MD548Z - Method for predicting the evolution of ulcerative colitis - Google Patents
Method for predicting the evolution of ulcerative colitis Download PDFInfo
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- MD548Z MD548Z MDS20120029A MDS20120029A MD548Z MD 548 Z MD548 Z MD 548Z MD S20120029 A MDS20120029 A MD S20120029A MD S20120029 A MDS20120029 A MD S20120029A MD 548 Z MD548 Z MD 548Z
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- 206010009900 Colitis ulcerative Diseases 0.000 title claims abstract description 22
- 201000006704 Ulcerative Colitis Diseases 0.000 title claims abstract description 22
- 238000000034 method Methods 0.000 title claims abstract description 22
- 230000007170 pathology Effects 0.000 claims abstract description 23
- 238000011282 treatment Methods 0.000 claims abstract description 11
- 230000002349 favourable effect Effects 0.000 claims abstract description 9
- 230000004807 localization Effects 0.000 claims description 5
- 101100499351 Chlorobaculum tepidum (strain ATCC 49652 / DSM 12025 / NBRC 103806 / TLS) lpd gene Proteins 0.000 claims description 2
- 201000010099 disease Diseases 0.000 abstract description 13
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 abstract description 13
- 239000003814 drug Substances 0.000 abstract description 3
- 238000004393 prognosis Methods 0.000 description 8
- 230000000750 progressive effect Effects 0.000 description 5
- 208000035473 Communicable disease Diseases 0.000 description 4
- 238000003745 diagnosis Methods 0.000 description 4
- 238000001514 detection method Methods 0.000 description 3
- 238000011160 research Methods 0.000 description 3
- 210000001072 colon Anatomy 0.000 description 2
- 238000002052 colonoscopy Methods 0.000 description 2
- 230000004054 inflammatory process Effects 0.000 description 2
- 238000011835 investigation Methods 0.000 description 2
- 238000011418 maintenance treatment Methods 0.000 description 2
- 208000006820 Arthralgia Diseases 0.000 description 1
- 206010061818 Disease progression Diseases 0.000 description 1
- 206010020843 Hyperthermia Diseases 0.000 description 1
- 208000022559 Inflammatory bowel disease Diseases 0.000 description 1
- 208000025865 Ulcer Diseases 0.000 description 1
- 238000007486 appendectomy Methods 0.000 description 1
- 230000008094 contradictory effect Effects 0.000 description 1
- 238000012937 correction Methods 0.000 description 1
- 239000003246 corticosteroid Substances 0.000 description 1
- 229960001334 corticosteroids Drugs 0.000 description 1
- 230000005750 disease progression Effects 0.000 description 1
- 210000004921 distal colon Anatomy 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 208000010227 enterocolitis Diseases 0.000 description 1
- 230000005713 exacerbation Effects 0.000 description 1
- 230000036031 hyperthermia Effects 0.000 description 1
- 208000015181 infectious disease Diseases 0.000 description 1
- 230000002458 infectious effect Effects 0.000 description 1
- KBOPZPXVLCULAV-UHFFFAOYSA-N mesalamine Chemical compound NC1=CC=C(O)C(C(O)=O)=C1 KBOPZPXVLCULAV-UHFFFAOYSA-N 0.000 description 1
- 229960004963 mesalazine Drugs 0.000 description 1
- 238000012544 monitoring process Methods 0.000 description 1
- 239000006041 probiotic Substances 0.000 description 1
- 235000018291 probiotics Nutrition 0.000 description 1
- 238000012545 processing Methods 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 210000000664 rectum Anatomy 0.000 description 1
- 230000000391 smoking effect Effects 0.000 description 1
- 239000000829 suppository Substances 0.000 description 1
- 230000001225 therapeutic effect Effects 0.000 description 1
- 230000000472 traumatic effect Effects 0.000 description 1
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- Investigating Or Analysing Biological Materials (AREA)
- Measuring Or Testing Involving Enzymes Or Micro-Organisms (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la gastroenterologie şi poate fi utilizată pentru pronosticarea evoluţiei colitei ulceroase. The invention relates to medicine, in particular to gastroenterology and can be used to predict the evolution of ulcerative colitis.
Este cunoscută metoda de pronosticare a evoluţiei colitei ulceroase, care include examenul clinic şi paraclinic cu stabilirea următorilor parametri, adică a factorilor de risc: localizarea patologiei la debut şi gradul de severitate la debutul patologiei, necesitatea aplicării corticosteroizilor la acutizări. Pe de altă parte, se stabilesc şi factorii favorabili ca fumatul şi apendicectomia în anamneză care vorbesc despre decurgerea favorabilă a patologiei [1]. The method of predicting the evolution of ulcerative colitis is known, which includes clinical and paraclinical examination with the establishment of the following parameters, i.e. risk factors: localization of the pathology at onset and the degree of severity at the onset of the pathology, the need for the application of corticosteroids during exacerbations. On the other hand, favorable factors such as smoking and appendectomy in the anamnesis are also established, which speak of the favorable course of the pathology [1].
Dezavantajul acestei metode constă în aceea că este descriptivă şi nu permite de a face pronosticuri în cazuri complicate, la prezenţa factorilor contradictorii, adică în cazul când sunt prezenţi concomitent atât factorii de risc cât şi cei favorabili. The disadvantage of this method is that it is descriptive and does not allow for making predictions in complicated cases, in the presence of contradictory factors, that is, when both risk and favorable factors are present simultaneously.
Problema pe care o soluţionează invenţia propusă constă în determinarea precisă şi rapidă a pronosticului evoluţiei colitei ulceroase utilizând datele clinice cunoscute la debutul maladiei, fără includerea procedurilor invazive, traumatice sau costisitoare suplimentare. The problem solved by the proposed invention consists in accurately and rapidly determining the prognosis of ulcerative colitis evolution using clinical data known at the onset of the disease, without including additional invasive, traumatic or costly procedures.
Conform invenţiei, metoda revendicată include examenul clinic şi paraclinic cu stabilirea următorilor parametri: vârsta la debutul patologiei (VD), gradul de severitate la debutul patologiei (GSDP), localizarea patologiei la debut (LPD), complicaţiile la debutul patologiei (CDP), timpul de la debutul patologiei până la tratamentul specific (TDPTS), timpul de la debutul patologiei până la remisie (TDPR), timpul de la debutul patologiei până la recidivă (TDPPR), apoi se calculează funcţia discriminantă (F) conform formulei: According to the invention, the claimed method includes clinical and paraclinical examination with the establishment of the following parameters: age at onset of pathology (VD), severity degree at onset of pathology (GSDP), localization of pathology at onset (LPD), complications at onset of pathology (CDP), time from onset of pathology to specific treatment (TDPTS), time from onset of pathology to remission (TDPR), time from onset of pathology to relapse (TDPPR), then the discriminant function (F) is calculated according to the formula:
F = - 5,000 - 0,942 x VD + 1,171 x GSDP + 1,811 x LPD + 1,311 x CDP + 0,492 x TDPTS + 1,024 x TDPR - 0,637 x TDPPR, unde parametrii menţionaţi primesc următoarele valori: F = - 5.000 - 0.942 x VD + 1.171 x GSDP + 1.811 x LPD + 1.311 x CDP + 0.492 x TDPTS + 1.024 x TDPR - 0.637 x TDPPR, where the mentioned parameters receive the following values:
VD 1 - vârsta până la 30 ani; 2 - vârsta de 31…49 ani; 3 - mai mult de 50 ani; GSDP 1 - grad uşor de severitate; 2 - grad mediu de severitate; 3 - grad sever; LPD 1 - localizare distală; 2 - localizare extinsă; 3 - informaţia lipseşte; CDP 0 - lipsesc complicaţii; 1 - sunt complicaţii; TDPTS 1 - mai puţin de 1 lună, 2 - 1…6 luni; 3 - mai mult de 6 luni; TDPR 1 - mai puţin de 1 lună; 2 - 1… 6 luni; 3 - mai mult de 6 luni; TDPPR 1 - până la 6 luni; 2 - după 6 luni până la 12 luni; 3 - mai mult de 12 luni,VD 1 - age up to 30 years; 2 - age 31…49 years; 3 - more than 50 years; GSDP 1 - mild severity; 2 - moderate severity; 3 - severe degree; LPD 1 - distal location; 2 - extensive location; 3 - information missing; CDP 0 - no complications; 1 - complications; TDPTS 1 - less than 1 month, 2 - 1…6 months; 3 - more than 6 months; TDPR 1 - less than 1 month; 2 - 1…6 months; 3 - more than 6 months; TDPPR 1 - up to 6 months; 2 - after 6 months up to 12 months; 3 - more than 12 months,
în cazul în care F < 0 se pronostichează o evoluţie favorabilă, iar când F > 0 - o evoluţie nefavorabilă a colitei ulceroase. If F < 0, a favorable evolution is predicted, and when F > 0 - an unfavorable evolution of ulcerative colitis.
Rezultatul constă în creşterea exactităţii pronosticării evoluţiei nefavorabile progresive a colitei ulceroase graţie prelucrării matematice a parametrilor clinici şi paraclinici cunoscuţi la etapa iniţială a bolii, fără sporirea volumului de investigaţii şi, respectiv, fără sporirea costului examinărilor. The result is an increase in the accuracy of predicting the progressive unfavorable evolution of ulcerative colitis thanks to the mathematical processing of clinical and paraclinical parameters known at the initial stage of the disease, without increasing the volume of investigations and, respectively, without increasing the cost of examinations.
Avantajul metodei revendicate constă în sporirea exactităţii şi a obiectivităţii pronosticării evoluţiei nefavorabile a colitei ulceroase fără sporirea volumului de investigaţii. Metoda propusă permite depistarea precoce a bolnavilor cu risc sporit de progresare a bolii, fapt ce impune o atenţie specială pentru această categorie de pacienţi cu ajustarea la timp a tratamentului. The advantage of the claimed method is to increase the accuracy and objectivity of the prognosis of the unfavorable evolution of ulcerative colitis without increasing the volume of investigations. The proposed method allows for the early detection of patients with an increased risk of disease progression, which requires special attention for this category of patients with timely adjustment of treatment.
Metoda se realizează prin calcularea funcţiei discriminante pentru fiecare pacient nou diagnosticat conform formulei descrise mai sus utilizând datele clinice şi paraclinice standarde. În cazul în care F > 0 se face un pronostic nefavorabil cu localizarea extinsă a CU, iar pentru F < 0 pronosticul este favorabil cu localizarea distală a CU peste 5 ani de evoluţie a bolii. The method is performed by calculating the discriminant function for each newly diagnosed patient according to the formula described above using standard clinical and paraclinical data. If F > 0, an unfavorable prognosis is made with the extended localization of UC, and for F < 0 the prognosis is favorable with the distal localization of UC over 5 years of disease evolution.
Verificarea funcţiei discriminante s-a efectuat pe un lot de 306 pacienţi cu diagnosticul de colită ulceroasă, apreciindu-se evoluţia clinică. Rezultatul a fost considerat favorabil în cazul dacă F < 0, iar când F > 0 evoluţia colitei ulceroase se consideră nefavorabilă. The discriminant function was tested on a group of 306 patients diagnosed with ulcerative colitis, assessing the clinical evolution. The result was considered favorable if F < 0, and when F > 0 the evolution of ulcerative colitis was considered unfavorable.
Drept indicaţie pentru utilizarea acestei metode serveşte depistarea pacienţilor cu risc sporit de evoluţie nefavorabilă progresivă a colitei ulceroase în scopul întocmirii unei tactici de tratament adecvat. The indication for using this method is the detection of patients at increased risk of progressive unfavorable evolution of ulcerative colitis in order to develop an appropriate treatment tactic.
Contraindicaţii pentru utilizarea acestei metode nu sunt. There are no contraindications to using this method.
Exemple concrete de realizare Concrete examples of implementation
Exemplul 1 Example 1
Pacienta A., 40, ani a fost internată în clinica de boli infecţioase cu diagnosticul de colită ulceroasă, unde a fost efectuat examenul clinic şi paraclinic cu stabilirea următoarelor valori pentru parametrii utilizaţi în metoda revendicată la debutul bolii: VD=2; debut treptat de gravitate uşoară GSDP=1, fără complicaţii CDP=0; s-a adresat la medici pentru prima dată şi a început tratamentul specific peste 8 luni TDPTS=3. Pe parcursul acestei perioade nu a avut o remisiune stabilă TDPR=3; lunar a efectuat tratament cu supozitoare antihemoroidale şi probiotice TDPPR=l. Patient A., 40, was admitted to the infectious diseases clinic with the diagnosis of ulcerative colitis, where the clinical and paraclinical examination was performed with the establishment of the following values for the parameters used in the claimed method at the onset of the disease: VD=2; gradual onset of mild severity GSDP=1, without complications CDP=0; she consulted doctors for the first time and started specific treatment after 8 months TDPTS=3. During this period she did not have a stable remission TDPR=3; she underwent monthly treatment with antihemorrhoidal suppositories and probiotics TDPPR=1.
A fost aplicată metoda propusă de cercetare. Valoarea calculată a funcţiei discriminante F = 3,631, adică F>0, ceea ce permite a pronostica o evoluţie nefavorabilă a maladiei. Metoda aplicată a demonstrat coincidenţa pronosticului cu rezultatul real la 5 ani de monitorizare - afectarea subtotală a colonului peste 5 ani de evoluţie. The proposed research method was applied. The calculated value of the discriminant function F = 3.631, i.e. F>0, which allows to predict an unfavorable evolution of the disease. The applied method demonstrated the coincidence of the prognosis with the real result at 5 years of monitoring - subtotal colon damage over 5 years of evolution.
Astfel, la o pacientă cu debut treptat, uşor, dar netratat adecvat a fost pronosticată şi confirmată evoluţia progresivă cu extinderea procesului inflamator. Thus, in a patient with a gradual, mild onset, but not adequately treated, progressive evolution with the extension of the inflammatory process was predicted and confirmed.
Exemplul 2 Example 2
Pacientul C., 21 ani, a fost internat în clinica de boli infecţioase cu diagnosticul de colită ulceroasă, unde a fost efectuat examenul clinic şi paraclinic cu stabilirea următoarelor valori pentru parametrii utilizaţi în metoda revendicată la debutul bolii: VD=1; debut brusc de gravitate medie GSDP=2 asociat cu hipertermie, artralgii CDP=1; în secţia de boli infecţioase a fost exclusă enterocolita de etiologie infecţioasă şi a fost efectuată colonoscopia, unde s-a depistat afectarea ulcero-erozivă a rectului LPD=1. Tratamentul specific cu mesalazină a fost început peste o lună după debutul bolii TDPTS=2. Starea s-a ameliorat, dar o remisiune stabilă nu a fost atinsă timp de mai mult de 6 luni după debutul bolii TDPR=3. După atingerea remisiunii clinice a prelungit tratamentul de menţinere numai 2 luni şi peste o lună după sistarea tratamentului s-a înregistrat o recidivă a colitei ulceroase TDPPR=1. Patient C., 21 years old, was admitted to the infectious diseases clinic with the diagnosis of ulcerative colitis, where the clinical and paraclinical examination was performed with the establishment of the following values for the parameters used in the claimed method at the onset of the disease: VD=1; sudden onset of medium severity GSDP=2 associated with hyperthermia, arthralgias CDP=1; in the infectious diseases department, enterocolitis of infectious etiology was excluded and colonoscopy was performed, where ulcerative-erosive damage to the rectum LPD=1 was detected. Specific treatment with mesalazine was started over a month after the onset of the disease TDPTS=2. The condition improved, but a stable remission was not achieved for more than 6 months after the onset of the disease TDPR=3. After achieving clinical remission, the maintenance treatment was prolonged for only 2 months and over a month after the cessation of treatment, a relapse of ulcerative colitis TDPPR=1 was recorded.
A fost aplicată metoda propusă de cercetare. Valoarea calculată a funcţiei discriminante F = 2,941, adică F>0, ceea ce permite a pronostica o evoluţie nefavorabilă a maladiei. Metoda aplicată a demonstrat coincidenţa pronosticului cu rezultatul real la 5 ani de supraveghere - afectarea totală a colonului peste 5 ani de evoluţie. The proposed research method was applied. The calculated value of the discriminant function F = 2.941, i.e. F>0, which allows to predict an unfavorable evolution of the disease. The applied method demonstrated the coincidence of the prognosis with the real result at 5 years of surveillance - total colon damage over 5 years of evolution.
Astfel, la un pacient cu localizarea distală la debutul colitei ulceroase a fost pronosticată şi confirmată evoluţia progresivă cu extinderea procesului inflamator. Thus, in a patient with distal location at the onset of ulcerative colitis, progressive evolution with the extension of the inflammatory process was predicted and confirmed.
Exemplul 3 Example 3
Pacientul C., 53 ani, a fost internat în clinica de boli infecţioase cu diagnosticul de colită ulceroasă, unde a fost efectuat examenul clinic şi paraclinic cu stabilirea următoarelor valori pentru parametrii utilizaţi în metoda revendicată la debutul bolii: VD=3; debut uşor GSDP=1, s-a adresat la medici şi a efectuat colonoscopia, unde s-a confirmat diagnosticul de colită ulceroasă cu afectarea recto-sigmei LPD=1; îndată a început tratamentul specific adecvat TDPTS=1; o remisiune stabilă a fost atinsă peste o lună TDPR=2. După atingerea remisiunii clinice a fost administrat tratamentul de menţinere timp de 3 luni, ulterior a întrerupt tratamentul. Recidiva următoare a fost înregistrată peste 16 luni TDPPR - 3. Patient C., 53 years old, was admitted to the infectious diseases clinic with the diagnosis of ulcerative colitis, where the clinical and paraclinical examination was performed with the establishment of the following values for the parameters used in the claimed method at the onset of the disease: VD=3; mild onset GSDP=1, he went to the doctors and underwent colonoscopy, where the diagnosis of ulcerative colitis with recto-sigmoid involvement was confirmed LPD=1; appropriate specific treatment was immediately started TDPTS=1; a stable remission was achieved after one month TDPR=2. After achieving clinical remission, maintenance treatment was administered for 3 months, then the treatment was discontinued. The next relapse was recorded after 16 months TDPPR - 3.
A fost aplicată metoda propusă de cercetare. Valoarea calculată a funcţiei discriminante F = - 4,215, adică F<0, ceea ce permite a pronostica o evoluţie favorabilă a maladiei. Metoda aplicată a demonstrat coincidenţa pronosticului cu rezultatul real la 5 ani de supraveghere - afectarea distală a colonului peste 5 ani de evoluţie. The proposed research method was applied. The calculated value of the discriminant function F = - 4.215, i.e. F<0, which allows to predict a favorable evolution of the disease. The applied method demonstrated the coincidence of the prognosis with the real result at 5 years of surveillance - distal colon involvement over 5 years of evolution.
Aşadar, în baza studiului prospectiv efectuat în baza Clinicii medicale nr. 4 a Universităţii de Stat de Medicină şi Farmacie Nicolae Testemiţanu din Chişinău pe un lot reprezentativ de pacienţi (306) cu colită ulceroasă a fost elaborată metoda propusă de pronosticare a evoluţiei progresive a CU care permite depistarea precoce a bolnavilor cu risc înalt de agravare, fapt ce impune o atenţie sporită pentru această categorie de pacienţi cu corijarea la timp a programului terapeutic. Therefore, based on the prospective study conducted at the Medical Clinic No. 4 of the Nicolae Testemiţanu State University of Medicine and Pharmacy in Chisinau on a representative group of patients (306) with ulcerative colitis, the proposed method for predicting the progressive evolution of UC was developed, which allows for the early detection of patients with a high risk of worsening, which requires increased attention for this category of patients with timely correction of the therapeutic program.
1. Riox K. What is the prognosis of ulcerative colitis. A clinical guide to IBD. Inflamm Bowel, 2009, vol. 14, suppl.2, p.52-53 1. Riox K. What is the prognosis of ulcerative colitis. A clinical guide to IBD. Inflamm Bowel, 2009, vol. 14, suppl. 2, p. 52-53
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| MDS20120029A MD548Z (en) | 2012-02-07 | 2012-02-07 | Method for predicting the evolution of ulcerative colitis |
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| MD451F1 (en) * | 1996-01-24 | 1996-08-30 | Univ De Stat Din Moldova | Method for beans treatment before sowing |
| MD1391G2 (en) * | 1999-05-27 | 2000-11-30 | Институтул Де Черчетэрь Штиинцифиче Ын Домениул Окротирий Сэнэтэуий Мамей Ши Копилулуй Ал Министерулуй Сэнэтэций | Method of diagnosis of gastroduodenal inflammatory chronic affections to children |
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| RU2004107725A (en) * | 2004-03-15 | 2005-09-10 | Ростовский научно-исследовательский онкологический институт МЗ РФ (RU) | METHOD FOR FORECASTING HEMANGIOM TREATMENT EFFICIENCY |
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2012
- 2012-02-07 MD MDS20120029A patent/MD548Z/en not_active IP Right Cessation
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| MD451F1 (en) * | 1996-01-24 | 1996-08-30 | Univ De Stat Din Moldova | Method for beans treatment before sowing |
| MD1391G2 (en) * | 1999-05-27 | 2000-11-30 | Институтул Де Черчетэрь Штиинцифиче Ын Домениул Окротирий Сэнэтэуий Мамей Ши Копилулуй Ал Министерулуй Сэнэтэций | Method of diagnosis of gastroduodenal inflammatory chronic affections to children |
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| RU2310850C1 (en) * | 2006-05-02 | 2007-11-20 | Государственное образовательное учреждение высшего профессионального образования "Уральская государственная медицинская академия Федерального агентства по здравоохранению и социальному развитию" (ГОУ ВПО УГМА Росздрава) | Method for predicting postoperative wound suppuration |
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Non-Patent Citations (1)
| Title |
|---|
| Riox K. What is the prognosis of ulcerative colitis. A clinical guide to IBD. Inflamm Bowel, 2009, vol. 14, suppl.2, p.52-53 * |
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| Publication number | Publication date |
|---|---|
| MD548Y (en) | 2012-10-31 |
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