RU2065167C1 - Method of diagnosis of vulva precancerous state - Google Patents

Abstract

FIELD: medicine, oncogynecology. SUBSTANCE: method involves determination of vitamin A and E ratio in blood erythrocyte plasma of patients. Risk group is detected at ratio coefficient increase above 2. EFFECT: prevention of precancerous disease and vulva cancer, early adequate therapy.

Description

 The invention relates to medicine, namely to gynecological oncology and can be used in gynecology to form a risk group for vulvar cancer with subsequent in-depth examination of these patients.

 The problem of prevention and treatment of vulvar cancer is one of the difficult sections of oncology. The most real possibility of preventing invasive vulvar cancer is the timely diagnosis and treatment of background, precancerous diseases and pre-invasive cancer. From this point of view, the main diagnostic tasks are the primary identification of pathological processes of the skin-mucous membranes, vulva, differential diagnosis between non-tumor and pre-tumor diseases of preinvasive and invasive cancer. Over 100 diseases of various genesis, including pretumor and tumor, are observed on the mucous membranes of the vulva. Kraurosis and vulvar leukoplakia often combine with each other, forming the background against which precancer and cancer develop. It is known, according to the data of Y.V. Bokhman (Y.V. Bokhman, M.A. Koyro, Yu.Tadzhibaeva "Malignant tumors of the vulva", Tashkent; "Medicine", UZ SSR, 1986 p. 17,18,30 ), 10 patients with kraurosis and 20 with leukoplakia have subsequently, without adequate treatment, pretumor diseases and cancer. Dysplasia and pre-invasive cancer can be suspected in patients with background dystrophic diseases (kraurosis and leukoplakia) and detected by additional in-depth diagnostic measures, including cytology and histology.

 It is known that for the purpose of the initial selection of patients at risk during mass preventive examinations (see Costa S. Mioli N. Vendra C. Trallo F. Poggs ML Grandi C. Patal henigna e maligna Vulva-2 Jncountri int. Oncol. Ginecol. Capanello , 9-10 sept. 1988, Roma, 1989, 155-165, Clm.) A colored sample is used with methylene paints (1-2 solution of methylene blue or toluidine blue). After treatment with a solution of the external genitalia of the vulva surface, 1 solution of acetic acid was used to remove the dye. The remaining stained areas were considered suspicious of cancer and later these signs were confirmed by more in-depth examination methods. These indicators can be false positive in 20-30% of patients in areas of focal replenishment.

 It is known that with precancer and vulvar cancer there is a significant increase in II-Oxy-17-KS-ketosteroids) and dehydroepiandrosterone (N.A. Krivets "Precancer and vulvar cancer", Alma-Ata, Kazakhstan, 1983, p. 95) selected by us as a prototype. These indicators are characteristic of the risk group for vulvar cancer.

 However, this method of identifying a risk group for cancer has disadvantages, namely, the process of identifying indicators is time-consuming, time-consuming, takes several days, requires rare reagents, sophisticated equipment, the use of a large number of organic solvents, accompanied by toxic effects on the body of medical personnel, and most importantly, the presence of a hormonal laboratory in a medical institution is necessary to carry out research on this technique.

 The aim of the invention is to accelerate and simplify the formation of risk groups for vulvar cancer among patients with background diseases.

 The goal is achieved by the fact that in the blood plasma of red blood cells of patients determine the ratio of vitamins A and E and with an increase in the ratio above 2, identify patients at risk.

 Significant distinguishing features of the proposed "Method for predicting vulvar cancer diseases" are that as an object of biochemical research, the authors propose a ratio of vitamins A and E, which, in contrast to the known methods of forming risk groups, provides an accurate definition of the group of patients with precancerous diseases of women, reduces time research, simplifies the procedure for biochemical research.

 Timely identification of pathological processes of the vulvar skin and mucous membranes, differential diagnosis between non-tumor and tumor diseases of the vulva, carried out by a quick and simplified method compared to known methods for identifying risk groups for vulvar cancer disease using samples of methylene paints or studies of II-Oxy17-KS-ketosteroids and dehydroepiane allows to conclude that the invention is new, unknown from the level of medicine in the field of diagnostic biochemical research.

 Salient features of the invention are the determination of the ratio of vitamins A and E in plasma of red blood cells and the identification of patients at risk with an increase in the ratio above 2, which ensures the achievement of a technical result.

 The invention has an inventive step, since for gynecologists and biochemists it does not follow explicitly from the level of medical technology.

 A method for predicting a disease of vulvar cancer is as follows.

 A patient in the morning on an empty stomach from the cubital vein draws blood in an amount of 3 ml with the addition of heparin to prevent coagulation. Blood is centrifuged for 10 min at 1.5 thousand rpm. Plasma is taken, and red blood cells are washed with saline followed by centrifugation. Vitamins A and E in plasma and erythrocytes are determined by the method of Chernyauskene R. C. Ch. Varskavichene Z. H. Gribauskas A.S. (Simultaneous fluorimetric determination of the concentrations of vitamins A and E. 1984. N 6. P. 362-365) in the extraction system water: ethanol: n-hexane. After 40 minutes of shaking, the samples are centrifuged for 10 minutes at 1,500 rpm and recorded on a spectrophotometer: for vitamin E, the excitation wavelength is 295 nm and fluorescence 320 nm; for vitamin A, the excitation wavelength is 335 mm, and the fluorescence is 460 mm. The gap width for vitamin E is 8 mm, for vitamin A 16 mm.

 The risk group included those patients in whom the ratio of vitamins A / E in plasma and erythrocytes was higher than 2. An in-depth examination of this patient population revealed signs of varying degrees of cell dysplasia in all.

 Examples of the study of A / E coefficient in healthy people and patients with various diseases of the vulva are shown in the table.

 The bulk of the examined patients presented in the table did not differ from healthy women. However, as can be seen from the table, among 26 women with leukoplakia, a risk group was identified in the amount of 6 women with a coefficient higher than 2, who were subsequently diagnosed with vulvar cancer, precancer and were subjected to appropriate anticancer treatment when examined by cytological and histological analyzes. .

 Example 1. Patient Z. 62 years old, medical history N 729 / r was admitted to the gynecological department of the Institute in June 1992 with a diagnosis of leukoplakia, vulvar kraurosis. A patient underwent a biochemical blood test to identify the possibility of developing vulvar cancer and to determine the appropriate treatment methodology. A patient in the morning on an empty stomach from the ulnar vein had a blood sampling of 3 ml with the addition of heparin to prevent coagulation. Blood was centrifuged for 10 min at 1.5 thousand rpm. Plasma was taken and the red blood cells were washed with physiological saline followed by centrifugation. Vitamins A and E in plasma and red blood cells were determined by the method of Chernyauskene R. Ch. Varshakavichene Z.Z. Gribluskas P.S. in the extraction system: water, ethanol: n-hexane. After 40 minutes of shaking, the samples were centrifuged for 10 minutes at 1.5 thousand rpm. and recorded on a spectrophotometer: for vitamin E, an excitation wavelength of 295 nm and a fluorescence of 320 nm; for vitamin A, the excitation wavelength is 335 nm, and fluorescence 460 nm. The width of the slit for vitamin E is 8 nm, for vitamin A 16 nm. The patient was assigned to the risk group, since the ratio of vitamins A / E was 2.6 (more than 2).

 Based on the obtained biochemical analysis data, the patient was suspected of precancer, according to the proposed method for predicting vulvar cancer diseases. The patient was examined additionally: cytological and histological studies which revealed severe dysplasia with atypia of the cells. The patient was subjected to surgical treatment in the amount of simple vulvectomy. The patient was discharged home in satisfactory condition.

 The technical result consists in the fact that the use of the method allows to identify risk groups for vulvar cancer and to prevent precancerous diseases and vulvar cancer, to prescribe adequate treatment in a timely manner. The stages of biochemical research make it possible to apply it in practical healthcare institutions, since the use of expensive reagents and equipment is excluded, the research process is accelerated and simplified, and toxic effects on medical staff are eliminated.

Claims (1)

 A method for diagnosing a precancerous condition of the vulva, including a biochemical blood test, characterized in that the level of vitamins A and E is determined in the patient’s plasma and red blood cells, then the ratio of the first indicator to the second is calculated in each sample and, with a value of more than two, the precancerous condition of the vulva is diagnosed.

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