RU2203491C2 - Method for evaluating degree of atopic dermatitis in small children - Google Patents

Abstract

FIELD: medicine, pediatrics, dermatology. SUBSTANCE: one should evaluate clinical signs of dermatosis, moreover, in case of severe flow of atopic dermatitis the value of spontaneous neutrophilic adhesion exceeds 51,81%±2,03% and ranged below 32,54%±4,89% in case of light flow of atopic dermatitis. EFFECT: quicker evaluation of atopic dermatitis degree. 1 tbl

Description

 The invention relates to medicine, namely to pediatrics and dermatology.

 The treatment and prognosis of atopic dermatitis depends on an assessment of the severity of the disease. Currently, attempts have been made to identify biochemical parameters to predict the development of atopic dermatitis and the severity of its course in children with a genetic predisposition. However, these laboratory indicators have not yet found wide practical application. Moreover, the predictive value of such laboratory criteria as the level of serum Ig E and the number of eosinophils is ambiguous (Gomberg M.A., Soloviev A.M., Akovbyan V.A. Atopic dermatitis. // Russian Medical Journal, 1998, 20, t. 6, p. 1332-1333).

For the prototype, the authors took patent 2140082 "Method for diagnosing the form of allergic dermatosis in young children" by authors Suchkova GD, Shilyaeva PP, Chemodanova V.V., Baklushina A.V., Fadeeva O.Yu., BI 29, from 20.10. 99. The proposed method improves accuracy and reduces the time of diagnosis of the form of allergic dermatosis at the time of combined manifestations of allergic dermatosis in the form of eczema and atopic dermatitis in children under three years of age by determining the spontaneous adhesion of neutrophilic cells isolated from 0.8-1 ml of the patient’s venous blood on a two-stage density gradient of ficoll Verografin. In this case, the ability of neutrophils to adhere to the plastic surface of immunological tablets with a v-shaped bottom during two-hour incubation at a temperature of 37 ^o C. was evaluated. The spontaneous adhesion index (SBP) was calculated by the formula
GARDEN = K _to - K _nonadg / K _to • 100%,
where K _to - the number of neutrophils in 5 large squares of the Goryaev chamber before incubation,
K _nonadg - the number of neutrophils in 5 large squares of the Goryaev chamber after incubation.

 If the neutrophil spontaneous adhesion indices were at the level of 53.75% ± 3.48%, then the child had a predominance of neurodermatitis in the case of eczema transformation into neurodermatitis, while a decrease in neutrophil spontaneous adhesion to 29.18% ± 1.83% indicated about the prevalence of eczema. As a result of clinical observations and studies, the authors found a correlation between the severity of atopic dermatitis and the rate of spontaneous adhesion of neutrophils and a method for diagnosing the clinical form of allergic dermatosis using a simple accessible technique for determining spontaneous adhesion of neutrophils performed in a short period of time was developed.

 The technical result of the proposed method by the authors is to quickly assess the severity in a short period of time in young children with atopic dermatitis by measuring the rate of spontaneous adhesion of neutrophils.

 Diagnosis is as follows.

 From 0.8-1 ml of the patient’s venous blood after adding it to a solution consisting of 2.7% Trilon B solution and 6% Descartes (polyglucin solution) in a 1: 2 ratio (0.5 ml Trilon B solution and 1 ml polyglucin ), leukocyte cells were released.

 The resulting mixture after stirring was left to stand at room temperature for 30 minutes. Plasma enriched in leukocytes was collected by a Pasteur pipette and layered on a two-stage density gradient of ficoll-verographin. By centrifugation at 1000 rpm for 30 min, two subpopulations of leukocytes (neutrophils and mononuclear cells) were obtained, which were washed twice in Hanks medium (pH 7.2-7.4).

 The viability of nucleated cells was determined and counted using vital staining with a 0.1% trypan blue solution prepared in phosphate buffer (pH 7.2-7.4). Viable cells were counted in the Goryaev chamber. The number of viable cells in suspensions was 90-95%.

0.1 ml of the suspension of neutrophils and 0.1 ml of Hanks solution (pH 7.4) were mixed, after which 0.1 ml of the suspension was placed in a Goryaev chamber and the number of cells in 5 large squares was counted, and the other part of the mixture, consisting of 0 , 05 ml of cells and 0.05 ml of Hanks's solution (pH 7.4) were instilled into immunological assay plates with a v-shaped bottom and placed in a thermostat for 2 hours at 37 ^° C. After incubation, the plate was thoroughly shaken, mixed and transferred. contents into the Goryaev counting chamber, where in 5 large squares the number of cells that did not adhere was counted during incubation.

The rate of spontaneous adhesion (SBP) (%) was calculated by the formula
GARDEN = K _to - K _nonadg / K _to • 100%,
where K _to - the number of neutrophils in 5 large squares of the Goryaev chamber before incubation,
K _nonadg - the number of neutrophils in 5 large squares of the Goryaev chamber after incubation.

 The authors examined 51 young children with varying severity of atopic dermatitis. In this case, a mild course of atopic dermatitis was observed in 13 children, 17 were diagnosed with moderate severity of dermatosis, and in 21 - severe. The clinical picture was assessed by the universal status of a formalized medical history 53 of the Leningrad OTKZ Ministry of Health of the RSFSR (1982), where the intensity of skin rashes, the prevalence of the process, the size of the lymph nodes, the frequency of exacerbations per year, and the duration of remission were highly informative. A comparison of the clinical examination data with the data of the proposed method, as well as monitoring the course of dermatosis in dynamics. Severity assessment was carried out according to the proposed clinical criteria by Revyakina V.A., Balabolkin I.I., Namazova L.S. et al. Early diagnosis, clinical features and principles of treatment of atopic dermatitis in children. - Moscow, 1998, pp. 11-12.

 In the course of research (see table), the authors established the following indicators of spontaneous adhesion of neutrophils. In the first group of children, the indices of spontaneous adhesion of neutrophils were 32.54% ± 4.89%, which corresponded to a mild form of atopic dermatitis (p <0.002), in the second group of children, the indices of spontaneous adhesion of neutrophils were 44.28% ± 3.45 % (p <0.035), which corresponded to moderate severity; in the third group of children, spontaneous neutrophil adhesion rates were 51.81% ± 2.02%.

 Thus, indicators of spontaneous neutrophil adhesion are of sufficient significance in assessing the severity of atopic dermatitis in young children, which allows prescribing pathogenetic therapy at an earlier date.

Clinical examples
Example 1. Patient G. 1 g. 5 months. A child from 3 pregnancies, with a threat of interruption, a second preterm birth. At birth, scream right away. Weight at birth 2650 g, length 52 cm. On artificial feeding from 4 months. Psychomotor development by age. Background pathology: encephalopathy, symptom of motor impairment. The mother's uncle has eczema of the hands. From the diseases: ARVI 5 times, acute bronchitis. The first rashes from 1 month on the skin of the cheeks in the form of erythema, peeling. By the year the process became common. On the skin of the extensor surfaces of the extremities, trunk, face, erythematosquamous lesions, papular elements, pityrious and finely plastic scales, crusts, hyperpegmented and depigmented spots, foci of microvesicles and weeping appeared. In the elbow bends lichenification. Itching is constant, worse at night. Lymph nodes are enlarged to the size of beans. Dermographism is white, persistent. According to a clinical examination, the condition of the child is assessed as atopic dermatitis of moderate severity. In the study of spontaneous neutrophil adhesion, an indicator of 58.32% was obtained, an assessment of severe atopic dermatitis was given. Observation of the child in dynamics (6 months) showed that exacerbations were more than 5 times with short-term remissions, the area of skin lesion increased, and the severity was clinically rated as severe. Thus, the claimed method is objective and informative, reflects changes in the body that have developed before the clinical manifestation.

 Example 2. Patient G. Age 6 months. Baby from 1 pregnancy, birth weight 2700 g, length 48 cm. Scream at birth immediately. Background pathology: encephalopathy, congenital heart disease. Psychomotor development by age. The first rashes from 4 months in the cheeks, forehead in the form of erythema and peeling. At 4.5 months, erythematosquamous lesions appeared on the skin of the shoulders, forearms, legs, hips, lower back, itching intensified. At the age of 6 months, he was hospitalized in a clinic with a diagnosis of atopic dermatitis, congenital heart disease. During the examination, a clinical assessment of the severity of atopic dermatitis is given - mild. A study of spontaneous adhesion of neutrophils was carried out, an indicator of 28.84% was obtained, which corresponded to a mild degree of atopic dermatitis. Observation of the child in dynamics (8 months) showed that skin rashes after treatment were resolved and remission occurred, which confirmed the correctness of the assessment of the severity of atopic dermatitis by the claimed method.

 Thus, the severity of atopic dermatitis in young children is determined by the indicator of spontaneous neutrophil adhesion, in the case of severe dermatosis, the indicator exceeds 51.81% ± 2.034% and is below 32.54% ± 4.89% in the case of mild atopic dermatitis.

Claims (1)

 A method for assessing the severity of atopic dermatitis in young children, including evaluating the clinical signs of dermatosis, characterized in that in the case of severe atopic dermatitis, the rate of spontaneous neutrophil adhesion exceeds 51.81% ± 2.03% and is below 32.54% ± 4.89% in the case of a mild course of atopic dermatitis.

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