RU2139542C1 - Method for predicting relapsing chronic pancreatitis exacerbation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves determining enzyme deflection index in blood. It is calculated from ratio enzyme yield time in duodenal contents to one of values describing the contents of this enzyme in blood, urine and in both blood and urine. At least one of the values being below a norm, exacerbation is to be diagnosed. EFFECT: enhanced accuracy of diagnosis.

Description

 The invention relates to medicine, more specifically to gastroenterology, and can be used in the diagnosis of inflammatory diseases of the pancreas.

 A known method for the diagnosis of exacerbation of chronic recurrent pancreatitis (CRD), including determining the debit hour of pancreatic enzymes in the duodenal contents, the levels of enzymes in the patient’s blood and urine, and when at least one of the accepted norms is exceeded, is diagnosed with exacerbation of chronic kidney disease (see Hubergritz N. B. Pathogenetic aspects of the clinic, diagnosis, treatment and prognosis of chronic pancreatitis, Diss. For the Ph.D., Donetsk, 1994, pp. 53-65).

 However, the known method has a low accuracy of diagnosis, since the specificity and information content of the indicators according to the known method is 2.6-8.8% (see ibid., Pp. 54, 56). With CRD, the level of enzymes in the blood is greatly underestimated without exacerbation. In the period of exacerbation of chronic kidney disease, their level rises, but still does not exceed generally accepted standards for pancreatic enzymes. But even in cases where there is an increase in the level of enzymes with suspected chronic kidney disease, it is not specific and requires differentiation from some diseases of the kidneys, liver, intestines, etc.

 The basis of the invention is the task of a method for diagnosing an exacerbation of chronic kidney disease by determining an additional diagnostic indicator and calculating the indices of "enzyme avoidance in the blood" and analyzing these values to increase the specificity and information content of the indicators, which will lead to an increase in the diagnosis accuracy to 94.8%.

 The problem is solved in that in the known method for the diagnosis of exacerbation of chronic kidney disease, including determining the debit hour of pancreatic enzymes in the duodenal contents, as well as indicators characterizing the content of these enzymes in the patient’s blood and urine, the creatinine concentration in the patient’s blood and if it does not exceed the accepted norm value is used to calculate the indices of “evasion of enzymes into the blood” in relation to the debit-hour of the enzyme in the duodenal contents to one of the indicators characterizing the content of at the same enzyme in blood, urine, blood and urine at the same time, and with a decrease in at least one calculated index compared to the norm, an exacerbation of CRF is diagnosed.

 Another difference of the proposed method is that as an indicator characterizing the content of the enzyme in the patient’s blood, an indicator selected from the series is used: amylase activity, lipase content, trypsin concentration, product of trypsin concentration and trypsin growth rate.

 Another difference of the proposed method is that as an indicator characterizing the content of the enzyme in the urine, an indicator selected from the series is used: uroamylase activity, uroamylase production rate after 60 minutes. after a food load, the product of the activity of uroamylase and the growth rate of uroamylase production.

 In addition, the difference of the proposed method is that as an indicator characterizing the content of the enzyme in the blood and urine of the patient simultaneously, the product of amylase activity in the blood and an indicator selected from the series are used: uroamylase activity, uroamylase production rate after 30 minutes. after food loading, uroamylase production rate after 60 minutes. after a food load, the sum of uroamylase production rates after a food load, the product of uroamylase activity and the growth rate of uroamylase production rates.

 Between the totality of the essential differences of the invention and the achieved technical result, there is a causal relationship.

 In patients suffering from CRD, fibrosis develops in the pancreas. As a result of this, the production of enzymes by it is reduced both during remission and during exacerbation of the disease. Therefore, the test for hyperfermentemia with exacerbation of chronic kidney disease is uninformative.

 The determination of the enzyme content in duodenal contents using stimulators of low power of aminophylline and calcium gluconate (according to the prototype) is not informative, and powerful stimulants (secretin, pancreosimine) provoke the release of enzymes into the blood and exacerbation of CRF (see Geller L.I. New methods for diagnosing diseases pancreas - Khabarovsk, 1979. - P. 30; Geller LI, Pashko MM The value of the activity of trypsin, amylase and lipase in the blood serum for the differential diagnosis of chronic pancreatitis and other organ diseases abdominal // Physician thing -. 1990. - N 3. - pp 86-88). In a number of patients with irritated pancreas syndrome in case of CRD, which is sometimes observed in the initial stages of the disease, there is an increase in the enzyme content in the contents of the duodenum. At various stages of CRD, an increase in the level of enzymes in the blood and urine is possible. But even in this case, testing by the prototype method turns out to be nonspecific, since, for example, hyperlipasemia can occur with biliary pathology, intestinal obstruction (see Degtyareva II Pancreatitis. - Kiev: Healthy "I, 1992. - P. 76); amylase is also formed in the parotid glands, liver, kidneys, lungs, skeletal muscles, and ovaries (see ibid., P. 73).

 With an exacerbation of CKD, less enzyme enters the duodenum, and more is released into the bloodstream and, accordingly, urine than in healthy ones. This situation, when the concentration of pancreatic enzymes in the duodenal contents decreases, but in the blood and urine increases, is called the phenomenon of "evasion of enzymes into the blood" (see Degtyareva II Pancreatitis. - Kiev: Healthy "I, 1992. - S. 73; Geller LI Chronic recurrent pancreatitis. - Khabarovsk: Khabarovsk book publishing house, 1976. - P. 13) and, if the tests for the content of enzymes in duodenal contents, in blood and urine comply with generally accepted standards, then it is more informative test for the phenomenon of "avoidance of enzymes in the blood" in of a particular patient, determined by the ratio of the debit-hour in duodenal contents to one of the indicators characterizing the content of the same enzyme in the blood and / or urine.If this ratio, called the evasion index, is reduced compared with the norm calculated for healthy people, then diagnose an exacerbation of chronic kidney disease in a particular patient.

 However, the diagnosis of CRF by the evasion index must be differentiated from chronic renal failure (CRF).

 In chronic renal failure, the release of enzymes from the blood is slowed down and their content in it increases even in the absence of inflammatory diseases of the pancreas (see Boger M.M. Pancreatitis. - Novosibirsk: Nauka, 1984. - P. 78). In the duodenal content, the indicator characterizing the content of enzymes (debit-hour) is also reduced, as in the case of the presence of “evasion of enzymes into the blood,” since pancreatic tissue undergoes constant toxic effects during chronic renal failure and acinar cell dystrophy develops in it. In such a situation, there may be a false "avoidance of enzymes in the blood", which reduces the specificity of the claimed test. In addition, with chronic renal failure, the content of enzymes in the urine is reduced. A situation may arise when the ratio of the debit-hour of enzymes in the duodenal contents and its content in the urine corresponds to the norm in a patient with exacerbation of chronic kidney disease due to chronic renal failure. That is, the value of the evasion index, for the calculation of which the enzyme content in the urine was used, is distorted in chronic renal failure.

 To increase the specificity of diagnosis by determining the index of avoidance, it is necessary to exclude the diagnosis of chronic renal failure in a patient. Therefore, one of the essential features of the proposed method is the determination of creatinine in the blood of the patient. And if this indicator does not exceed the accepted norm (see table), then the evasion index is determined. To increase the accuracy of the diagnosis, several evasion indices for each patient are calculated using several indicators of the content of all three enzymes in the blood, urine or blood and urine at the same time. If at least one evasion index in magnitude is below the norm, then an exacerbation of CRF is diagnosed. The inventive method for the diagnosis of exacerbation of chronic kidney disease is highly informative and specific. The inventive method was tested on 112 patients. The accuracy of the diagnosis was 94.8%. At the same time, the diagnostic accuracy of the prototype method is 2.6-8.8%.

 The inventive method is as follows.

A patient takes blood from a vein on an empty stomach and analyzes it by known methods for creatinine content, the norm of its content is 0.044-0.1 mmol / l (see Laboratory research methods in the clinic / Under the editorship of V.Z. Menshikov. - M. : Medicine, 1987. - S. 221); the lipase content (L) according to the Tits method (see M. Boger M. Research methods of the pancreas. - Novosibirsk: Nauka, 1982. - P. 87-88); trypsin (T) concentrations by the immunoreactive method (see Clinical assessment of laboratory tests / Ed. by N.U. Tits. - M.: Medicine, 1986. - P. 350). The activity of amylase (A _cr. ) In the blood and urine (uroamylases - A _ur. ) Is analyzed by the Karavei method (see Degtyareva I.I. Pancreatitis. - Kiev: Zdorovya, 1992. - P. 71-72).

To determine the debit hour of the enzyme in the duodenal contents, an original two-channel duodenal probe (see Russian patent N 2051699 dated 05/12/93, A 61 B 10/00) and a well-known technique (see N. B. Gubergrits. Pathogenetic aspects of the clinic, diagnostics, are used). , treatment and prognosis of chronic pancreatitis. - Dis. MD (Donetsk), 1994. - P. 61-62). The production rate of amylase and lipase is determined by the same methods as the content of these enzymes in the blood, and trypsin is determined by the Full-Gross-Michaelis method (see Handbook of functional diagnostics / Edited by I.A. Kassirsky. - M .: Medicine , 1970 .-- S. 620). Uroamylase production rates are basal (D ₁ ), after a food load after 30 minutes. (D ₂ ) and after 60 minutes (D ₃ ) is also determined by a known method (see N. B. Gubergrits. Pathogenetic aspects of the clinic, diagnosis, treatment and prognosis of chronic pancreatitis: Dis. MD, Donetsk, 1994. - P. 53-54) . A “test breakfast” is used as a food load (see ibid., P. 54; Korotko G.F., Ablyagov A.A. Differentiation of endosecretory reactions of the stomach, duodenum and pancreas to test breakfasts of different composition // Human Physiology. - 1993. - N 3. - S. 135-140).

где Т₁ - концентрация трипсина в крови больного натощак; Т₂ - через 2 часа после пищевой нагрузки.The rate of increase in flow rates (K _d ) of uroamylase and the growth rate of trypsin (K _Tr ) are calculated by the formulas (1) and (2), respectively:

where T ₁ is the concentration of trypsin in the patient’s blood on an empty stomach; T ₂ - 2 hours after a food load.

где Д - дебит-час фермента в дуоденальном содержимом. "Д" может иметь значения: "Д_а", "Д_тр", "Д_л". Индексы "а", "тр", "л" означают соответственно "амилаза", "трипсин", "липаза"; С - показатель содержания того же фермента в крови, моче, крови и моче одновременно и может принимать значения: А_кр; Т₁; Т₁ • К_тр; Л; А_ур; Д₃; А_ур • К_л; А_кр • А_ур; А_кр • Д₂; А_кр • Д₃; А_кр • (Д₂ + Д₃); А_кр • А_ур • К_д. И если уровень креатинина не превышает нормы и хотя бы один из рассчитанных по формуле (3) индексов уклонения ниже нормы, то диагностируют обострение ХРП.If it is established that the production rates of enzymes in the duodenal contents, their blood and urine contents, as well as the creatinine level in the patient’s blood do not exceed generally accepted norms, then to clarify the diagnosis, the indices of “evasion (I) of enzymes into the blood” are calculated by the formula (3) :

where D is the debit-hour of the enzyme in the duodenal contents. "D" may have the meanings: "D _a ", "D _tr ", "D _l ". The indices "a", "tr", "l" mean respectively "amylase", "trypsin", "lipase"; C is an indicator of the content of the same enzyme in blood, urine, blood and urine at the same time and can take values: A _cr ; T ₁ ; T ₁ • K _tr ; L; A _ur ; D ₃ ; A _ur • K _l ; A _cr • A _ur ; A _cr • D ₂ ; A _cr • D ₃ ; And _cr • (D ₂ + D ₃ ); A _cr • A _ur • K _d . And if the creatinine level does not exceed the norm and at least one of the indices of evasion calculated by formula (3) is lower than the norm, then an exacerbation of CRF is diagnosed.

 Specific examples of the implementation of the proposed method.

Example 1. Patient K., 37 years old, was admitted to the hospital with complaints of pain in the epigastric region, nausea, bloating. Sick about 3 years, when periodically noted abdominal pain. The last deterioration began about a month ago, when after eating acute pain intensified. On palpation of the abdomen, pain in the epigastrium and in the left hypochondrium is determined. Using fibrogastroscopy, gastroduodenitis was detected. However, appropriate treatment (antacids, enveloping agents, metronidazole) was ineffective. Suspected CRD in the acute stage. A survey was conducted to eliminate the diagnosis of chronic kidney disease by the prototype method. Defined content:
And _cr = 29 g / l • hour; And _ur = 140 g / l • hour; T ₁ = 20 ng / ml; T ₂ = 18.1 ng / ml; L = 0.75 units ; _And D = 120 420 g / l • h; D _tr = 65000 ng / ml; D _l = 4850 units; D ₁ = 500 g / l • hour; D ₂ = 650 g / l • hour; D ₃ = 530 g / l • hour.

Индексы уклонения И рассчитывались по формуле (3):

Как видно из обследований и расчетов, несмотря на соответствующие принятым нормам показатели содержания ферментов в дуоденальном содержимом, крови и моче (диагностика по прототипу), при нормальном содержании креатинина в крови больного К. (исключение ХПН), индексы уклонения И_а ¹, И_а ², И_а ⁴, И_а ⁵, И_а ⁶, И_а ⁷, И_а ⁸, И_а ⁹ по своей величине ниже установленных норм (см. таблицу). Выставлен окончательный диагноз больному К.: ХРП в стадии обострения. Проведено лечение контрикалом, панкреатином. Состояние больного улучшилось, величина индексов уклонения возросла. К моменту выписки из клиники больного К. : И_а ¹ = 7250, И_а ² = 6340, И_а ⁴ = 39,94, И_а ⁸ = 432, И_а ⁹ = 30,0. Больному назначено амбулаторное лечение.Since all indicators were within normal limits, an ultrasound scan of the abdominal organs was performed to clarify the diagnosis, in which an increase in the pancreas, unevenness of its structure, and blurred contours were revealed, which indicated the presence of an inflammatory process in it. Due to the ambiguity of the diagnosis, a diagnosis was made according to the claimed method. For this, the blood content of the patient K. creatinine was additionally checked. It was equal to 0.045 mmol / l, which corresponded to the accepted norm (0.044-0.1 mmol / l) (see: Laboratory research methods in the clinic / Edited by V.Z. Menshikov. - M .: Medicine, 1987. - С . 221). The calculation of the evasion indices was carried out according to formulas (1) and (2):

The evasion indices And were calculated by the formula (3):

As can be seen from the examinations and calculations, despite the indicators of the content of enzymes in the duodenal contents, blood and urine (diagnostics according to the prototype) that correspond to the accepted standards, with the normal content of creatinine in the blood of patient K. (exclusion of CRF), evasion indices And _a ¹ , And _a ² , And _a ⁴ , And _a ⁵ , And _a ⁶ , And _a ⁷ , And _a ⁸ , And _a ⁹ in size is lower than the established norms (see table). The final diagnosis was made for patient K.: CRD in the acute stage. The treatment was done with contracal and pancreatin. The patient's condition improved, the value of the evasion index increased. At the time of discharge from the clinic, patient K.: And _a ¹ = 7250, And _a ² = 6340, And _a ⁴ = 39.94, And _a ⁸ = 432, And _a ⁹ = 30.0. The patient was prescribed outpatient treatment.

Example 2. Patient S., 42 years old, was admitted to the hospital with complaints of nausea, frequent stools, attacks of girdle pain in the left hypochondrium after eating smoked meats, spicy dishes. Sick for about a year. Soreness in the projection of the head of the body of the pancreas. According to ultrasound data, the pancreas is slightly increased, echogenicity is reduced, the structure is uneven, the outline is wavy. A survey was conducted to establish a diagnosis of CRD by the prototype method. Defined content:
And _cr = 14 g / l • hour; And _ur = 78 g / l • hour; T ₁ = 50 ng / ml; T ₂ = 45.4 ng / ml; L = 0.70 units ; _And D = 120 480 g / l • h; D _tr = 66000 ng / ml; D _l = 5000 units; D ₁ = 600 g / l • hour; D ₂ = 1190 g / l • hour; D ₃ = 1084 g / l • hour
Since all indicators do not exceed the norm, to clarify the diagnosis, diagnostics were carried out according to the claimed method. For this, the creatinine content in the blood of patient C. was additionally determined. It was equal to 0.066 mmol / l, which corresponds to the accepted norm. To determine the evasion indices are additionally calculated by the formula (1) and (2) K _d = 3,79 and K _Tr = 1,1. By the formula (3), the indices And were calculated:
And _a ¹ = 8605.7; And _a ² = 1544.6; And _a ³ = 111.1; And _a ⁴ = 110.3; And _a ⁵ = 7.23; And _a ⁶ = 7.94; And _a ⁷ = 3.78; And _a ⁸ = 407.55; And _a ⁹ = 29.1; And _mp ¹ = 1320; And _mp ² = 1200; And _l = 7142;
As can be seen from the examinations and calculations, despite the indicators of the content of enzymes in the duodenal contents, blood and urine (diagnosis according to the prototype) that correspond to the accepted standards, with normal creatinine in the blood of patient C. (exclusion of the diagnosis of chronic renal failure) evasion indices And _a ³ , And _a ⁵ , And _a ⁶ , And _a ⁷ , And _a ⁸ , And _a ⁹ , And _Tr ¹ , And _Tr ² in size are lower than the established norms (see table.). The final diagnosis made by patient C. - CRD in the acute stage. Conducted appropriate treatment (trasilol, festal, antispasmodics). The treatment was effective. Before discharge from the clinic, the evasion indices for patient C increased: And _a ³ = 201, And _a ⁵ = 8, And _a ⁶ = 8.2, And _a ⁷ = 5.3, And _a ⁸ = 460, And _a ⁹ = 30 , 0, And _mp ¹ = 2152, And _mp ² = 1600. The patient feels well.

Example 3. Patient R., 52 years old, was admitted to the hospital with complaints of pain in the epigastrium, right and left hypochondria, bloating, constant nausea. Abuses alcohol. Sick for three years, exacerbation began about a month ago after drinking a large amount of alcohol. An examination revealed an increase in the liver, its compaction, surface roughness, and enlargement of the spleen. When studying hepatic blood samples, an increase compared with the norm of transaminases and bilirubin was noted. Ultrasound revealed signs of cirrhosis. The pancreas was not visualized due to flatulence. Diagnosed with alcoholic cirrhosis of the liver. The treatment carried out by hepatoprotectors (essentiale, karsil) had no effect: the patient continued to be disturbed by pain. The patient notes that the pain decreases when an ice bladder is applied in the epigastrium and left hypochondrium, which is typical for pancreatitis. After appropriate preparation, a second pancreatic ultrasound was performed: diffuse changes with calcifications in its parenchyma were revealed. However, ultrasound data are insufficient to establish whether the diagnosed CRD is in the stage of exacerbation or remission. The following indicators were determined (examination by the prototype method):
And _cr = 14.3 g / l • hour; And _ur = 76 g / l • hour; T ₁ = 28 ng / ml; T ₂ = 18 ng / ml; L = 1.4 units ; _And D = 118 580 g / l • h; D _tr = 64500 ng / ml; D _l = 5740 units; D ₁ = 450 g / l • hour; D ₂ = 1000 g / l • hour; D ₃ = 584 g / l • hour.

Since all indicators of the content do not exceed the generally accepted norm, to clarify the diagnosis, a study was carried out according to the claimed method. To exclude the diagnosis of chronic renal failure, patient R. was determined by the content of creatinine in the blood. It corresponded to 0.060 mmol / L. To calculate the evasion indices are additionally calculated by the formulas (1) and (2) K _d = 3,52 and K _Tr = 1,56. By the formula (3) calculate a series of indices And:
And _a ¹ = 8292.3; And _a ² = 1560.3; And _a ³ = 203.0; And _a ⁴ = 109.1; And _a ⁵ = 7.58; And _a ⁶ = 14.1; And _a ⁷ = 5.23; And _a ⁸ = 443.3; And _a ⁹ = 30.99; And _mp ¹ = 2303.6; And _mp ² = 1476.6; And _l = 4100.

As can be seen from the calculations, only one index And _mp ² = 1476.6 turned out to be lower than the established norm (see table). According to the claimed diagnostic method, the patient was diagnosed with exacerbation of chronic kidney disease (alcohol) as the main disease. Concomitant disease - alcoholic cirrhosis of the liver. The treatment of the underlying disease was carried out: the use of contracal, endoscopic papillosphincterotomy. The condition of patient R. improved significantly - the pain and nausea stopped. The treatment of a concomitant disease (cirrhosis of the liver) continued with the inclusion of glucocorticosteroids in it (with exacerbation of pancreatitis, they were contraindicated). The patient's condition after treatment has improved significantly. When extracting checked the index And _mp ² = 1638.

 Example 4. Patient V., 52 years old, complains of bouts of pain in the epigastrium, which are provoked by physical activity and are little dependent on food intake. Sick for 3 years. Repeatedly examined, but the diagnosis has not been established. The abdomen is soft, painful in the pit of stomach. Diaphragmatic hernia is suspected. An X-ray and fibroscopy revealed gastroesophageal reflux. The treatment (motilium, cirucal) was ineffective, the attacks were repeated. Relief was observed when applying cold (typical for pancreatitis). However, with multiple ultrasound, the pancreas was visualized only by fragments. To clarify the diagnosis, the level of enzymes in the blood, urine, and duodenal contents was studied.

And _cr = 18 g / l • hour; And _ur = 84 g / l • hour; T ₁ = 53 ng / ml; T ₂ = 44 ng / ml; L = 1.2 units ; _And D = 148 400 g / l • h; D _tr = 115000 ng / ml; D _l = 6200 units; D ₁ = 583 g / l • hour; D ₂ = 1000 g / l • hour; D ₃ = 740 g / l • hour.

Due to the ambiguity of the diagnosis (the level of enzymes is normal), its refinement was carried out according to the claimed method. For this, first of all, the creatinine content in the blood of patient B. was determined. It was equal to 0.089 mmol / l. Then calculated by the formulas (1) and (2) K _d = 2.98 and K _Tr = 1.3 and according to the formula (3) indices:
And _a ¹ = 8244.4; And _a ² = 1766.6; And _a ³ = 200.54; And _a ⁴ = 98.15; And _a ⁵ = 8.2; And _a ⁶ = 11.14; And _a ⁷ = 4.74; And _a ⁸ = 592.8; And _a ⁹ = 32.9; And _mp ¹ = 2113.2; And _mp ² = 1625.5; And _l = 5166.6
As can be seen from the surveys and calculations, the index of “trypsin evasion into the blood” (I _tr ¹ ) is below the established norm. The diagnosis of exacerbation of chronic kidney disease is confirmed. Conducted anti-specific treatment (trasilol, panzinorm, kvamatel). Attacks of pain stopped, the patient began to gain weight. After 2 months, the patient was examined again: And _mp ¹ = 2200.

Example 5. Patient Yu., 50 years old, was admitted to the hospital with complaints of pain in the epigastrium, right and left hypochondria, nausea, vomiting, bloating. Pain develops in the form of seizures that are triggered by the ingestion of fatty, acute. Sick 5 years. On palpation, pain in the gallbladder area, in the projection of the pancreas. Ultrasound - thickening of the walls of the gallbladder, parietal thick bile, deformation in the neck of the gallbladder. The echogenicity of the pancreas is slightly increased, the contours are wavy. Conclusions: signs of chronic cholecystitis, diffuse changes in the pancreas. To clarify the presence of chronic recurrent pancreatitis, a survey was conducted according to the prototype method. The content of enzymes in the blood, urine, and duodenal contents was determined:
And _cr = 24.6 g / l • hour; And _ur = 116 g / l • hour; T ₁ = 51 ng / ml; T ₂ = 43 ng / ml; L = 1.4 units ; D _a = 260,000 g / L • h; D _tr = 114000 ng / ml; D _l = 5320 units; D ₁ = 580 g / l • hour; D ₂ = 988 g / l • hour; D ₃ = 739 g / l • hour.

The diagnosis of CRF was removed: normal enzyme levels. The patient was treated for chronic cholecystitis (probing, taking choleretic, antispasmodic, anti-inflammatory drugs). However, the patient's condition worsened. To clarify the diagnosis, the patient was examined according to the claimed method. For this, the content of creatinine in the blood is additionally checked. It corresponded to the norm - 0.051 mmol / l. Calculated by the formulas (1) and (2) K _d = 2.97 and K _Tr = 1.19. Evasion indices were calculated by the formula (3):
And _a ¹ = 10569.1; And _a ² = 2241.3; And _a ³ = 351.8; And _a ⁴ = 91.1; And _a ⁵ = 10.7; And _a ⁶ = 14.3; And _a ⁷ = 6.1; And _a ⁸ = 754.6; And _a ⁹ = 30.7; And _mp ¹ = 2235.3; And _mp ² = 1878.4; And _l = 3800.

Given the decrease in the index (And _l ) - "lipase evasion in the blood", it was decided that the poor condition of the patient is mainly due to CRP in the acute stage. Chronic cholecystitis is a concomitant disease. The main emphasis in treatment is placed on the treatment of pancreatitis (ranitidine, gordox, pancurmen). For the treatment of cholecystitis, only flaming (a weak choleretic agent) is prescribed. The patient's condition improved, the pain stopped. At discharge, the index And _l = 4100 was re-determined.

Example 6. Patient Z., 28 years old, was admitted to the hospital with complaints of bouts of pain in the right half of the epigastrium, in the epigastric region. Attacks occurred after eating smoked, fatty foods, accompanied by fever, vomiting, and yellowness of the skin. Sick for 2 years. Over the past month, attacks have become more frequent: every 2-3 days began to occur. On palpation, diffuse soreness was determined in the gallbladder zone, in the epigastrium, in the Shofar zone (projection of the head of the pancreas). Ultrasound: the intestines are pneumatized, which is why the organs of the abdominal cavity are not clearly visible. The gall bladder is spasmodic. The pancreas is increased echogenicity, the contours are fuzzy. To clarify the diagnosis, patient Z. was examined according to a known method:
And _cr = 28 g / l • hour; And _ur = 120 g / l • hour; T ₁ = 50 ng / ml; T ₂ = 42 ng / ml; L = 1.7 units ; _And D = 254 800 g / l • h; D _tr = 110,000 ng / ml; D _l = 6880 units; D ₁ = 490 g / l • hour; D ₂ = 648 g / l • hour; D ₃ = 537 g / l • hour.

Given the increase in blood lipase levels, a diagnosis was made according to a known method - CRF in the acute stage. The development of jaundice during bouts of pain was explained by squeezing the common bile duct of the edematous head of the pancreas. Treatment with contrycal, omez, panzinorm did not give effect. They decided to examine the patient Z. according to the claimed method to clarify the diagnosis of chronic kidney disease. Checked the creatinine content in the patient’s blood. It was within the normal range of 0.073 mmol / L. Calculated by the formulas (1) and (2) K _d = 2.42 and K _Tr = 1.19. Evasion indices are calculated by the formula (3):
And _a ¹ = 9100.0; And _a ² = 2123.3; And _a ³ = 474.5; And _a ⁴ = 75.8; And _a ⁵ = 14.0; And _a ⁶ = 16.9; And _a ⁷ = 7.7; And _a ⁸ = 877.4; And _a ⁹ = 31.33; And _mp ¹ = 2200; And _mp ² = 1848; And _l = 4047.

 A survey according to the claimed method showed that all indices are in compliance. The diagnosis of exacerbation of chronic kidney disease is removed. Repeated ultrasound examination revealed a small calculus wedged into the neck of the gallbladder. There are no symptoms of pancreatic edema. Diagnosed with calculous cholecystitis. Patient Z. had a cholecystectomy. The pain attacks stopped.

Example 7. Patient S., 62 years old, complains of nausea, vomiting, a feeling of heaviness in the epigastrium, pain in the epigastrium after eating, thirst, dry skin. Has been ill with diabetes for 20 years. The last 2 years have been a concern for abdominal pain. An objective examination: the skin is dry, palpation tenderness in the left half of the epigastrium. An ultrasound scan revealed an increase in echogenicity of pancreatic tissue. Blood sugar - 12.3 mmol / L. To confirm the diagnosis of exacerbation of chronic kidney disease, patient S. was examined according to a known method. The levels of pancreatic enzymes in the blood, urine, and duodenal contents were determined:
And _cr = 27 g / l • hour; And _ur = 118 g / l • hour; T ₁ = 62 ng / ml; T ₂ = 47.7 ng / ml; L = 1.3 units. ; D _a = 239,000 g / L • h; D _tr = 135000 ng / ml; D _l = 5200 units; D ₁ = 569 g / l • hour; D ₂ = 971 g / l • hour; D ₃ = 741 g / l • hour.

 Given the increase in blood trypsin levels, a diagnosis was made according to a known method - CRF in the acute stage. Treatment with contrycal, omez. pancurmen was ineffective. To clarify the diagnosis, a survey was conducted according to the claimed method. Blood creatinine was checked: 2.8 mmol / l, it exceeds the norm. And yet, a study was conducted according to the claimed method. All values of the evasion indices corresponded to the norm. An examination using fibrogastroscopy revealed erosive gastroduodenitis. Due to prolonged diabetes mellitus, patient C developed chronic renal failure. As a result, the patient developed chronic erosive gastroduodenitis, and the level of blood trypsin increased. Changes in the pancreas recorded by ultrasound are probably age-related. To clarify the diagnosis of chronic renal failure, additional examinations were carried out: blood urea - 15.7 mmol / l; general urine analysis: specific gravity - 1008, protein - 2.3 g / l, erythrocytes - 10-12 in s / sp., white blood cells - 5-6 in s / sp., sugar - 2.1 g / l, cylinders - 8-10 in p / sp. Patient S. was transferred to the nephrology department, where he received treatment for diabetic glomerulosclerosis, chronic renal failure I-II art. and erosive gastroduodenitis of uremic origin. Discharged with improved biochemical parameters.

Claims (4)

 1. A method for the diagnosis of exacerbation of chronic recurrent pancreatitis, including determining the debit hour of pancreatic enzymes in the duodenal contents, as well as indicators characterizing the content of these enzymes in the patient’s blood and urine, characterized in that they additionally determine the creatinine concentration in the patient’s blood and not exceeding its accepted norm value is used to calculate the indices of "evasion of enzymes in the blood" in relation to the debit-hour of the enzyme in the duodenal contents to one of the indicators, arakterizuyuschih content of the enzyme in blood, urine, blood and urine at a time and with a decrease in the magnitude of at least one index calculated in comparison with normal diagnose exacerbation of chronic recurrent pancreatitis.  2. The method according to claim 1, characterized in that as an indicator characterizing the content of the enzyme in the patient’s blood, an indicator selected from a series of amylase activity, lipase content, trypsin concentration, product of trypsin concentration and trypsin growth rate is used.  3. The method according to claim 1, characterized in that as an indicator characterizing the content of the enzyme in the urine, an indicator selected from a series of uroamylase activity, uroamylase production rate 60 minutes after a food load, a product of uroamylase activity and a growth rate of uroamylase production rate is used.  4. The method according to claim 1, characterized in that as a parameter characterizing the content of the enzyme in the blood and urine of the patient simultaneously, the product of amylase activity in the blood and an indicator selected from the uroamylase activity range, uroamylase production rate 30 minutes after a food load, uroaminase production rate after 60 minutes after a food load, the sum of uroaminase production rates after a food load, uroaminase activity multiplied by the growth rate of uroamylase production rates.

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