulin lysis (XIIa-DEL), level of soluble fibrin-monomer complexes (SFMC), activity of protein C (prC) are analysed in ALL patients during CT 2-3 times per week. If at least 2 of 4 criteria are detected, namely: ≥41% increase of fibrinogen level, ≥76% increase of SFMC, ≥11% prolongation of XIIa-DEL time and ≥12% reduction of prC activity in comparison with previous analysis, development of infectious complications is predicted.

EFFECT: method provides early prediction of infection development in patients with acute lymphoblastic leukaemia during chemotherapy.

7 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: level of anti-flu antibodies in blood serum from umbilical vein (A), concentration of middle molecular peptides in blood plasma from umbilical vein (units of optical density) (B), total number of T-lymphocytes (CD3+) in points: 1 point - CD3+ higher than 48%; 2 points - CD3+ 47%-41%; 3 points - CD3+ 40% and lower in venous umbilical blood are determined in term new-born babies at birth. After that, prediction of frequent development of acute respiratory viral infections is realised by means of discriminant equation: D=+0.008×A-111.694×B-1.537×C, where D is discriminant function with boundary value, equal - 34.16. If D is equal or is larger than boundary value, absence of development of frequent respiratory viral infections during the first year of life in term new-born babies with intrauterine flu A(H3N2) is predicted. If D is lower than boundary value, frequent development of acute respiratory viral infections during the first year of life in term new-born babies is predicted.

EFFECT: increased probability of correct prediction of frequent development of acute respiratory viral infections during the first year of life in term new-born babies.

2 ex

FIELD: chemistry.

SUBSTANCE: group of inventions relates to surface hydrophilisation and immobilisation of antibodies on the surface of a cycloolefin copolymer. Disclosed method of making a capillary-action analytical device, which includes steps of: a) providing a capillary substrate, b) changing the hydrophilic property of the surface, c) mixing a matrix and immobilised molecules in solution form to obtain a solution which includes immobilised molecules covalently bonded to the matrix, and d) depositing the solution on a well defined region in at least one storage area. Also a capillary-action analytical device made using said method is described.

EFFECT: enabling change of the substrate by chemical treatment of the surface and depositing immobilised molecules in an optimum matrix on given regions, with less consumption of matrix material, which enables to use several different matrix material in the same chip.

33 cl, 3 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to a method for determining a degree of severity of infantile cerebral paralysis in infants. The method consists in measuring clinical signs of the disease; the infant's peripheral blood is analysed for erythrocytes with micronuclei; the clinical signs of the diseases are rated according to the Rivermead scale; an enzyme immunoassay is used to measure the tumour necrosis factor (TNF-α) in the infant's peripheral blood serum in the infants suffering from infantile cerebral paralysis, measured to the clinical signs; if the measured erythrocytes with micronuclei are found in the number of 0.55±0.14%, whereas serum TNF-α increases to 6.14±3.025 pg/ml, a moderate degree of severity is stated, while the measured count of erythrocytes with micronuclei is 1.27±0.47% and more with the serum TNF-α of 9.58±0.39 pg/ml and more shows a severe degree.

EFFECT: using the declared method enables developing the faster and less invasive method for determining the degree of severity of infantile cerebral paralysis.

5 dwg, 8 tbl, 2 ex

FIELD: chemistry.

SUBSTANCE: method includes collecting blood in an anticoagulant solution, adding an equal volume of an elution buffer containing 1 M NaCl, 0.2 M NaHCO3 (pH 9.3), 20 mM EDTA or a buffer containing 1 M NaCl, 20 mM EDTA. The obtained mixture is incubated at room temperature for 4-6 minutes while stirring, followed by separating the collected blood into plasma and a blood cell fraction by centrifuging and collecting the supernatant fluid, from which the overall fraction of extracellular nucleic acids (exNA) is extracted.

EFFECT: use of the invention shortens the duration of obtaining an overall fraction of exNA, increases the output of blood exNA, increases the sensitivity of detecting market NA, which are specific for cancerous diseases and pregnancy pathologies.

3 cl, 3 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: clinical anamnestic parameters are determined in the patients with hyperplastic processes in the endometrium, and a hysteroscopy with an endometrial biopsy is performed. The activity of calpains, total activity of proteasomes, and activity of 20S proteasomes are determined. Age-dependent discriminator functions Y1 and Y2 are determined by formulas. If Y1>Y2, the patient is referred to a group of low risk of endometrial cancer development. If Y1<Y2, the patient is referred to a group of high risk of endometrial cancer development.

EFFECT: invention enables the high-sensitivity and specificity prediction of endometrial cancer development in the patients suffering from the hyperplastic processes in the endometrium.

1 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: seromucoid concentration is measured in supernatant of a biological fluid aspirated from the nasopharynx of the newborns suffering a generalised form of the intrauterine mono-cytomegalovirus infection or mixed cytomegalovirus infection. If the seromucoid concentration is 0.110-0.140 absorbance units, the early stage of the generalised form of the intrauterine mono-cytomegalovirus infection is diagnosed. If the seromucoid concentration is 0.141-0.171 absorbance units, the early stage of the generalised form of the intrauterine mixed cytomegalovirus infection caused by a combination of the cytomegalovirus and type 1 herpes simplex virus is diagnosed.

EFFECT: using the declared method enables the effective differential diagnosis of the generalised form of the intrauterine mono or mixed cytomegalovirus infection in the newborns.

1 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: predicting toxaemia of pregnancy is ensured by determining 24-hour urine placenta-like alkaline phosphatase and lactoferrin when the woman is 20-22 weeks pregnant, and then 2 weeks later, and the measured placenta-like alkaline phosphatase and lactoferrin of more than 16.0 ng/ml enable estimating potential toxaemia of pregnancy.

EFFECT: method enables predicting potential toxaemia of pregnancy, including the comprehensive assessment of protein risk factors taking into account the clinical presentation and significance of each factor in numeric equivalent.

1 tbl

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine. Claimed is method, including determination of presence or absence of K-rasG12D mutation. Presence of K-rasG12D mutation points to the fact that patient will not respond to treatment with B-Raf inhibitor.

EFFECT: invention provides effective method of identifying patient who does not respond to treatment with B-Raf inhibitor.

6 cl, 34 dwg, 12 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to oncology, and can be used for detecting endogenous intoxication (EI) symptoms in the patients suffering colorectal cancer. That is ensured by studying the complete blood count and deriving an integral intoxication index (III) by formula: EI=(Im+St+Seg+Myel+Plas)*10(Bas+Eos+Lym+Mon)*Er*CC, wherein III is the integral intoxication index; Im is immature leukocytes, %; St is stab neutrophils, %; Seg is segmented neutrophils, %, Myel is myelocytes, %; Plas is plasma cells, %; Bas is basophiles, %; Eos is eosinophils, %; Lym is lymphocytes, %; Mon is monocytes, %; Er is absolute erythrocytes to the power of 1012; CC is an absolute colour characteristics.

EFFECT: invention provides diagnosing the absence (III=4,6) or presence (III=10,4) of the EI symptoms and associated respiratory disorders and enables assessing the therapy efficacy.

FIELD: medicine.

SUBSTANCE: predicting heart rhythm disorder in the patients with pre-excitation syndromes is ensured by measuring patient's blood plasma matrix metalloproteinase-9 (MMP-9), and if the measured value is less than 90.6 ng/ml, the favourable clinical course accompanied by no heart rhythm disorders (HRD) is predicted, whereas the MMP-9 concentration of more than 90.6 ng/ml enables predicting HRD.

EFFECT: method enables predicting HRD in the patients with pre-excitation syndromes by high sensitivity and specificity of the method with its low invasiveness and no counterindications.

3 ex

FIELD: medicine.

SUBSTANCE: technique consists in measuring a pinopod count in the germinal epithelium, an expression level of progesterone and oestrogen alpha receptors in the endometrial stroma, calculating their ratio, and determining an expression level of implantation LIF factor on the 21st-24th day of the menstrual cycle ('implantation window'). If the pinopod count is less than 35%, the expression ratio of progesterone and oestrogen alpha receptors in the endometrial stroma less than 3.5, as well as the LIF expression level of less than 2 points, disturbed fertility associated with uterine myoma is diagnosed.

EFFECT: technique enables applying the differentiated approach to managing the patients planning pregnancy, suffering uterine myoma undeforming the uterine cavity, as well as with myomatous nodule up to 5,0 cm in diameter.

2 ex, 4 dwg

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, in particular to cardiology, and can be used for determining success in recovering the sinus rhythm in patients with paroxysmal atrial fibrillation. A rhythmogram is registered and the following mathematical averaging by a "sliding window" method is realised. The coefficient of rhythm biochronological ordering is calculated by formula limmam=2n(n+1)k=0n1(k+1)ak, where lim a is the coefficient of rhythm biochronological ordering (relative units), a stands for values of R-R intervals (milliseconds), n stands for the quantity of intervals, m is the quantity of averaging cycles, k is an averaged interval number. If the value of lim a<5.5, the possibility of recovering the sinus rhythm by both a pharmacological and an electric cardioversion is lower than 10%, in case of lim a (≥5,5; ≤6,5), the possibility of recovering the sinus rhythm by the electric cardioversion is higher than 90%, with lim a>6,5 the possibility of recovering the sinus rhythm by the pharmacological cardioversion is higher than 90%.

EFFECT: method makes it possible to estimate the probability of recovering the sinus rhythm in patients with paroxysmal atrial fibrillation with high sensitivity and specificity.

3 ex

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