RU2271143C2 - Method for differential diagnostics of toxic encephalopathy against the impact of the complex of toxic substances and disculatory (vascular) encephalopathy - Google Patents

Abstract

FIELD: medicine, neurology, professional pathology.

SUBSTANCE: one should carry out either biochemical blood testing and electroencephalography or SMIL test, or ultrasound dopplerography of the main cranial arteries, rheoencephalography (REG) to detect the volume of cerebral circulation and hypercapnic loading and their digital values. Then it is necessary to calculate diagnostic coefficients F by the following formulas: Fb/e=6.3-0.16·a1+0.12·a2-1·a3+0.2·a4, or F_SMIL=9.6+0.16·a5-0.11·a6-0.14·a7+0.07·a8, or Fhem=48.6-0.04·a9+0.15·a10+13.7·a11-0.02·a12+24.7·a13, where Fb/e -diagnostic coefficient for biochemical blood testings and EEG; F_SMIL - diagnostic coefficient for SMIL test; Fhem - diagnostic coefficient for hemodynamic testing; 6.3; 9.6 and 48.6 - constants; a1 - the level of vitamin C in blood; a2 - δ-index by EEG; a3 - atherogenicity index; a4 - the level of α-proteides in blood; a5 - scale 3 value by SMIL; a6 - scale K value by SMIL; a7 - scale 5 value by SMIL; a8 - scale 7 value by SMIL; a9 - the level of volumetric cerebral circulation; a10 - the value of linear circulatory rate along total carotid artery, a11 - the value of resistive index along total carotid artery; a12 - the value for the tonicity of cerebral vessels at carrying out hypercapnic sampling by REG; a13 - the value for the intensity of cerebral circulation in frontal-mastoid deviation by REG. At F value being above the constant one should diagnose toxic encephalopathy, at F value being below the constant - discirculatory encephalopathy due to applying informative values.

EFFECT: higher accuracy of diagnostics.

6 ex, 1 tbl

Description

The present invention relates to medicine, namely to neurology and occupational pathology, and can be used for the differential diagnosis of toxic and discirculatory encephalopathy.

To date, accurate methods for the differential diagnosis of toxic encephalopathy and discirculatory encephalopathy have not been developed. There are methods for differential diagnosis of toxic encephalopathy, including clinical neurological examination, ultrasound dopplerography (Doppler ultrasound) of the main arteries, head arteries, electroencephalography, rheoencephalography (REG), a psychological study of emotional-volitional and mnestic-intellectual spheres, biochemical study of lipid metabolism 3 [ four]. However, these methods are not sufficiently accurate for the differential diagnosis of toxic encephalopathy in firefighters and discirculatory encephalopathy.

The objective of the invention is the most accurate differential diagnosis of toxic and discirculatory encephalopathy.

The problem is solved by carrying out a biochemical blood test and electroencephalography, or SMIL test, or ultrasound dopplerography of the main arteries of the head and rheoencephalography with determination of the volume of cerebral blood flow and hypercapnic load and calculation of the diagnostic coefficient F for specific examination methods, using the formulas:

F _{b / e} = 6.3-0.16 · a1 + 0.12 · a2-1 · a3 + 0.2 · a4,

or F _smil = 9.6 + 0.16 · a5-0.11 · a6-0.14 · a7 + 0.07 · a8,

or F _heme = 48.6-0.04 · a9 + 0.15 · a10 + 13.7 · a11-0.02 · a12 + 24.7 · a13,

where F _{b / e} is a diagnostic coefficient for biochemical blood tests and EEG;

F _smil - diagnostic coefficient for the test SMIL;

F _heme is a diagnostic coefficient for hemodynamic studies of the brain during ultrasound and REG;

6.3; 9.6 and 48.6 are constants;

digital indicators are discriminatory ratios,

a1,2 ... 13 are the numerical values of the indicators of the examination (a1 is the level of vitamin C in the blood, a2 is the EEG δ-index, a3 is the atherogenicity index, a4 is the level of α-lipoproteins in the blood; a5 is a scale 3 indicator for SMIL, a6 - indicator of scale K by SMIL, a7 - indicator of scale 5 by SMIL, a8 - indicator of scale 7 by SMIL; a9 - level of volumetric cerebral blood flow, a10 - linear velocity of blood flow in the common carotid artery, a11 - value of the resistive index by of the common carotid artery with ultrasound, a12 is an indicator of the tone of the cerebral vessels during hypercapnic samples by REG, a13 - the value of the intensity of cerebral blood flow in the front-mastoid lead by REG);

and with an F value greater than a constant, toxic encephalopathy is diagnosed, with an F value less than a constant, discirculatory encephalopathy is diagnosed.

A comparative analysis of the proposed solution with the prototype [2] shows that the proposed method is different in that they calculate the diagnostic coefficients F according to the proposed formulas. The obtained value is compared with a constant, with an F value greater than const, toxic encephalopathy is diagnosed, with an F value less than const, discirculatory encephalopathy is diagnosed. In addition, unlike the prototype, our system is focused on objective clinical, physiological and biochemical parameters, therefore, the results of differential diagnosis do not depend on the competence of doctors in matters of professional pathology. Thus, the proposed technical solution meets the criteria of the invention of "novelty."

From the analysis of patent and specialized literature, the authors found that the proposed technical solution has features that distinguish it not only from the prototype, but also from other technical solutions in this and related fields. There is a method for predicting ischemic stroke in patients with hypertensive discirculatory encephalopathy using the discriminant equation, where risk factors are informative [5]. A method of differential diagnosis of toxic and discirculatory encephalopathy, including differential diagnosis of toxic encephalopathy according to the set of proposed indicators, has not been identified in the literature available to us. The proposed parameters make it possible to differentiate toxic encephalopathy in firefighters with a high degree of accuracy (85.7%). Thus, the proposed method meets the criterion of "inventive step".

The developed method is easy to use and can be used by doctors in clinics and hospitals, which meets the criterion of "industrial applicability".

The method is as follows.

The patient undergoes either a biochemical blood test (determination of vitamin C in the blood, α-lipoproteins, atherogenicity index) and electroencephalography, or a SMIL test, or ultrasound dopplerography of the main arteries of the head, rheoencephalography, with determination of the volume of cerebral blood flow and hypercapnic load, and their numerical values are determined .

Then calculate the diagnostic coefficients F according to the formulas:

F _{b / e} = 6.3-0.16 · a1 + 0.12 · a2-1 · a3 + 0.2 · a4,

F _smil = 9.6 + 0.16 · a5-0.11 · a6-0.14 · a7 + 0.07 · a8,

F _heme = 48.6-0.04 · a9 + 0.15 · a10 + 13.7 · a11-0.02 · a12 + 24.7 · a13,

where F _{b / e} is a diagnostic coefficient for biochemical blood tests and EEG;

F _smil - diagnostic coefficient for the test SMIL;

F _heme is a diagnostic coefficient for hemodynamic studies of the brain during ultrasound and REG;

6.3; 9.6 and 48.6 - const;

digital indicators are discriminatory factors;

a1,2 ... 13 are the numerical values of the indicators of the examination (a1 is the level of vitamin C in the blood, a2 is the EEG δ-index, a3 is the atherogenicity index, a4 is the level of α-lipoproteins in the blood; a5 is a scale 3 indicator for SMIL, a6 - indicator of scale K by SMIL, a7 - indicator of scale 5 by SMIL, a8 - indicator of scale 7 by SMIL; a9 - level of volumetric cerebral blood flow, a10 - linear velocity of blood flow in the common carotid artery, a11 - value of the resistive index by of the common carotid artery with ultrasound, a12 is an indicator of the tone of the cerebral vessels during hypercapnic samples by REG, a13 - the value of the intensity of cerebral blood flow in the front-mastoid lead by REG);

with an F value greater than a constant, toxic encephalopathy is diagnosed; with an F value less than a constant, discirculatory encephalopathy is diagnosed.

Diagnostic coefficients F _{b / e} ; F _smil and F _{heme are} obtained by subtracting the discriminant functions of toxic and discirculatory encephalopathy for the corresponding indicators (F _{1b / e} -F _{2b / e} ; F _1smil -F _2smil and F _1hem -F _2hem ):

F _{1b / e} = -17.3 + 0.14 · a1 + 0.22 · a2 + 2.1 · a3 + 0.6 · a4

F _{2b / e} = -23.6 + 0.3 · a1 + 0.1 · a2 + 3.1 · a3 + 0.4 · a4

F _{1 smil} = -39.6 + 0.5 · a5 + 0.3 · a6 + 0.4 · a7 + 0.2 · a8

F _{2 smil} = -49.2 + 0.34 · a5 + 0.41 · a6 + 0.54 · a7 + 0.13 · a8

F _1heme = -331.8 + 0.74A9 + 0.88A10 + 99.0A11 + 0.12A12 + 95.0A13

F _2heme = -380.4 + 0.78A9 + 0.73A10 + 85.3A11 + 0.14A12 + 70.3A13

The discriminant analysis was performed in a group of patients with discirculatory and toxic encephalopathy. Patients with toxic encephalopathy were firefighters exposed to a complex of toxic substances (vinyl chloride, sulfur dioxide, hydrogen fluoride, dioxins, furans, carbon monoxide and other toxic gases) [1]. The reliability of the obtained informative indicators as a result of discriminant analysis is presented in table 1.

Table 1
Informative indicators of discriminant analysis of patients with toxic and discirculatory encephalopathy No. Indicators F inclusion p a1 Blood Vitamin C Content (μm / L) 13.5 0,0007 a2 EEG Delta Index (%) 9.6 0.003 a3 Atherogenic index (units) 7.8 0.008 a4 The content of α-lipoproteins in the blood (%) 6.5 0.014 a5 The volume of cerebral blood flow by REG (ml / min) 42,4 0.000000 a6 LSK on OSA (cm / s) 16.9 0.00008 a7 ICS OCA 13,4 0,0004 a8 The tone of the cerebral vessels in the hypercapnic sample (B / A), (%) 3.9 0.05 a9 The intensity of cerebral circulation (A) by REG (Ohm) 3.8 0.05 a10 Indicator 3 of the SMIL scale (T-points) 126.9 0.000000 a11 The indicator of the scale K in SMIL (T-points) 12.0 0,0008 a12 Indicator 5 of the SMIL scale (T-points) 6.6 0.011 a13 Indicator 7 of the SMIL scale (T-points) 5.7 0.018

Example 1

Patient A., a participant in the elimination of the fire, underwent a biochemical examination and EEG, their numerical values were determined:

a1 - the level of vitamin C in the blood is 29 μm / l;

A2 - value of the δ-index by EEG - 12%;

a3 - atherogenicity index is equal to 3.2;

A4 - the level of α-lipoproteins in the blood - 35%;

F _{b / e} = 6.3-0.16 · 29 + 0.12 · 12-1 · 3.2 + 0.2 · 35 = 6.9

The resulting value is 6.9> 6.3. Conclusion: Patient A. has toxic encephalopathy.

Example 2

Patient D., a participant in the elimination of numerous fires, underwent a biochemical examination and EEG, their numerical values were determined:

a1 - the level of vitamin C in the blood is 32 μm / l;

A2 - value of the δ-index by EEG - 20%;

a3 - atherogenicity index is equal to 3.8;

A4 - the level of α-lipoproteins in the blood - 23%;

F _{b / e} = 6.3-0.16 · 32 + 0.12 · 20-1 · 3.8 + 0.2 · 23 = 4.38

The resulting value is 4.38 <6.3. Conclusion: Patient D. suffers from dyscirculatory encephalopathy.

Example 3

The patient K. (firefighter) underwent a psychological examination - the SMIL test and determined the numerical values of the test:

A5 - indicator scale 3 for SMIL equal to 75 points;

a6 - the indicator of the scale K for SMIL is 44 points;

a7 - indicator scale 5 for SMIL equal to 38 points;

a8 - the indicator of scale 7 for SMIL is 73 points;

F _smil = 9.6 + 0.16 · 75-0.11 · 44-0.14 · 38 + 0.07 · 73 = 16.55

The resulting value is 16.55> 9.6. Conclusion: patient K. has toxic encephalopathy.

Example 4

Patient R., a participant in the elimination of fires, underwent a psychological examination test SMIL and determined the numerical values of the test:

A5 - the scale 3 indicator for SMIL is 58 points;

a6 - the indicator of the scale K for SMIL is 35 points;

a7 - indicator scale 5 for SMIL equal to 62 points;

a8 - scale indicator 7 for SMIL is 41 points;

F _smil = 9.6 + 0.16 · 58-0.11 · 35-0.14 · 62 + 0.07 · 41 = 9.3

The resulting value is 9.3 <9.6. Conclusion: Patient R. suffers from dyscirculatory encephalopathy.

Example 5

Patient K., a participant in the elimination of fires, underwent ultrasound dopplerography of extracranial vessels and rheoencephalography in a front-mastoid lead with hypercapnic load and their numerical values were determined:

a9 - level of cerebral blood flow volume - 762 ml / min;

A10 - level of linear velocity of blood flow in the common carotid artery - 35 cm / s;

a11 is the resistive index value for the common carotid artery with ultrasound scan = 0.6;

A12 - an indicator of the tone of the cerebral vessels during a hypercapnic test by REG = 60;

a13 is the value of the intensity of cerebral blood flow in the front-mastoid lead by REG = 0.8;

F _heme = 48.6-0.04 · 762 + 0.15 · 35 + 13.7 · 0.6-0.02 · 60 + 24.7 · 0.8 = 50.15.

The resulting value is 50.15> 48.6. Conclusion: patient K. has toxic encephalopathy.

Example 6

Patient S., a participant in the elimination of fire, underwent ultrasound dopplerography of extracranial vessels and rheoencephalography in fronto-mastoid lead with hypercapnic load and their numerical values were determined:

A9 - level of cerebral blood flow volume - 720 ml / min;

A10 - level of linear velocity of blood flow in the common carotid artery - 28 cm / s;

a11 is the value of the resistive index for the common carotid artery with USDG = 0.68;

a12 is an indicator of the tone of the cerebral vessels during a hypercapnic test by REG = 70.3;

a13 is the value of the intensity of cerebral blood flow in the front-mastoid lead by REG = 0.5;

F _heme = 48.6-0.04 · 720 + 0.15 · 28 + 13.7 · 0.68-0.02 · 70.3 + 24.7 · 0.5 = 44.25.

The resulting value is 44.25 <48.6. Conclusion: Patient C. is ill with dyscirculatory encephalopathy.

As a result of the discriminant analysis based on biochemical and electroencephalographic indicators, an optimal combination of four was obtained; psychological - four; hemodynamic - five signs, in which the diagnostic accuracy was maximum. Therefore, for the differential diagnosis of toxic and discirculatory encephalopathy, we used 13 of the above indicators described above.

Evaluation of the effectiveness of the proposed method of differential diagnosis was carried out in the training and control samples. In the training sample (32 people), the correct recognition was 83.3% for patients with toxic encephalopathy and 86.8% for patients with discirculatory encephalopathy (30 people). The control sample included 30 patients with toxic and 30 with discirculatory encephalopathy, with a recognition accuracy of 85.5 and 92%, respectively.

The proposed method makes it possible to differentiate toxic encephalopathy using a minimum number of the most informative diagnostic indicators, thereby contributing to a decrease in the volume of paraclinical studies. The diagnostic method justified by us is focused on objective clinical, physiological and biochemical parameters, therefore, the diagnostic results do not depend on the competence of doctors in matters of professional pathology and angioneurology.

Literature:

1. Benemansky V.V. The effect of dioxin-containing compounds on the body of workers / B.V. Benemansky, O.I. Giblets // Research report No. 02990004196. - Angarsk, 1999.

2. Clinic, diagnosis, treatment and rehabilitation in the long-term period of professional neurointoxication in firefighters / V.G. Kolesov, G.M. Bodyienkova, O.L. Lachman: Method, recommendations. - Angarsk, 2002 .-- 26 p.

3. Long-term consequences of chronic occupational neurointoxication / V.N. Dumkin, M.N. Ryzhkova, L.E. Milkov: Method. recommendations No. 10-11 / 29. - M.: Ministry of Health of the USSR, 1987 .-- 28 p.

4. Tarasova L.A. Occupational diseases with a predominant lesion of the nervous system: In hand-ed. Izmerova N.F .: Occupational diseases. - M .: Medicine, 1996. - S.136-200.

5. Shprah V.V. Encephalopathy. - Irkutsk, 1997 .-- P.38.

Claims (1)

A method for differential diagnosis of toxic encephalopathy from the effects of a complex of toxic substances and discirculatory encephalopathy, including biochemical, instrumental or psychological research, characterized in that for the analysis using the formula F _{b / e} = 6.3-0.16 · a1 + 0.12 · a2-1 · a3 + 0.2 · a4, where F _{b / e} is a diagnostic coefficient for biochemical blood tests and EEG; 6.3 is a constant; 0.16; 0.12; one; 0.2 - discriminatory coefficients; a1 is the level of vitamin C in the blood; A2 - δ-index by EEG; a3 is the atherogenic index; A4 - the level of α-lipoproteins in the blood; or F _smil = 9.6 + 0.16 · a5-0.11 · a6-0.14 · a7 + 0.07 · a8, where F _smil - diagnostic coefficient for the test SMIL; 9.6 is a constant; 0.16; 0.11; 0.14; 0,07 - discrimination factors; A5 - indicator scale 3 for SMIL; a6 - indicator of the scale K for SMIL; a7 - indicator scale 5 for SMIL; A8 - indicator scale 7 for SMIL; or F _heme = 48.6-0.04 · a9 + 0.15 · a10 + 13.7 · a11-0.02 · a12 + 24.7 · a13, where F _heme is a diagnostic coefficient for hemodynamic studies of the brain during ultrasound and REG; 48.6 is a constant; 0.04; 0.15; 13.7; 0.02; 24.7 - discrimination factors; A9 - level of volumetric cerebral blood flow; A10 - the value of the linear velocity of blood flow in the common carotid artery; a11 - value of the resistive index for the common carotid artery for ultrasound, A12 - an indicator of the tone of the cerebral vessels during a hypercapnic test by REG; a13 - the value of the intensity of cerebral blood flow in the front-mastoid lead by REG; and with an F value greater than a constant, toxic encephalopathy is diagnosed, with an F value less than a constant, discirculatory encephalopathy is diagnosed.