RU2012885C1 - Method of determining sensitivity of patients suffering from ischemia to intravenous laser therapy - Google Patents

Abstract

FIELD: medicine, in particular, cardiology. SUBSTANCE: idea of new method consists in determining activity of any lysosomal enzyme contained in patient's blood serum, comparing obtained result with criterion value which is assumed to be equal to 2K where K is equal to magnitude of activity of given enzyme in healthy people. If magnitude of activity of given enzyme proves below 2K, positive effect of laser therapy of given patient suffering from ischemia is predictable. If higher than criterion value, positive effect of laser therapy for such patient is considered to be beyond prognosis. EFFECT: ease of performance. 5 cl

Description

 The invention relates to medicine, namely to cardiology, and is intended for the targeted selection of patients with coronary heart disease (CHD) for intravenous laser therapy (RT).

 Until recently, there were only a few reports in the literature on the clinical use of intravenous laser radiation for the treatment of myocardial infarction. (Experience with the use of low-intensity intravenous laser irradiation in the acute period of myocardial infarction).

 Only in 1988-1989. The number of reports on the successful use of intravascular blood irradiation for the treatment of acute myocardial infarction in various clinics of the country increased. Foreign reports of intravenous RT patients with coronary artery disease in the available literature could not be found. It has been confirmed that intravenous laser irradiation, especially in the early stages, stabilizes and, in certain cases, reduces the infarction zone, which is proved by precordial mapping, myocardial scintigraphy, and a serial study of creatine phosphate kinase.

 There have been reports of the use of laser irradiation of blood as an independent therapeutic factor in heart rhythm disturbances such as paroxysmal atrial fibrillation, ventricular and supraventricular paroxysmal tachycardia, and frequent episodes of ventricular fibrillation. (On the possibility of using low-energy helium-neon laser radiation in the treatment of heart rhythm disturbances. The first experience of using intracardiac laser irradiation as the main therapeutic factor in patients with sinus node syndrome).

 There are indications that in the process of intravenous RT, the coagulemic potential decreases: the thrombin and fibrin time lengthens, the concentration of fibrinogen decreases, the fibrinolytic blood activity increases, and platelet aggregation decreases. There is an improvement in microcirculation conditions under the influence of laser exposure, which is expressed by a decrease in platelet aggregation, accelerated arterial blood flow, a decrease in regional vascular resistance, and arterial dilatation. In the blood of patients, a decrease in the content of lipid peroxidation products was observed.

 Thus, literature data convincingly indicate the presence of a powerful biological effect of low-intensity laser radiation. Due to this, the therapeutic effect of laser light has been widely used in various fields of medical practice. However, only the first steps have been taken in this direction. It requires a comprehensive study of the mechanisms of action of laser radiation in coronary heart disease, the development of optimal modes of radiotherapy.

 Probably, due to the novelty of this direction in the treatment of patients with coronary artery disease, as well as due to the general rarity of the development of methods for predicting in medicine, it was not possible to find methods for predicting the effectiveness of intravenous radiotherapy for patients with coronary artery disease, that is, other ways to solve this problem that could serve as analogues and prototype.

 There is a broader task - determining indications and contraindications for any type of therapy. In our case, intravenous laser therapy was carried out only for those patients to whom it was indicated. However, far from all patients who are shown laser therapy, a positive effect is achieved. Our goal was to develop a method that would allow us to determine the sensitivity of a coronary artery disease patient to intravenous laser therapy, or, in other words, to develop a method for predicting the effectiveness of intravenous radiotherapy in a particular patient.

 The essence of the invention is that in a patient with coronary artery disease take blood from a vein in the amount of 6-8 ml in the morning on an empty stomach. The blood is centrifuged, serum is taken and the activity of acid phosphatase, or cathepsin D, or β-glucosidase, or β-galactosidase is determined by conventional methods. The obtained value is compared with the criterion and when the enzyme content in the blood serum of a patient with coronary artery disease is below the criterion value, it is predicted to have a positive effect if iv is administered to it, and if the enzyme content is above the criterion value, the futility of iv iv therapy to the patient is predicted. (i.e., to this patient in case of its use, intravenous RT will not give a positive therapeutic effect).

 The rationale for the method.

 The activity of acid phosphatase, cathepsin D, β-glucosidase and β-galactosidase was studied in 56 patients with IHD. 14 patients had acute heart attack, 42 - progressive angina pectoris. The diagnosis was verified on the basis of a history, ECG, and laboratory findings. Patients were taken, mainly of working age, with a persistent course of the disease, not amenable to drug therapy, with a malignant course of myocardial infarction or progressive angina pectoris, with a recurring daily intense and frequent pain syndrome.

 Myocardial patients were taken in the acute stage, with a delayed transition from the acute stage to the subacute, with persistent frequent pains, with an unstable course of myocardial infarction, with a return to the acute stage.

 Blood sampling was carried out before the course of RT. The comparison group was the placebo group (group O).

 Intravenous RT is performed with a helium-neon laser (wavelength 0.6328 μm) equipped with a device that allows the transmission of radiation to a thin monofilament fiber. The installation provides laser radiation power at the output of the optical fiber of 0.5-5 mW. Optical fibers are chemically sterilized (rhodolone solution, alcohol solution of chlorhexidine, etc.).

 The peripheral vein (usually cubital) of the patient is punctured with a Dufo-type needle. In sterile conditions, the end of the fiber is inserted through the lumen of the needle into the vein, after which the needle is removed from the vein through the fiber. The depth of fiber insertion into the vein does not matter and usually 5-20 mm is selected. The puncture site is plugged. Duration of blood irradiation in one session 30 min. The procedures are repeated daily, the course of treatment is 4-7 exposures.

 From the table it can be seen that in patients with ischemic heart disease with no positive effect after RT, the level of all enzymes is significantly higher than in patients with a positive effect from RT.

 Criteria were determined for each enzyme, focusing on which it can be concluded about the appropriateness or inappropriateness of the use of laser therapy for this patient with coronary artery disease.

 The criterion value for each enzyme was determined equal to 2K, where K is the value of the activity of this enzyme in the blood serum of healthy people (see "Control" in the table above).

Criteria for all enzymes were as follows (μmol / min x L):
for acid phosphatase 28.0
for cathepsin D 20.2
for b-glucosidase 14.0
for b-galactosidase 46.0
A comparison of the enzyme activity values with the criterion value in the group of patients in whom there was an improvement after intravenous radiotherapy and in the group where such improvement was not observed, shows the following:
- in 80% of patients with coronary artery disease with a positive effect of RT, the activity of acid phosphatase is less than the criterion value for this enzyme,
- in 80% of patients with ischemic heart disease with no effect from RT, the activity of acid phosphatase is greater than the criterion value,
- in 90% of patients with ischemic heart disease with a positive effect from RT, the activity of cathepsin D is less than the criterion value for this enzyme,
- in 68% of patients with no effect of RT, the activity of cathepsin D is greater than its criterial value,
- in 99% of patients with a positive effect of RT, the activity of β-glucosidase is below the criterion value for this enzyme,
- in 73% of patients with no positive effect of RT, the activity of β-glucosidase is higher than the criterion value for this enzyme,
- in 89% of patients with a positive effect of RT, β-galactosidase activity is below the criterion value for this enzyme,
- in 62% of patients with coronary artery disease with no positive effect of RT, β-galactosidase activity is higher than the criterion value of this enzyme.

 Patient R., 50 years old, was delivered at night complaining of intense pressing pain behind the sternum, which could not be stopped with nitroglycerin. From the anamnesis it is known that the last two years the patient had sharp bouts of angina pectoris. I did not contact the doctors. In the last month before hospitalization, pain behind the sternum became more frequent, became daily, pain at rest appeared. Tolerance to physical activity did not exceed 100-200 m walk. On the ECG, the electrical axis of the heart is not deviated, sinus rhythm, 75 per minute. Signs of left ventricular myocardial hypertrophy. In the hospital, the pain syndrome recurred daily. Sustak-forte intake is up to 8 tablets per day, synoptin - 120 mg per day, trasicore - 60 mg per day. Reception of nitroglycerin - up to 20 tablets per day.

 In dynamics on the ECG, small focal changes in the anterior basal sections appeared. On the 32nd day, due to the ineffectiveness of drug therapy, intravenous helium-neon laser therapy was used. 5 sessions in one day. After the third session on the ECG, repolarization was restored, the negative T wave became positive. Significant reduction in angina attacks, the latter persisted only when walking. After the fifth session, angina attacks stopped completely.

 A month later, the patient was examined on an outpatient basis: there was a good tolerance to physical activity in terms of bicycle ergometry.

 The activity of lysosomal enzymes in patient R. before the start of laser therapy (μmol / min x L): Acid phosphatase - 26/6 / b-glucosidase - 7/2 cathepsin D - 18/1 / b-galactosiadase - 29/4.

 Patient K. / 54 years. He was admitted with complaints of pressing pain behind the sternum in the precardial region / not stopping nitroglycerin / expiratory dyspnea. From the anamnesis: IHD suffers for 4 years / deterioration occurred in the last week before hospitalization.

 Reception of nitroglycerin - 50 tablets per day. Tolerance to physical activity is sharply reduced (functional class 3 - 4). ECG: sinus rhythm / 75 per min. Slight left ventricular myocardial hypertrophy / incomplete blockade of the right branch of the bundle of His. Moderate myocardial changes of an exchange-dystrophic nature.

 In the hospital, the pain syndrome recurred daily at short intervals. Consumption of Sustac Forte - 10-12 tablets per day, calcium antagonists 120-160 mg. Reception of nitroglycerin - about 50 tablets per day.

 Laser therapy began on the fifth day, contained five sessions every other day.

 After the third session - unstable improvement, the number of seizures decreased, taking nitroglycerin - 20 tablets per day.

 After the fifth session, the seizures resumed.

 The activity of lysosomal enzymes in patient K. before the start of laser therapy (μmol / min x l) Acid phosphatase - 40/9 / b-glucosidase - 19/4 / cathepsin D - 25/4 / b-galactosiadase - 59/1.

Claims (5)

 1. METHOD FOR DETERMINING SENSITIVITY TO INTRAVENOUS LASEROTHERAPY OF PATIENTS WITH ISCHEMIC HEART DISEASE by determining the activity of enzymes in the blood, which consists in determining the activity of the lysosomal enzyme in the patient’s blood serum, the obtained value is compared with twice the normal value and when the enzyme activity is twice as normal, positive sensitivity to laser therapy in this patient, and with an activity value higher than twice the norm - about the negativity of laser therapy for this patient Nogo.  2. The method according to p. 1, characterized in that the activity of acid phosphatase is determined in blood serum.  3. The method according to p. 1, characterized in that the blood serum determines the activity of cathepsin D.  4. The method according to p. 1, characterized in that the blood serum determines the activity of b-glucosidase.  5. The method according to p. 1, characterized in that the activity of B-galactosidase is determined in blood serum.

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