RU2269923C1 - Method for diagnosing porto-portal and porto-central hepatic fibrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves determining pulsating arterial blood flow parameters. To do it, measuring electrodes are applied in main liver body mass location zone. Electrode-to-electrode distance is additionally measured and hepatic index is calculated from formula HI=ρ*L²*Ad*ET*HBR/Z²*1000*S, where HI is the hepatic index (l/min/m²), ρ is the constant reflecting volume blood resistance (150 Ohm cm), L is electrode-to-electrode distance (cm), Z is the base impedance (Ohm), Ad is the differential rheogram amplitude (Ohm/s), ET is blood expulsion time (s), HBR is heart beat rate per 1 min, S is the body surface (m²), 1000 is the coefficient for converting to liters. HI value being greater than 0.225 l/min/m², porto-portal and/or porto-central hepatic fibrosis is diagnosed.

EFFECT: wide range of functional applications.

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Description

The invention relates to medicine, namely to gastroenterology, and can be used for impedance diagnostics of portoportal and portocentric liver fibrosis.

There is a known morphological method for determining portoportal and portocentric liver fibrosis, evaluated semi-quantitatively by R. G. Knodell (1981) with a histological index of fibrosis of 3 points [Serov V.V. Comparative morphological characteristics of chronic viral hepatitis B and C // Ros. journal gastroenterol., hepatol., coloproctol. - 1999. - No. 1. - S.36-40].

The disadvantage of the morphological method is its invasiveness, trauma for the patient, a high probability of complications such as bleeding, biliary peritonitis and the inability to obtain a reproducible result in repeated studies.

There is another way to diagnose portoportal and portocentric liver fibrosis by calculating the number of points according to the classification score scale of M. Bonacini using 3 parameters: platelet count, prothrombin time and AlAT / AsAT activity ratio. Patients with a score of 7 or more are diagnosed with fibrosis of 3-4 points, i.e. Portoportal and portocentric fibrosis of the liver or suggest cirrhosis [Yushchuk ND, Znoiko OO, Safiullina N.Kh., Kelly EI Puncture liver biopsy and the possibility of non-invasive monitoring of fibrosis in chronic viral hepatitis C // Klin. prospects gastroenterol., hepatol. - 2002. - No. 1. - S.9-16].

The disadvantages of the method include invasiveness, for example, venous blood sampling for research.

The invention is aimed at solving the problem: the development of a non-invasive method for the diagnosis of portoportal and portocentric liver fibrosis, with high accuracy.

The task is achieved by the fact that the pulsed arterial blood flow is determined impedansometrically, for which measuring electrodes are applied in the area of the main array of the liver, the interelectrode distance is additionally measured, and the liver index (PI) is calculated according to the generally accepted tetrapolar study formula:

PI = ρ · L ² · Ad · Ti · HR / Z ² · S · 1000, where

PI - hepatic index (l / min / m ² ),

ρ is a constant reflecting the volume resistance of the blood - 150 Ohm · cm,

L is the interelectrode distance (cm),

Z - base impedance (Ohm),

Ad is the amplitude of the differential rheogram (Ohm / s),

Ti - time of expulsion of blood (sec),

Heart rate - the number of heartbeats in min,

S - body area (m ² ),

1000 - figure for transfers liters and a PI value of 0.225 l / min / m ² portoportalny diagnose and / or portotsentralny liver fibrosis.

The method is as follows.

The subject is superimposed with point electrodes to record the rheogram on the body region, in the projection of which the main mass of the liver is located, namely: along the anterior axillary line on the right along the upper and lower edges of hepatic dullness, determined using the generally accepted method of percussion and connect them to the input of the reoplethysmograph (for example, RPG 2-02), which provides the measurement of the base impedance of the investigated body area. The interelectrode distance L in cm is determined, the impedance measuring device is turned on, and the base impedance in Ohms is determined on its scale.

According to the above formula, in accordance with the values of ρ, L, Z, Ad, Ti, heart rate and S, the examined patient's PI are found and with its value of more than 0.225 l / min / m ² portoportal and / or portocentral liver fibrosis is diagnosed.

Examples of specific performance of the method.

Example 1

Patient Vlasova T.G., 46 years old.

Diagnosis: Gallstone disease. Chronic calculous cholecystitis. Chronic hepatitis of a minimal degree of activity. Chronic pancreatitis.

The diagnosis is confirmed by laboratory and instrumental examination methods. According to a morphological study of the liver, the index of histological activity of the process in the liver according to the R. G. Knodell scale (1981) is 3 points, which corresponds to chronic hepatitis with a minimal degree of activity. Fibrosis of the liver parenchyma was absent, which on the scale of stages of fibrosis (R. G. Knodell 1981) corresponded to 0 points.

PI was determined according to the following program: measured height 156 cm, body weight 70 kg, applied spot electrodes to the area of the body corresponding to the main array of the liver, then laid the patient on the couch. The electrodes were connected to the input of the polyreocardiograph, the monitoring system of the polyereocardiogram was turned on, and the measured basic impedance (Z) in the area of the body corresponding to the main array of the liver was noted from the display. In the subject, he was 10.43 ohms. With the values corresponding to the patient ρ = 150 Ohm · cm, L = 8 cm, Ad = 0.1 Ohm / s, Ti = 0.32 sec, heart rate = 74 per min, S = 1.69 m ² , PI was determined by the formula which amounted to 0.123 l / min / m ² .

PI = 150 · 8 ² · 0.1 · 0.32 · 74 / 10.43 ² · 1000 · 1.69 = 0.123

The PI value of 0.123 l / min / m ² is less than the threshold value of 0.225 l / min / m ² , therefore, the conclusion is made that there is no portoportal and / or portocentral liver fibrosis.

Example 2. Patient Tugolukova ON, 29 years old.

Diagnosis: Gallstone disease. Chronic calculous cholecystitis. Chronic hepatitis mild activity.

The diagnosis is confirmed by laboratory and instrumental examination methods. According to a morphological study of the liver, the index of histological activity of the process in the liver according to the R.G. Knodell scale (1981) is 2 points, which corresponds to chronic hepatitis with a minimal degree of activity. Fibrous strands penetrated into the lobule with violation of the border plate, forming portortal septa in the liver tissue, which on the scale of fibrosis stages (R. G. Knodell, 1981) corresponds to 3 points.

The patient was determined the data necessary for the calculation: height - 157 cm, weight - 75 kg, ρ = 150 Ohm · cm, L = 8 cm, Ad = 0.1 Ohm · sec, Ti = 0.28 sec, Heart rate = 70, 5 per minute The application of electrodes and determination of the basic impedance was carried out similarly to the program of example 1. The basic impedance (Z) was 5.09 Ohms.

With these calculated data, the PI was 0.399 l / min / m ² .

PI = 150 · 8 ² · 0.1 · 0.28 · 70.5 / 5.09 ² · 1000 · 1.75 = 0.399

The PI value, equal to 0.398 l / min / m ² , is greater than the threshold value of 0.225 l / min / m ² , therefore, the conclusion is made: portoportal liver fibrosis.

Example 3. Patient Kosnyreva TG, 58 years old.

Diagnosis: Gallstone disease. Chronic calculous cholecystitis. Stenosis of Vater's nipple 1 degree. Latent cholangitis. Liver failure. Severe chronic activity of hepatitis.

The diagnosis is confirmed by laboratory and instrumental examination methods. According to a morphological study of the liver, the index of histological activity of the process in the liver according to the R.G. Knodell scale (1981) is 14 points, which corresponds to severe hepatitis with a severe degree of activity. Fibrous strands penetrated into the lobule with violation of the border plate, forming portoportal and portocentral septa in the liver tissue, which according to the scale of fibrosis stages (R. G. Knodell, 1981) corresponds to 3 points.

The patient needed the data necessary for the calculation: height - 145 cm, weight - 51 kg, ρ = 150 Ohm · cm, L = 8 cm, Ad = 0.1 Ohm / s, Ti = 0.30 sec, Heart rate = 82, 1 per minute The application of electrodes and determination of the basic impedance was carried out similarly to the program of example 1. The basic impedance (Z) was 3.59 Ohms. With these calculated data, the PI was 1.237 l / min / m ² .

PI = 150 · 8 ² · 0.1 · 0.30 · 82.1 / 3.59 ² · 1000 · 1.4 = 1.237

The PI value equal to 1.237 l / min / m ² is greater than the threshold value of 0.225 l / min / m ² , therefore, the conclusion is made: portoportal and portocentric fibrosis of the liver.

A comparison of PI indicators in the absence or presence of portal liver fibrosis (0 or 1 point according to Knodell, 1981) was performed in 15 patients with a different index of histological activity of hepatitis and 16 patients with a histological activity index of hepatitis from 1 to 14 points, for which according to morphological research portoportal and / or portocentral liver fibrosis was established (3 points according to Knodell, 1981). The results are presented in tables 1 and 2.

Table 1
Indicators of the hepatic index determined by the impedance method in patients with absence (0 points) or the presence of portal liver fibrosis (1 point) No. Surname Age The degree of fibrosis in points PI (l / min / m ² ) one Shestakova 33 one 0,054 2 Istomina 68 one 0,069 3 Bogomyakova 36 one 0,095 four Boyarshinova 41 one 0,098 5 Smooth 39 0 0,098 6 Mosyagina 42 one 0.102 7 Naumova 61 one 0.106 8 Vlasova 46 0 0.123 9 Lobzhanidze 41 one 0.142 10 Levina 43 one 0.147 eleven Korotaeva 48 one 0.173 12 Shamanova 45 one 0.193 13 Volkova 21 one 0.204 fourteen Blinova 17 one 0.214 fifteen Pykhteeva 63 one 0.225 M 0.86 0.136 ± m 0.09 0.014

table 2
Hepatic index indices determined by impedancemetric methods in patients with portoportal and / or portocentric liver fibrosis No. Surname Age The degree of fibrosis in points PI (l / min / m ² ) one Bushmakin 61 3 0.228 2 Museychuk 54 3 0,307 3 Zueva 73 3 0.352 four Pepelyaeva 62 3 0.355 5 Vyatkina 70 3 0.372 6 Tugolukova 29th 3 0.399 7 Pychkova 72 3 0.442 8 Obodyansky 62 3 0.433 9 Mineeva 45 3 0.445 10 Wunder 45 3 0.481 eleven Belysheva 38 3 0.516 12 Plesnyavtseva 27 3 0.516 13 Verkhozina 36 3 0.636 fourteen Vlasova 71 3 0.675 fifteen Makarova 70 3 0.813 16 Kosnyreva 58 3 1,237 M 3.0 0.513 ± m 0,0 0,061

In patients without liver fibrosis (0 points) or portal fibrosis (1 point), the PI value was in the range from 0.058 to 0.225 l / min / m ² . In patients with portoportal and portocentric liver fibrosis (3 points), the PI value was in the range from 0.228 to 1.237 l / min / m ² . In patients without liver fibrosis or with portal fibrosis, the average PI was 0.136 ± 0.014 l / min / m ² , which is significantly less (ρ <0.001) than in patients with portoportal and portocentral liver fibrosis (0.513 ± 0.061 l / min / m ² ), while morphologically confirmed invasive examination of the liver was taken by us as a control.

By the method of statistical analysis, the optimal diagnostic threshold was determined, which amounted to 0.225 l / min / m ² for PI.

The advantages of the proposed method are its sensitivity due to an accurate threshold figure, the possibility of repeated studies, non-invasiveness, high speed, simplification of the study due to the lack of regulated processing regimes of liver biopsy samples, low cost, as it eliminates the need for expensive reagents and equipment for establishing a pathological diagnosis .

Claims (1)

A method for the diagnosis of portoportal and portocentric liver fibrosis, characterized in that the subject determines pulsating arterial blood flow, for which measuring electrodes are applied in the area of the main array of the liver, the interelectrode distance and body area of the subject are additionally measured, and the liver index (PI) is calculated by the formula PI = ρ · L ² · Ad · Ti · HR / Z ² · 1000 · S, where PI is the hepatic index, l / min / m ² ; ρ is a constant reflecting the volume resistance of the blood - 150 Ohm · cm, L is the interelectrode distance, cm, Z is the base impedance, Ohm, Ad is the amplitude of the differential rheogram, Ohm / s, Ti - the time of expulsion of blood, s, Heart rate - the number of heart contractions, min, S - body area, m ² , 1000 - indicator for translation in liters, and with a PI value of more than 0.225 l / min / m ^2, portoportal and / or portocentral liver fibrosis is diagnosed.