RU2189170C2 - Method for diagnosing the cases of neurocirculatory dystonia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves measuring arterial blood pressure, heart beat rate before and after applying growing in time loads on bicycle ergometer device. Double product increment (DPIDPI₅₀) is calculated as difference between the double products at the third min of loading with 50 W and in initial state. Cardiac loading index is calculated as ratio of the double product and to power of the load in W. The known reference values of DPIDPI₅₀ and the cardiac loading index are taken as criteria of neurocirculatory dystonia. EFFECT: high accuracy of diagnosis; assigning objective value to cardiac, vascular and asthenic complaints; revealed mechanisms of falling tolerance to physical loading. 10 cl, 2 dwg

Description

 The invention relates to medicine, namely to cardiology, and can be used to improve the diagnosis of neurocirculatory dystonia / NCD /.

NDC is a very common disease, up to 30% of the population suffers from it. Usually, for the diagnosis of NDC, a set of indicators is used / Makolkin V.I., Abbakumov S.A. Neurocirculatory dystonia in therapeutic practice, 1985, 1987 /, including:
1. Cardiac complaints or symptoms: cardialgia, palpitations, sensation of interruptions in the work of the heart, extrasystole.

 2. Vascular disorders: lability of blood pressure / blood pressure and pulse, detected during dynamic observation and with little physical exertion, headaches, dizziness, fainting, cold extremities.

 3. Vegetative dysfunction: vegetative-vascular crises, persistent red dermographism, excessive sweating, periods of low-grade fever.

 4. Respiratory disorders: feeling of lack of air, respiratory arrhythmia, dissatisfaction with the breath.

 5. Psycho-emotional disorders: anxiety, anxiety, a feeling of internal trembling, irritability, sleep disturbances.

 6. Asthenic syndrome: weakness, fatigue, poor tolerance of physical exertion and stressful situations.

 7. Long-term benign history without signs of the formation of organic cardiovascular pathology.

 8. Negative dynamics / inversion / T wave in samples with hyperventilation and positive dynamics of a smoothed or negative T wave in pharmacological samples.

 The severity of the clinical picture of NDC, its constituent syndromes may be different, on the basis of this it was proposed to divide the disease according to severity / Makolkin. V.I., Abbakumov S.A., 1985 /. It is easy to notice that the proposed criteria for the most part are subjective and are based either on the assessment of their condition by the patient, or on the subjective assessment of the symptom by the doctor.

 The fundamental criterion for the diagnosis should be objective, have clear quantitative boundaries and be associated with the most important indicators of the functional state of the body - the state of systemic circulation, myocardial contractility, and tissue respiration function. Information about the state of these systems to a certain extent can be obtained by conducting samples with dosed physical activity.

 There is a way to assess the functional state of the cardiovascular system, based on the determination of oxygen consumption with increasing physical exertion. Many studies have shown a decrease in exercise tolerance in patients with NDC / Makolkin VI, Abbakumov SA, 1985; Sorokina T.A. Neurocirculatory dystonia, 1979; Olbinskaya L.I., Golyakov V. L. Early diagnosis and prevention of cardiovascular diseases. Novosibirsk, 1983. P. 132-133 /, but the features of the reaction of the cardiovascular system itself to dosed physical activity in patients with NDC and pathogenetic mechanisms to reduce tolerance have not been studied.

 The use of stress tests is based on the fact that physical activity causes functional stress of all adaptive systems of the body - cardiovascular, endocrine, external and tissue respiration, gas exchange, etc. A factor interconnecting the above systems is to ensure that the body consumes oxygen adequate to the physical stress. The higher the level of oxygen consumption during the load, the greater the reserve capacity of the cardiovascular system. The method of functional classification of patients with coronary heart disease is based on this / Aronov D.M. et al., 1980 /. In this case, the main factor limiting oxygen consumption is the functional inferiority of the coronary blood flow. But on the other hand, an inadequate load on the increase in oxygen consumption by the myocardium reflects the inferiority of the body's regulatory systems. With this in mind, the proposed method for diagnosing NDC was based on the principle of determining oxygen consumption at stepwise increasing loads, more precisely, determining the number of metabolic units / ME /, indicating how many times during increasing loads oxygen consumption increases compared to resting state. An integrative indicator that reflects the body’s oxygen consumption is the double product / DP /, defined as the product of heart rate and systolic blood pressure and divided by one hundred. Within submaximal loads, this indicator closely correlates with oxygen consumption by the myocardium and the size of the heart / Robinson B.F., 1967; Kitamura K. et. al. Amsterdam E.A., Mason D.F., 1977; Holmberg S., 1971 /, a regression formula was established to calculate myocardial oxygen consumption by the value of DP. Thus, the increase in DP / PDP /, based on a clear quantitative principle, can complement the descriptive nature of clinical indicators. The ratio of DP to the power of the work performed allows you to objectify the lack of functional adaptive abilities of the body and standardize this adaptive insufficiency.

 The criterion for the objective diagnosis of NDC, which we selected as a prototype and allows us to assess the role of the cardiac component in the origin of the main cardiac symptoms / inadequate tachycardia, shortness of breath, fatigue, palpitations /, was the method proposed by N.P. Bazhanov / Cardiology, 1980, 1, p. 19-23 /, based on the study of phase analysis of systole in a sample with dosed physical activity. This method allows you to identify the difference in changes in the phase composition of systole depending on the severity of the course of NDC, revealing the absence of an increase in heart rate. This method has several disadvantages: it is quite complicated, requires the presence of a noise-resistant polyanalyzer, changes in the phase composition of the systole are not specific to NDC. The author himself noted that adverse changes in the phase composition (third type) are observed mainly in patients with a prolonged, severe course of NCD and the presence of multiple symptoms, the type of reaction of the phase composition of systole depends on the severity of NDC.

 The technical result of the invention is to obtain a reliable objective criterion for the diagnosis of NDC, revealing the essence of the disease - a violation of the regulatory systems of the body and, above all, a violation of the regulation of the reaction of the cardiovascular system to various physical / household and industrial / loads, the model of which is dosed physical load on a bicycle ergometer.

The definition of dysfunction of regulatory systems is based on the fact that in NCC patients, due to dysregulation of regulatory mechanisms, there is a significantly greater increase in oxygen consumption by the myocardium with stepwise increasing standard physical loads, which is reflected in a significantly larger increase in DP with increasing loads. This inadequacy of the reaction of the cardiovascular system to dosed physical activity manifests itself as an increase in the MPD and the ratio of the DP to the power of the work performed - the cardiac loading index / SNI / - by values not characteristic of healthy individuals. As the criteria for the diagnosis of NDC, we took the values of the SDP and SNI, which are separated from the average values for patients with NDC by the value of one standard deviation. These values for PDP ₅₀ -51.7 for SNI ₅₀ -3.2, for SNI ₇₅ -2.5, for SNI ₁₀₀ -2.1.

 Our analysis of hemodynamic parameters in a sample with dosed physical activity allowed us to identify significant differences in the proposed indicators compared with their changes in healthy individuals / cm. table 1 /.

 We conducted an analysis of the information content of these criteria using the formulas given by V.V. Menshikov / 1982 / and Pomerantsev V.P. and Tskipuri Yu.I. / 1992 /.

для ПДП₅₀=89,5%, для СНИ₅₀=84,2%, для СНИ₇₅=89,5, для СНИ₁₀₀-84,2%.Diagnostic sensitivity / PM /, determined by the formula

for PDP ₅₀ = 89.5%, for SNI ₅₀ = 84.2%, for SNI ₇₅ = 89.5, for SNI ₁₀₀ -84.2%.

для ПДП₅₀=80,0%, для СНИ₅₀=80%, для СНИ₇₅=66,6, для СНИ₁₀₀-53,3%.Diagnostic specificity / DS /, determined by the formula

for PDP ₅₀ = 80.0%, for SNI ₅₀ = 80%, for SNI ₇₅ = 66.6, for SNI ₁₀₀ -53.3%.

для ПДП₅₀=85,3%, для СНИ₅₀=82,4%, для СНИ₇₅=79,4, для СНИ₁₀₀-73,5%.Diagnostic efficiency / DE /, determined by the formula

for PDP ₅₀ = 85.3%, for SNI ₅₀ = 82.4%, for SNI ₇₅ = 79.4, for SNI ₁₀₀ -73.5%.

 In most cases, the SNI values characteristic of NDC appear already at a load of 50 W and are stored at a load of 75 and 100 W. Only in 20% of patients with NDC, the characteristic values of SNI are absent at a load of 50 W and occur at a load of 75 and 100 watts.

рассчитываются величины прироста двойного произведения /ПДП/ как разница между ДП на последующей ступени нагрузки и предыдущей, на каждой ступени нагрузки рассчитывается сердечный нагрузочный индекс /СНИ/ как отношение ДП к мощности нагрузки в ваттах. Критерием прекращения пробы является достижение субмаксимальной частоты сердечных сокращений. При наличии ПДП₅₀≥51,7 и СНИ₅₀≥3,2 или СНИ₇₅≥2,5 или СНИ₁₀₀≥2,1 диагностируют НЦД.Diagnosis of NDC using the proposed method is carried out during a physical exercise test carried out in compliance with generally accepted safety measures / Physical tests to assess the functional ability of the cardiovascular system, 1971 / with achievement of submaximal heart rate determined by Andersen KL et. al., 1971, according to a continuously increasing stepwise method, starting with a load of 50 W and an increase in load by 25 W every 3 minutes. The values of systolic blood pressure / SBP /, diastolic blood pressure / DBP / and ECG heart rate are recorded in the initial state, at each stage of the load for 3 minutes of its completion, as well as 1, 4 and 7 minutes of the recovery period. In the initial state, for 3 min of each stage of the load, 1, 4 and 7 min of rest, a double product is calculated according to the formula

the values of the growth of the double product are calculated (PDP) as the difference between the DP at the next stage of the load and the previous one, at each stage of the load, the heart load index / SNI / is calculated as the ratio of the DP to the load power in watts. The criterion for stopping the sample is to achieve a submaximal heart rate. In the presence of an RAP of ₅₀ ≥51.7 and an SNI of ₅₀ ≥3.2 or an SNI of ₇₅ ≥2.5 or an SNI of ₁₀₀ ≥2.1, NDC is diagnosed.

 Examples.

 Example 1. Patient S., 20 years old, was sent by the military commissariat to clarify the diagnosis and resolve the issue of fitness for training at the military department. In the history of NDC. The diagnosis was made 3 years ago, since then has not been treated, no complaints. An objective examination of the pathology was not detected. (see table 2).

 Conclusion: RAP and SNA indicators are less than the proposed values. Exercise data testify against the diagnosis of NDC.

 Example 2. Patient S. 19 years. It was sent to clarify the diagnosis and resolve the issue of fitness for military service. Dizziness worries, periodically in a stuffy room, fainting conditions occur. An objective examination: persistent red dermographism, sweating of the palms, otherwise - without pathology. With a neurological examination - without pathology. Dizziness and fainting have been troubling for 4 years (see table 3).

Conclusion: reduced load tolerance, DPD ₅₀ -51, CHI values ₅₀ > 3.2, SNI ₇₅ > 2.5, SNI ₁₀₀ > 2.1. The data of a stress test indicate a violation of the function of regulatory systems that provide an adequate response to physical activity, confirm the diagnosis of NDC.

 Example 3. Patient 3. 22 years. Over the past three years, headaches, dizziness, periodically stitching pains in the heart region, weakness have been disturbing, fluctuations in blood pressure 110-140 / 70-80 mm have been recorded. Hg An objective examination - hyperhidrosis, the rest - without pathology (see table. 4).

Conclusion: load tolerance is high, PDP ₅₀ > 5.7, values СНИ ₅₀ > 3.2, СНИ ₇₅ > 2.5, СНИ ₁₀₀ > 2.1. The data of a stress test indicate a violation of the function of regulatory systems that provide an adequate response to dosed physical activity, confirm the diagnosis of NDC.

 The proposed diagnostic method has high diagnostic efficiency, physiological, simple, allows you to objectify cardiac, vascular and asthenic complaints, objectively identify mechanisms to reduce exercise tolerance. It can be used in the practice of medical-labor and military-medical examination, creates new criteria for the diagnosis of NDC, increases the efficiency of diagnosis, is simple, reliable, and can be used in any conditions, including in the clinic.

Claims (1)

A method for diagnosing neurocirculatory dystonia, including measuring systolic blood pressure, heart rate in the initial state and when performing a test with a stepwise increasing submaximal physical load on a bicycle ergometer, starting from a load of 50 W with an increase in load power by 25 W every 3 min, characterized in that calculating a gain double product (FPU ₅₀₎ - the difference between the double product (DP) for 3 min at 50 watts and the load in the initial state and the calculated heart load yn CEN (NDA) as a ratio of DP to the load power in watts under load of 50, 75 and 100 W and in the presence of UDP ₅₀ ≥ 51,7, or CNI ₅₀ ≥ 3,2, or CNI ₇₅ ≥ 2,5, or SNI ₁₀₀ ≥ 2.1 diagnose neurocirculatory dystonia.

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