RU1774263C - Method of differentially diagnosing stable and non-stable stenocardia - Google Patents

Abstract

Usage: medicine, in particular cardiologists for the diagnosis of two clinical variants of coronary heart disease - stable and unstable angina pectoris. Purpose: improving the accuracy of the method. SUMMARY OF THE INVENTION: platelet phosphorylase A2 activity is determined and, at a value of 0.31-0.44 µM / hr / m, the activity of phosphorylase A2 is diagnosed as stable, and unstable angina at a value of 0.45 µ MR / h / mg or more. The proposed method does not require special equipment, time consuming and can be widely used in medical practice with a diagnosis accuracy of 99%.

Description

The invention relates to medicine, namely cardiology, and relates to the differential diagnosis of two clinical variants of coronary heart disease - stable and unstable angina pectoris.

A known method for the diagnosis of stable and unstable angina pectoris by cl and nico-electrocardiographic examination of patients. It is believed that the main diagnostic criterion is clinical, which takes into account the nature of the pain syndrome, its development over time, etc.

However, this method does not have sufficient accuracy, because it is based on a subjective assessment of the manifestations of the disease, and in a number of cases, with the atypical clinical picture, its possibilities are even more limited. The data of the electrocardiographic study are uninformative, there are no specific changes on the ECG, and monitoring of patients, which allows to clarify the diagnosis, requires long-term observation and is practically inaccessible for widespread use.

A known method for the diagnosis of stable and unstable angina by determining the coefficient of intensity of chemoluminescence of leukocyte mass (ed. St. No. 1138127, class A 61 B 10/00, 1985), selected as a prototype. This method is not specific enough and accurate. Since this method uses a biophysical method that requires special equipment and a scarce reagent, the possibility of its widespread use in medical institutions is problematic.

The purpose of the invention is to improve the accuracy of the method.

The method is carried out as follows.

Platelets are isolated from 10 ml of blood by differential centrifugation using non-wettable dishes.

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About CO

 The blood taken from the ulnar vein on an empty stomach with a wide needle is mixed with a 3.2% solution of sodium citrate in a ratio of 9:: 1, then centrifuged for 10 min at 120 d. Platelet-rich plasma is sucked off with a plastic syringe from the deposited red blood cells, transferred to another tube and centrifuged at 1200 d for 20 minutes.

To remove the remaining red blood cells, the resulting precipitate was suspended in a 0.84% solution of ammonium chloride in a volume equal to the volume of the initial plasma, kept for 10-15 minutes in a refrigerator and centrifuged again under the same conditions. Platelet sediment was resuspended in 2 ml of Tris solution (pH 7.0) and treated with an ultrasonic disintegrator at 20 kHz for 30 s. All procedures are carried out at 4 ° C.

The protein content is determined in 0.02 ml of the obtained homogenate, and the activity of phosphorylase A in 0.2 ml (50-100 μg of protein) using an incubation medium containing 1 ml of the final concentration: sodium 2-glycerophosphate 20, cysteine-HC 13 glucose-1-phosphate 10, a - 10, EDTA - 5.1% glycogen solution, total volume 1 ml. Incubation was carried out at 37 ° C for 20 minutes. Unlike the experimental samples, glucose-1-phosphate was added to the control samples after precipitation of the proteins with 10% trichloroacetic acid solution (1 ml). The content of inorganic phosphorus is determined in 0.3 ml of protein-free filtrate by the triton method on a spectrophotometer at 660 nm (5). The enzyme activity is expressed in μMR per 1 mg of protein per 1 hour of incubation.

We examined 70 patients aged 40 to 60 years, 50 of them with unstable angina pectoris, 20 with a stable course of angina pectoris.

The control group consisted of 20 healthy individuals of the same age groups.

The invention is illustrated by the following examples.

Example 1. Patient B ,, 58 years old / complained of pain behind the sternum of a compressive nature during physical exertion. The pains go away at rest. Disease duration 5 years. Electrocardiogram without features.

The activity of phosphorylase A in platelets is 0.44 μM / h / mg protein. Clinical diagnosis: coronary heart disease. Angina pectoris, stable flow.

Example 2. Sick B., 61 years old. Upon admission to the clinic, the patient complained of pain behind the sternum arising from a small physical exertion (after 100150m walk). She suffers from angina pectoris for 6 years. Pain behind the sternum was rare, with significant physical exertion: e. The patient did not have permanent therapy. State

worsened over the past 5-6 weeks, Attacks of pain became more frequent, began to occur with slight physical exertion, the pain was stopped by taking nitroglycerin. No pathological changes were detected on the electrocardiogram,

The activity of phosphorylase A in platelets is 0.45 μM / h / mg protein. Clinical diagnosis: coronary heart disease. Unstable angina.

5 The patient was treated with nitrates, aspirin. After 2 weeks, the state of health improved, the pains became rare, 1-2 times a day, went away on their own. Stabilization of the state corresponded to a decrease in the activity of phosphorylase A in platelets to 0.31.

Example 3. Patient K., 46 years old. 3 years suffers from coronary artery disease. Twice suffered myocardial infarction. In pre- and

In the postinfarction period, angina pectoris persisted. On the electrocardiogram, cicatricial changes in the anterior wall of the left ventricle were detected. A study of the activity of phosphorylase A in platelets during a stable course of angina pectoris revealed an increase to 0.44. After 2 years, the state of health worsened, pain intensified, became more intense, and pains behind the sternum appeared at rest. The activity of phosphorylase A in platelets during this period increased to 0.67 µm / h / mg protein. The patient was hospitalized with a diagnosis of unstable angina. On therapy (finoptin, nitrates), the state of health improved, stabilized. On the 14th day of stay in the clinic, phosphorylase activity decreased to 0.33 µM / h / mg protein, which coincided with stabilization of the course of angina pectoris.

5 The method makes it possible to differentiate the stages of the disease development, to judge the degree of destabilization, and also to reliably monitor the effectiveness of therapy with an accuracy of 99%.

Claims (1)

0 Claims A method for differential diagnosis of stable and unstable angina by examining blood cells, characterized in that, with the aim of 5 to increase the accuracy of the method, the activity of phosphorylase A2 is determined in platelets and, with a value of 0.31 - 0.44 µM / h / mg, stable angina pectoris is diagnosed, and with a value of 0.45 µM / h / mg or more, it is unstable.