RU2276359C1 - Differential diagnosis method for detecting chronic nonbacterial prostatitis forms - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves determining α₂-macroglobulin activity level in prostate secretion sample. Its activity level belonging to an interval from 0.1 to 0.2 IU/ml, noninflammatory chronic nonbacterial prostatitis is to be diagnosed. The value being equal to or greater than 0.2 IU/ml, inflammatory chronic nonbacterial prostatitis is to be diagnosed.

EFFECT: high accuracy of diagnosis.

Description

The invention relates to medicine and will find application in urology, in particular in the diagnosis of forms of chronic abacterial prostatitis.

Chronic prostatitis remains currently very common, insufficiently studied and poorly treatable disease. It affects men predominantly young and middle-aged, that is, the most sexually active, often complicated by a violation of copulative and generative functions.

Obvious is not only the medical, but also the social significance of the problem of increasing the effectiveness of the diagnosis and treatment of chronic prostatitis.

Modern medicine does not have in-depth and reliable information on causal factors and mechanisms of development of chronic prostatitis, especially abacterial. In most cases of chronic prostatitis, its etiology, pathogenesis, and pathophysiology remain unknown (Nickel JC: Prostatitis: Infectious Disease? Infect Urol 2000a; 13: 31-38).

The most widespread today in the world is the classification proposed by the US National Institute of Health (1995), in which category III is distinguished - chronic abacterial prostatitis with and without inflammatory component (Laurent O.B., Segal A.S. Chronic prostatitis. In the book: X Russian Congress of Urologists. Materials: Prostatitis. Moscow, October 1-3, 2002, M .; 2004. 209-222).

Currently, the main diagnostic methods for chronic prostatitis are microscopic, bacteriological and immunological methods for the study of urine, prostate secretion of ejaculate, blood.

When studying the available medical and patent literature, various methods for the diagnosis of chronic prostatitis were identified.

So, in the patent of the Russian Federation No. 2103691, bull. No. 3, 1998. IPC G 01 N 33/53, 33/48 describes the "Method for the diagnosis of chronic prostatitis", which provides for the determination of the level of soluble leukocyte antigen - 2 (RAL - 2) in semen and with its content of 20 μg / ml and higher diagnosed with chronic prostatitis.

In the patent of the Russian Federation No. 2210779, bull. No. 23, 2003, MGR G 01 N 33/92 described "A method for diagnosing the activity of the course of chronic prostatitis", in which the secretion of the prostate gland is examined, and the concentration of diene conjugates and Schiff bases is determined in it, and the coefficient of inflammation activity (CAV) is calculated ) according to the formula. With a decrease in its value, the activity of the course of chronic prostatitis increases.

The disadvantages of these methods is the inaccuracy of the diagnosis of various forms of chronic prostatitis.

As a prototype, the diagnostic method described in the article by Jeffrey A Stern, Alisa E Koch, Phillip L Campbell, Anthony J Schaeffer “Evaluation of cytokines: macrophage inflammation protein MIP-1α and chemoattractant protein for MCP-1 monocytes as indicators of inflammation in secret prostate gland ”(The Journal of Urology, April 2003, Volume 169, Number 4, p. 28), which involves the study of the cytokines MIP-1α and MCP-1 in prostate secretion.

The disadvantage of this method for the diagnosis of chronic prostatitis is its complexity, the inability to determine various forms of chronic prostatitis.

The aim of the present invention is the differential diagnosis of forms of chronic abacterial prostatitis and also simplification of the method of this diagnosis. This goal is achieved by determining the activity of α ₂ -macroglobulin (α ₂ -MG) in the prostate secretion according to the method of Nartikova and Paschina (1979).

Clinical examinations of volunteers - healthy men allowed us to establish that the level of activity of α ₂ -MG is on average 0.1 IU / ml and lower.

The method is as follows. The activity of α ₂ -macroglobulin is determined by the persistent arginine-esterase activity of the trypsin-α ₂ -MG complex formed after the interaction of trypsin excess with prostate secretion diluted 10 times and subsequent inactivation of free trypsin not bound to α _2- MG, soybean inhibitor trypsin. The complex of α ₂ -MG with trypsin retains almost completely the ability to hydrolyze N-benzoyl-arginine ethyl ester (BAEE).

The course of determination.

1.75 ml of 0.05 M Tris-HCl buffer, pH 8.0, is added to 0.1 ml of diluted 10-fold prostate secretion, then 0.05 ml of 0.1% trypsin solution is added. After incubation for 5 minutes at 25 ° C, add 0.1 ml of a 0.3% solution of soybean trypsin inhibitor, mix and after 5 minutes add 1 ml of a solution of BAEE. After mixing, the increase in optical density at 253 nm is measured immediately for 10 minutes against a control sample containing only reagents (2 ml Tris-HCl, buffer and 1 ml BAEE solution).

With an increase in the activity of α ₂ -MG from 0.1 to 0.2 IE / ml, chronic non-inflammatory abacterial prostatitis is diagnosed, and with 0.2 IE / ml and higher, an inflammatory-type HAP.

Example No. 1.

Patient S., 28 years old

Complaints: frequent urination, pain in the lower abdomen and perineum.

Anamnesis: considers himself sick for one year, was not treated.

Physical examination: with digital rectal examination, the gland is compacted, symmetrical, normal in shape, and painful.

Prostatic Symptom Index (IPS) - 30

Laboratory diagnostics:

Prostate-specific antigen (PSA) - 0.22 ng / ml.

Assessment of urine and prostate secretion by Meares and Stamey.

1 - portion of urine (PM) - 1-2 lake. in sight. S. Epidermidis less than 10 ³ in 1 ml.

2 - PM - S. Epidermidis - less than 10 ³ in 1 ml. Secretion of the prostate (SP) - white blood cells up to 100. S. Epidermidis - less than 10 ³ 1 ml.

3 - PM - S. Epidermidis - less than 10 ³ in 1 ml.

Analysis of the secretion of the prostate - microflora is not detected.

The activity level of α ₂ -MH in prostate secretion is 1.0 IE / ml.

Diagnosed with Chronic abacterial prostatitis, inflammatory form.

Example No. 2.

Patient W., age 35 years.

Complaints of aching pain in the perineum, inner thighs, a weak stream of urine, rapid painful urination, weakened ejaculation.

Clinical course: recurrent course, 1-3 clinical episodes per year.

Anamnesis: considers himself ill for about 3 years; there were no infections of the genitourinary system; once a year he conducted courses of spa treatment.

Physical examination: with digital rectal examination - spherical gland, the contours are clear, the sizes are normal, dense, painless.

IPS - 17.

Laboratory diagnostics:

PSA - 3.26 ng / ml.

Assessment of urine and prostate secretion by Meares and Stamey.

1 - PM - 1-2 lake. in the field of view, microflora is not detected.

2 - PM - 0-1 lake. in the field of view, microflora is not detected.

SP - S. Epidermidis - less than 10 ² in 1 ml.

3 - PM - 7-8 lake. in the field of view, microflora is not detected.

The activity level of α ₂ -MG in prostate secretion is 0.14 IE / ml.

Diagnosed with Chronic abacterial prostatitis, non-inflammatory form.

The advantages of the proposed method compared to the prototype are that it allows differential diagnosis between forms of chronic abacterial prostatitis and, depending on this, determine treatment tactics. In addition, this method simplifies the diagnosis of these forms.

α ₂ -MG is the main inhibitor of kinin-forming enzymes. When interacting with α ₂ -MG, kallikrein loses its enzymatic properties, while maintaining esterase activity. There is evidence that α ₂ -MG is able to form low molecular weight peptides that have a toxic effect on pathogenic bacteria, which can change the course of bacterial inflammation. Forming a protective barrier against microbes and parasites in the focus of inflammation, it limits the spread of the pathological process. Along with this, α ₂ -MG changes the response of lymphocytes to chemotaxis, mitogenic factors, interleukins and foreign agents, suppresses the chemotactic reaction of monocytes in response to plasminogen and potassium activators, and inhibits the reaction of neutrophilic granulocytes to complement C3- and C5a fractions.

α ₂ -MG belongs to unique inhibitors, since, when bound to it, enzymes lose their proteolytic ability.

The proposed method was tested on 32 patients and showed high information content.

Claims (1)

A method for differential diagnosis of forms of chronic abacterial prostatitis, involving clinical examination, characterized in that the level of activity of α ₂ -macroglobulin is determined in prostate secretion and, with its activity from 0.1 to 0.2 IE / ml, non-inflammatory chronic abacterial prostatitis is diagnosed, and when 0.2 IE / ml and higher diagnose chronic abacterial prostatitis of the inflammatory form.