RU2279091C2 - Method for diagnosing toxic encephalopathy cases caused by toxic substance complex action - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out electroencephalographic examination and biochemical blood tests to determine β2-index from the electroencephalogram, catalase level, lipid hydroperoxide level, β-lipoproteins level or multi-factor standard personality study (MFSPS) and Spillberger-Khanin test for reactive anxiousness are applied with scale 1 values (Hs), K, 3 in MFSPS and reactive anxiousness level after Spillberger-Khanin. The obtained data are used for calculating diagnostic coefficient to be compared with a constant. The coefficient value being greater than the constant, toxic encephalopathy is to be diagnosed.

EFFECT: high accuracy of early stage diagnosis.

2 cl, 1 tbl

Description

The present invention relates to medicine, namely to neurology and occupational pathology, and can be used to diagnose toxic encephalopathy.

To date, accurate methods for the diagnosis of toxic encephalopathy have not been developed. There are methods for diagnosing toxic encephalopathy, including clinical neurological examination, electroencephalography (EEG), rheoencephalography, a psychological study of emotional-volitional and mnestic-intellectual spheres, biochemical study of lipid metabolism [2, 4]. However, these techniques are not sufficiently accurate for the diagnosis of toxic encephalopathy.

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

The task is achieved by the fact that the patient undergoes either a biochemical blood test and electroencephalography, or tests SMIL and Spielberger-Hanin to determine the level of reactive anxiety and calculate the diagnostic coefficients F by the formulas:

Fb / e = 13.3-1.2 · a1 + 0.3 · a2 + 1.24 · a3 + 0.12 · a4;

or Fsmil = 25.8-0.16 a5-0.23 a6 + 0.24 a7 + 0.11 a8,

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

F smil - diagnostic coefficient for psychological indicators;

13.3 and 25.8 are constants;

digital indicators are discriminatory factors;

a1,2 ... 8 - gradations and numerical values of the indicators of the examination (a1 - catalase level in the blood, a2 - β2 - EEG index, a3 - the level of lipid hydroperoxide in the blood, a4 - the level of β-lipoproteins in the blood, a5 - indicator of scale 1 (Hs) for SMIL, a6 - indicator of scale K for SMIL, a7 - indicator of scale 3 (Well) for SMIL, a8 - level of reactive anxiety according to the Spilberger-Khanin method);

and with an F value, more than a constant diagnoses toxic encephalopathy.

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. When the value of the diagnostic coefficients F is greater than a constant, toxic encephalopathy is diagnosed. In addition, unlike the prototype, our system is focused on objective clinical, physiological and biochemical parameters, so the diagnostic results 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 atherosclerotic discirculatory encephalopathy using the discriminant equation, where risk factors are informative [5]. A method for the diagnosis of toxic encephalopathy, including diagnosis according to the complex of proposed indicators, has not been identified in the literature available to us. The proposed parameters make it possible to diagnose toxic encephalopathy with a high degree of accuracy (91.4%). 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.

A patient with suspected toxic encephalopathy is given either a biochemical blood test (determination of catalase levels, lipid hydroperoxides, β-lipoproteins) and electroencephalography, or SMIL and Spielberger-Hanin tests for reactive anxiety and determine their numerical values. Then calculate the diagnostic coefficients F according to the formulas:

Fb / e = 13.3-1.2 · a1 + 0.3 · a2 + 1.24 · a3 + 0.12 · a4; or

Fsmil = 25.8-0.16 · a5-0.23 · a6 + 0.24 · a7 + 0.11 · a8,

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

F smil - diagnostic coefficient for psychological indicators;

13.3 and 25.8 are constants;

digital indicators are discriminatory factors;

a1,2 ... 8 - gradations and numerical values of the indicators of the examination (a1 - catalase level in the blood, a2 - β2 - EEG index, a3 - the level of lipid hydroperoxide in the blood, a4 - the level of β-lipoproteins in the blood, a5 - an indicator of scale 1 (Hs) for SMPS, a6 is an indicator of scale K for SMIL, a7 is a indicator of scale 3 (Well) for SMIL, a8 is the level of reactive anxiety according to the Spilberger-Hanin method), and if the value of the diagnostic coefficients F is more than a constant, the toxic is diagnosed encephalopathy.

The diagnostic coefficients Fb / e and Fsmil were obtained by subtracting the discriminant functions of toxic encephalopathy and the control group for the corresponding indicators (F1b / e - F2b / e and F1smil - F2smil):

F1 b / e = -25.5 + 1.2 · a1-0.2 · a2 + 0.06 · a3 + 0.72 · a4

F2 b / e = -38.8 + 2.4 · a1-0.5 · a2-1.3 · a3 + 0.6 · a4

F1 smil = -33.4 + 0.04 · a5-0.48 · a6 + 0.64 · a7-0.51 · a8

F2 smil = -59.2 + 0.2 · a5 + 0.25 · a6 + 0.4 · a7-0.62 · a8

The discriminant analysis was performed in a group of patients with toxic encephalopathy and healthy individuals. 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 in patients with toxic encephalopathy and healthy individuals No. Indicators F inclusion R a1 Catalase (number) 21,2 0.00004 a2 β-2 EEG index (%) 7.9 0.007 a3 The content of β-lipoproteins in the blood (%) 5.1 0.05 a4 The content of lipid hydroperoxides in the blood (conventional units) 3.6 0,03 a5 Indicator 1 of the scale for SMIL (T-points) 383.9 0.000000 a6 Indicator K of the scale for SMIL (T-points) 36.7 0.000000 a7 Indicator 3 of the scale for SMIL (T-points) 13.1 0,0004 a8 Level of reactive anxiety (points) 3,7 0.05

Example 1

Patient P., a participant in the elimination of fire, in which there was a similar release of toxic products of substances, conducted a biochemical examination of blood and EEG, determined their numerical values:

a1 - Catalase level in the blood is 6.7;

a2 - The value of β ₂ - EEG index - 3.7%;

a3 - The level of lipid hydroperoxides in the blood - 2.4 srvc .;

A4 - The level of β-lipoproteins in the blood is 51%;

Fb / e = 13.3-1.2-6.7 + 0.3 · 3.7 + 1.24 · 2.4 + 0.12 · 51 = 15.44

The resulting value is 15.44> 13.3. Conclusion: Patient P. has toxic encephalopathy.

Example 2

Patient K., fire exterminator, underwent biochemical examination of blood and EEG, their numerical values were determined:

a1 - The level of catalase in the blood is 10.5;

a2 - The value of β2 - index by EEG - 1.1%;

a3 - The level of lipid hydroperoxides in the blood - 1.7 srvc .;

A4 - The level of β-lipoproteins in the blood is 50.7%;

Fb / e = 13.3-1.2-10.5 + 0.3 · 1.1 + 1.24 · 1.7 + 0.12 · 50.7 = 9.21

The resulting value is 9.21 <13.3. Conclusion: patient K. has no data for toxic encephalopathy.

Example 3

The patient A., a participant in the elimination of fires, conducted psychological tests SMIL and Spielberger-Khanin, determined by their numerical values:

a5 - The scale 1 indicator for SMIL is 78 points;

a6 - The indicator of the scale K for SMIL is 45 points;

a7 - The scale 3 indicator for SMIL is 82 points;

a8 - The level of reactive anxiety is 45 points;

F smil = 25.8-0.16-78-0.23-45 + 0.24 · 82 + 0.11 · 45 = 27.6

The resulting value is 27.6> 25.8. Conclusion: patient A. has toxic encephalopathy.

Example 4

The patient R., a participant in the elimination of fires, conducted psychological tests SMIL and Spielberger-Khanin, determined by their numerical values:

a5 - The scale 1 indicator for SMIL is 48 points;

a6 - The scale indicator K for SMIL is 35 points;

a7 - The scale 3 indicator for SMIL is 34 points;

a8 - The level of reactive anxiety is 45 points;

F smil = 25.8-0.16 -48-0.23-35 + 0.2434 + 0.1145 = 23.18

The resulting value is 23.18 <25.8. Conclusion: Patient R. has no data for toxic encephalopathy.

As a result of the discriminant analysis based on biochemical and electroencephalographic indicators, an optimal combination of 4 signs was obtained; according to psychological indicators - 4 signs, in which the accuracy of the diagnosis was maximum. Therefore, for the diagnosis of toxic encephalopathy in firefighters, we used 8 of the above indicators described above.

Evaluation of the effectiveness of the proposed diagnostic method was carried out in the training and control samples. In the training sample (32 people), the correct recognition was 91.9% for patients with toxic encephalopathy and 92.4% for patients in the control group (32 healthy individuals). In the control sample - 30 patients with toxic encephalopathy and 30 patients in the control group, the correct recognition was 87.2% and 85.3%, respectively.

The proposed method makes it possible to diagnose toxic encephalopathy using the minimum number of the most informative diagnostic indicators, thereby contributing to a decrease in the volume of paraclinical studies. The diagnostic system 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.

Information sources

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

2. Long-term consequences of chronic professional neurointoxications / VN Dumkin, MN Ryzhkova, L. Ye. Milkov: Method. recommendations No. 10-11 / 29. - M.: Ministry of Health of the USSR, 1987 .-- 28 p.

3. Sobchik L.N. Standardized multifactor method of personality research: Methodological guide / Series "Methods of psychological diagnosis." - Issue 1. - M., 1990. - 76 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.39.

Claims (2)

1. A method for the diagnosis of toxic encephalopathy from the effects of a complex of toxic substances, including the use of electroencephalography and a biochemical blood test, characterized in that the β2 index is determined by EEG, the level of catalase, the level of lipid hydroperoxide, the level of β-lipoproteins in the patient’s blood, the diagnostic coefficient is calculated by the formula: Fb / e = 13.3-1.2 · a1 + 0.3 · a2 + 1.24 · a3 + 0.12 · a4, where F b / e is a diagnostic coefficient; 13.3 is a constant; 1,2; 0.3; 1.24; 0,12 - discriminatory coefficients; a1 - catalase level in the blood; A2 - β2 - EEG index; a3 - the level of lipid hydroperoxide in the blood; A4 - the level of β-lipoproteins in the blood, the obtained values are compared with a constant and at Fb / e> constants they diagnose toxic encephalopathy. 2. A method for the diagnosis of toxic encephalopathy from exposure to a complex of toxic substances, including a psychological study, characterized in that the patient undergoes a standardized multivariate personality study (SMIL), and the Spilberger-Hanin test for reactive anxiety, indicators of scale 1 (Hs), K, 3 are determined according to SMIL and the level of reactive anxiety according to the Spielberger-Hanin test, the diagnostic coefficient is calculated by the formula: F smil = 25.8-0.16 · a5-0.23 · a6 + 0.24 · a7 + 0.11 · a8, where F smil - diagnostic coefficient; 25.8 is a constant; 0.16; 0.23; 0.24; 0.11 - discrimination factors; A5 is an indicator of scale 1 (Hs) for SMIL; a6 - indicator of the scale K for SMIL; a7 is an indicator of scale 3 (Well) for SMIL; a8 - level of reactive anxiety according to the method of Spielberger-Khanin, the obtained value is compared with a constant and with Fsmil> constants, toxic encephalopathy is diagnosed.