RU2299003C2 - Method for differential diagnostics of the syndrome of autonomic dystonia of nontoxic genesis and the syndrome of autonomic dystonia due to the action of the complex of chemical substances - Google Patents

Abstract

FIELD: medicine, neurology.

SUBSTANCE: it is necessary to carry out SMIL test or detect the content of nonesterified fatty acids (NEFA) and blood peroxidase activity. Then it is important to calculate diagnostic coefficient according to one of the following formulas: F_SMIL=6.11+0.1603·a₁-0.1193·a₂-0.08·a₃, F_POL=7.28+0.00248·a₄-0.02588·a₅, where a₁ - the value of scale 1 by SMIL, a₂ - the value of scale K by SMIL, a₃ - the value of scale L by SMIL, a₄ - NEFA blood content, a₅ - blood peroxidase activity, 6.11, 7.28 - the constants. At value F>constant one should diagnose the syndrome of autonomic dystonia of nontoxic etiology.

EFFECT: higher accuracy of diagnostics.

4 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 autonomic dystonia syndrome (SVD) of toxic and non-toxic genesis.

To date, issues of differential diagnosis of SVD under the influence of toxic substances and SVD of non-toxic nature have not been sufficiently developed. There are methods for differential diagnosis of SVD of toxic and non-toxic nature, including clinical neurological examination, psychological study of the emotional-volitional spheres, electroencephalography, and brain NMR [2, 3, 7, 9, 11]. However, these techniques are not accurate enough for the differential diagnosis of autonomic dystonia from exposure to a complex of toxic substances and autonomic dystonia syndrome of non-toxic nature.

The objective of the invention is to improve the accuracy of differential diagnosis of SVD under the influence of toxic substances and SVD somatic nature.

The problem is solved by conducting a standardized multivariate personality study (SMIL) test for a patient with autonomic dystonia syndrome [10] or by studying lipid peroxidation and antioxidant defense indicators with determination of levels of non-esterified fatty acids (NEFA) and blood peroxidase activity [3, 4] and analysis obtained indicators during the SMIL test by the formula:

F _smil = 6.11 + 0.1603 · a ₁ -0.1193 · a ₂ -0.08 · a ₃ ,

where F _smil - diagnostic coefficient for the test SMIL,

6.11 is a constant;

digital indicators are discriminatory factors;

and _{1, 2, 3} - the numerical values of the indicators of the survey:

a ₁ - indicator 1 of the scale for SMIL,

and ₂ is an indicator of the scale K for SMIL,

and ₃ is an indicator of the L scale for SMIL;

when determining the content of NEFA and the activity of blood peroxidase according to the formula:

F _floor = 7.28 + 0.00248 · a ₄ −0.02588 · a ₅ ,

where F _floor is a diagnostic coefficient for indicators of lipid peroxidation and antioxidant protection,

7.28 is a constant;

digital indicators are discriminatory factors;

and _{4 ... 5} - numerical values of the indicators of the survey:

and ₄ - the content of NEZHK in the blood,

and ₅ - blood peroxidase activity.

Having calculated the diagnostic coefficients F according to the proposed formulas, the obtained value is compared with a constant. With a value of F> constants, the syndrome of autonomic dystonia of toxic etiology is diagnosed, and with a value of F <constants, a syndrome of autonomic dystonia of non-toxic origin is diagnosed.

A comparative analysis of the proposed solution with the prototype [3] shows that the proposed method differs from the prototype by discriminant analysis of the obtained data of psychological and biochemical studies.

It is known to use the discriminant equation in predicting ischemic stroke in patients with hypertensive genital discirculatory encephalopathy, where risk factors are informative [8]. In the proposed solution, other indicators are used as informative, which are used to carry out diagnostics, and not a forecast. A method for the differential diagnosis of SVD of toxic and non-toxic etiology, including differential diagnosis of toxic SVD according to the set of proposed indicators, has not been identified in the literature available to us. Thus, the proposed method meets the criterion of "inventive step".

The proposed parameters allow us to differentiate SVD under the influence of toxic substances with a high degree of accuracy - 93%.

The developed method is easy to use, while using the minimum number of proposed indicators.

The method is as follows.

The patient undergoes either a standardized multivariate personality study test (SMIL) or a study of the state of lipid peroxidation and antioxidant protection (determination of the content of NEFA and peroxidase activity) and determine their numerical values.

Then calculate the diagnostic coefficients F according to the formula:

F _smil = 6.11 + 0.1603 · a ₁ −0.1193 · a ₂ −0.08 · a ₃ ,

where F _smil - diagnostic coefficient for the test SMIL,

6.11 is a constant;

digital indicators are discriminatory factors;

and _{1, 2, 3} - the numerical values of the indicators of the survey:

a ₁ - indicator 1 of the scale for SMIL,

and ₂ is an indicator of the scale K for SMIL,

and ₃ is an indicator of the L scale for SMIL,

or F _floor = 7.28 + 0.00248 · a ₄ −0.02588 · a ₅ ,

where F _floor is a diagnostic coefficient for indicators of lipid peroxidation and antioxidant protection,

7.28 is a constant;

digital indicators are discriminatory factors;

and _{4 ... 5} - numerical values of the indicators of the survey:

and ₄ - the content of NEZHK in the blood,

and ₅ - blood peroxidase activity.

With a value of F> constants, the SVD of toxic etiology is diagnosed, and with a value of F <constants, an SVD of non-toxic genesis is diagnosed.

Diagnostic _Smeal F coefficients, F _floor obtained by subtracting the discriminant functions SVD toxic etiology and SVD nontoxic nature for relevant indicators (F _{1smil 2smil} -F; F _{1pol 2pol} -F):

F _{1 smil} = -57.81 + 0.3972 · a ₁ + 0.6082 · a ₂ + 0.4210 · a ₃

F _{2 smil} = -63.92 + 0.2369 · a ₁ + 0.7275 · a ₂ + 0.5047 · a ₃

_1pol F = -5.22 + 0.00178 * a ₄ + a ₅ · 0.04732

F _{2 floor} = -12.5-0.0007 · a ₄ + 0.0732 · a ₅

The discriminant analysis was carried out in groups of patients with SVD of toxic and non-toxic genesis. Patients with SVD of a toxic nature were firefighters exposed to a complex of chemicals (vinyl chloride, carbon monoxide, dioxins, furans, etc.) [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 SVD of toxic etiology and SVD of non-toxic nature No. Indicators F inclusion p a ₁ Indicator 1 of the SMIL scale (T-points) 57.22 0.0000 a ₅ Peroxidase Activity (μmol / indigo carmine / min / ml) 12.64 0,0007 a ₂ The scale indicator K SMIL (T-points) 9.77 0.0023 a ₄ The content of NEFA in the blood (μm / l) 4.08 0,0473 a ₃ The scale indicator L SMIL (T-points) 2.72 0.1020

Example 1

Patient K., a participant in the fire extinguishing at OJSC Irkutskkabel, underwent psychological testing - a standardized multivariate personality study test (SMIL) and determined the numerical values of the test:

a ₁ - indicator 1 of the scale for SMIL is 93,

and ₂ - the indicator of the scale K by SMIL is 41,

and ₃ - the indicator of the scale L by SMIL is 43,

F _smil = 6.11 + 0.1603 · 93-0.1193 · 41-0.08 · 43 = 12.68.

The obtained value of 12.68> 6.11 is likely in a patient of SVD of toxic genesis.

Example 2

A patient G., a participant in the fire extinguishing at OJSC Irkutskkabel, underwent psychological testing - the SMIL test and determined the numerical values of the test:

a ₁ - indicator 1 of the scale for SMIL is 66,

and ₂ - the indicator of the scale K for SMIL is 55,

and ₃ - the indicator of the scale L for SMIL is 51,

F _smil = 6.11 + 0.1603.66-0.1193.55-0.08.51 = 6.04.

The obtained value of 6.04 <6.11 is likely in a patient of SVD of non-toxic genesis.

Example 3

Patient P. had no history of acute intoxication with a complex of toxic substances, but he took part in eliminating the fire at Irkutskkabel OJSC. He conducted a study of lipid peroxidation and antioxidant protection indicators and determined their numerical values:

and ₄ - the level of NEFA in the blood is 467.32 μm / l,

and ₅ - the activity of blood peroxidase is equal to 196.8 (μmol / indigo carmine / min / ml),

F _floor = 7.28 + 0.00248 · 467.32-0.02588 · 196.8 = 3.34.

The obtained value of 3.34 <7.28 is likely in a patient of SVD of non-toxic origin.

Example 4

Patient P., with a diagnosis of occupational neurointoxication obtained during the elimination of a fire at OAO Irkutskkabel, was examined for lipid peroxidation and antioxidant protection. Their numerical values are defined:

and ₄ - the level of NEFA in the blood is equal to 1060.9 μm / l,

and ₅ - the activity of blood peroxidase is equal to 61.4 (μmol / indigo carmine / min / ml).

F _floor = 7.28 + 0.00248 · 1060.9-0.02588 · 61.4 = 8.33.

The obtained value of 8.33> 7.28 is likely in a patient of SVD of toxic genesis.

As a result of the discriminant analysis, we used 5 of the listed indicators described above for the differential diagnosis of SVD of toxic and non-toxic genesis.

The proposed method makes it possible to differentiate SVD of toxic etiology with sufficient accuracy and using the minimum number of the most informative diagnostic indicators, thereby contributing to a decrease in the volume of paraclinical studies.

Literature

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3. Gavrilov BB Spectrophotometric determination of the content of lipid hydroperoxides in blood plasma / Gavrilov BB, Mishkorudnaya MI // Laboratory work. - 1983 .-- No. 3. - p. 47.

4. Goncharenko M.S. Method for assessing lipid peroxidation / Goncharenko M.S., Latinova A.M. // Laboratory work. - 1985. - No. 1. - p. 6-61.

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Claims (1)

A method for differential diagnosis of autonomic dystonia syndrome (VDS) from the effects of a complex of toxic substances and autonomic dystonia syndrome of non-toxic nature, including the test of a standardized multivariate personality study - SMIL, or determining the content of unesterified fatty acids (NEFA) and blood peroxidase activity, characterized in that it additionally carry out the analysis of the obtained indicators during the SMIL test by the formula F _smil = 6.11 + 0.1603 · a ₁ -0.1193 · a ₂ -0.08 · a ₃ , where F _smil - diagnostic The coefficient for the SMIL test, 6.11 is a constant, 0.1603; 0.1193; 0.08 are discriminatory coefficients, a ₁ is a scale indicator 1 for the SMIL test, ₂ is a scale indicator K for the SMIL test, and ₃ is a scale indicator L for the SMIL test; when determining NEFA and blood peroxidase activity according to the formula F _floor = 7.28 + 0.00248 · a ₄ -0.02588 · a ₅ , where F _floor is a diagnostic coefficient for lipid peroxidation and antioxidant protection, 7.28 is a constant 0.00248; 0.02588 are discriminatory coefficients, and ₄ is the content of NEFA in the blood, and ₅ is the activity of blood peroxidase, and with a value of F> constants, SVD of toxic etiology is diagnosed, and with a value of F <constant - SVD of non-toxic genesis.