RU2312356C2 - Method for evaluating ischemic stroke severity degree in people being not more than 50 years old - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves determining homocystein concentration in patient venous blood serum. The homocystein concentration being less than 10.4 mcmole/l, ischemic stroke is evaluated as one of low severity degree. The homocystein concentration being equal to 10.4-15.1 mcmole/l, ischemic stroke is evaluated as one of moderate severity degree. The homocystein concentration being greater than 15.1 mcmole/l, ischemic stroke is evaluated as one of high severity degree.

EFFECT: objective evaluation method applicable in acute disease period; enhanced effectiveness in selecting therapy scheme adjustment.

Description

The invention relates to medicine, in particular to neurology and clinical laboratory diagnostics.

There are many known methods for assessing the severity of cerebral stroke patients based on clinical indicators. For example, the National Institute of Health Stroke Scale (NIH-NINDS) (Goldstein LB, Bertels C., Davis JN: Interrater reliability of the NIH stroke scale // Arch. Neurol. - 1989. - V.46. - P.660-662 ) A modified version of the scale consists of 15 points that evaluate the main functions that are most often violated due to cerebral stroke: level of consciousness, speech, eyeball movements, movements in the limbs, and sensitivity in points. The absence of a dysfunction is estimated at 0 points, a slight violation - at 1 point, a moderate violation - at 2 points, the most pronounced violations are rated at 3 or 4 points. Having estimated a separate function, the sum of points is found. The higher the amount of points, the worse the condition of the patient. Another scale is the Orgogozo Scale (Orgogozo JM, Dartigues JF Clinical trials in acute brain infarction: The questions of assessment criteria. In Acute Brain Ischemia: Medici and Surgical Therapy (Battistini N., Courbier R., Fieschi C., Fiorani P. , Plum F. eds.). - N. - Y .: Raven Press, 1986. - P.282-289) - consists of 10 points that also evaluate the main communicative and motor functions. The absence of impairment or mild impairment of function is estimated at 10 or 15 points, moderate impairment - at 5 points, the most pronounced impairment is estimated at 0 points. Having estimated a separate function, the sum of points is found. The maximum total score is 100, the lower the total score, the worse the condition of the patient.

These tests are simple and time-consuming, but have several disadvantages:

1. The inability to accurately quantify the extent of certain violations.

2. Evaluation of the possibilities in performing functions is carried out either by the doctor or by the patient himself, which does not exclude the presence of a share of subjectivity.

3. The complexity of the interpretation of some violations.

4. There are no clear indications of specific limits on the amount of points at which the severity of the patient is assessed as mild, or as moderately severe, or as severe.

Closest to the claimed is a method for diagnosing the severity of ischemic stroke, including a blood test. On the 1st day, the level of antigen-positive cells (CD95-lymphocytes, in%) is determined by the method of immunophenotyping in venous blood as the percentage of fluorescent cells observed in the preparation when viewing 200 lymphocytes minus the percentage of fluorescent cells observed in the negative control preparation and when the value is increased CD95 lymphocytes up to 9.6 ± 3.65% are diagnosed with mild ischemic stroke, with an increase in CD95 lymphocytes to 16.8 ± 2.7%, moderate ischemic stroke, and with an increase in CD95- lymphocytes up to 28.1 ± 3.2% - severe ischemic stroke (Gerasimova M.M., Medvedeva S.L., Medvedev S.V., Gerasimov S.M. Method for diagnosing the severity of ischemic stroke. Application for invention No. 2003109483/14, M. Cl. 7 G01N 33/577, BIMP No. 34, 12/10/2004. - P.507).

The disadvantage of this method is the complexity of the method, as well as the lack of automation when counting fluorescent cells, which does not exclude the presence of a share of subjectivity.

The objective of the proposed method is to reduce the complexity and increase the objectivity of assessing the severity of ischemic stroke.

The task is achieved by conducting a study of venous blood. In the serum of venous blood of patients with ischemic stroke under the age of 50 years, the homocysteine (GC) content is determined, and at a homocysteine concentration of less than 10.4 μmol / L, ischemic stroke is assessed as mild, with a homocysteine concentration in the range of 10.4-15.1 μmol / L evaluate ischemic stroke as moderate, with a homocysteine concentration of more than 15.1 μmol / L, evaluate ischemic stroke as severe.

The novelty of the method:

- In the serum of venous blood determine the content of homocysteine;

- At a homocysteine concentration of less than 10.4 μmol / L, ischemic stroke is assessed as mild, at a homocysteine concentration in the range of 10.4-15.1 μmol / L, ischemic stroke is assessed as moderate, at a homocysteine concentration of more than 15.1 μmol / l assess ischemic stroke as severe.

The proposed method allows to reduce the complexity and increase the objectivity of assessing the severity of ischemic stroke.

It is known that, with an increase in its concentration in the blood, homocysteine has a damaging effect on the vascular wall and on the blood coagulation system, creating conditions for atherosclerotic changes in blood vessels and increased thrombosis that underlie cardio- and cerebrovascular diseases (including ischemic stroke) ) The literature provides data on an increase in cardiovascular risk by 70%, a risk of developing cerebrovascular diseases by 150-250%, a risk of stroke of 4.1 times with moderate hyperhomocysteinemia. Moreover, this risk factor has no lower limit: the lower the level of homocysteine, the lower the risk of developing vascular diseases. In a study by Selhub S. et al. a statistically significant increase in the frequency of stenosis in the carotid artery was found to be more than 25% of its diameter with a homocysteine content of more than 14.4 μmol / L (Selhub S., Jacques PF, Bostom AG et al. Association between plasma homocysteine concentration and extracranial carotid-artery stenosis // N. Engl. J. Med. - 1995.- V.332. - P.86-91).

Therefore, a study of the concentration of homocysteine in serum can be used to assess the severity of the condition of patients with ischemic stroke under the age of 50 years.

A comparative examination of patients with ischemic stroke (n = 30) and control subjects (n = 15) was conducted. The severity of patients was traditionally evaluated according to international clinical scales. In terms of severity, patients were divided into three groups: 1 group - with a mild degree of severity (n = 8), 2 - with a moderate (n = 11), 3 - with a severe (n = 11). As a result of the study, the dependence of the clinical course of the disease on the level of homocysteinemia was established. Spearman's rank correlation coefficient between the concentration of homocysteine and the total score on the Orgogozo scale was R = -0.47 (P = 0.0088, t (N-2) = - 2.817). Moreover, in patients with moderate severity, the average concentration of homocysteine was 58% higher than the level of homocysteine observed in patients with mild severity. And in patients with a severe degree of severity, the content of homocysteine in the blood serum was 110% higher than the value observed in patients with a mild degree of severity.

Table 1.
Homocysteine concentration in patients with ischemic stroke, depending on the severity of the condition Severity of ischemic stroke Easy Moderate Pronounced Orgogozo scale, points 90.7 ± 1.70 78.9 ± 5.88 * 35.0 ± 4.04 * The concentration of homocysteine, µmol / l 8.1 ± 2.24 12.8 ± 2.33 * 17.0 ± 1.89 *

The determination of homocysteine concentration in blood serum makes it possible to objectify the assessment of the severity of the condition of patients with ischemic stroke.

The dependence of the severity of the condition of patients with ischemic stroke under the age of 50 years on the concentration of homocysteine in blood serum is confirmed by the data of the correlation analysis and are reliable.

The method is as follows. In patients with ischemic stroke, 1 ml of blood from the ulnar vein is taken. The resulting blood is placed in an ice bath until the serum is separated. Not later than 30 minutes after receipt, the blood is centrifuged for 10 minutes at 3000 rpm. In the blood serum, the concentration of homocysteine is determined on an IMMULITE immunochemiluminescent analyzer (USA) using kits from DPC, USA.

The principle of the method for determining homocysteine: protein-bound homocysteine is reduced to free and converted to S-adenosyl-L-homocysteine (SAH) by enzymatic means in the sample preparation procedure prior to immunoassay. Free homocysteine is then converted to S-adenosyl-L-homocysteine using SAH hydrolase in the presence of excess adenosine. This enzyme is specific for the L-form of homocysteine, in which the latter is present in the blood.

In the process of immunoassay, an unstable compound is formed, accompanied by continuous emission of light. The number of complexes formed, and accordingly the yield of photons measured by a luminometer, is inversely proportional to the concentration of homocysteine in the sample.

Example 1. Patient S., 47 years old. He was admitted to the hospital in the acute period of ischemic stroke in the vertebrobasilar basin according to the lacunar subtype. The diagnosis was made on the basis of clinical, neurological and neurophysiological studies, data of ultrasound duplex scanning of cerebral vessels and computed tomography of the brain. Consciousness is clear. Oriented completely. There is no paresis of gaze. Speech is not broken. There are no paresis of the muscles of the limbs. Atactic syndrome is moderately expressed. In the study of venous blood in serum, the concentration of HC was determined - 6.3 μmol / L. The condition was rated as mild and corresponded to an assessment on the Orgogozo scale of 90 points. The Department of Neurology conducted complex therapy, including neuroprotectors, vasoactive drugs, antiplatelet agents and antioxidants. After 10 days, the patient was discharged with a decrease in the degree of atactic syndrome.

Example 2. Patient O., 50 years old. He was admitted to the hospital in the acute period of ischemic stroke in the carotid basin according to the atherothrombotic subtype. The diagnosis was made on the basis of clinical, neurological and neurophysiological studies, data of ultrasonic duplex scanning of cerebral vessels and computed tomography of the brain. Consciousness is clear. Oriented completely. There is no paresis of gaze. Speech is mild dysarthria. Mild hemiparesis is noted. In the study of venous blood in serum, the concentration of HC was determined - 12.2 μmol / L. The condition is rated as moderate severity (score on the Orgogozo scale - 80). The Department of Neurology conducted complex therapy, including neuroprotectors, vasoactive drugs, antiplatelet agents and antioxidants. Given the increased level of homocysteine in serum, B vitamins were added to the treatment (B ₆ and B ₁₂ ). The duration of inpatient treatment was extended to 14 days. At discharge, an increase in muscle strength of the extremities and an improvement in speech (score on the Orgogozo scale - 90) were noted.

Example 3. Patient P., 49 years old. He was admitted to the hospital in the acute period of ischemic stroke in the carotid basin according to the atherothrombotic subtype. The diagnosis was made on the basis of clinical, neurological and neurophysiological studies, data of ultrasound duplex scanning of cerebral vessels and computed tomography of the brain. The level of consciousness is stunning. Voice contact is difficult. Paresis of the gaze, asymmetry of the facial muscles are noted. Rough hemiparesis. In the study of venous blood in serum, the concentration of HC was determined - 15.8 μmol / L. The condition is rated as severe severity (score on the Orgogozo scale - 40). In the Department of Neurology, comprehensive intensive therapy was carried out, including neuroprotectors, vasoactive drugs, antiplatelet agents and antioxidants. Given the severity of the condition and the increased level of homocysteine in the blood serum, B vitamins (B ₆ and B ₁₂ ) and folic acid were added to the treatment, as well as enhanced antiplatelet therapy. The duration of inpatient treatment was extended to 21 days. At discharge, the patient's condition improved: the consciousness is clear, the patient can have a reasonable conversation, the volume of eyeball movement has increased, the degree of asymmetry of the facial muscles has decreased.

Example 4. Patient F., 40 years old. He was admitted to the hospital in the acute period of ischemic stroke in the carotid basin according to the cardioembolic subtype. The diagnosis was made on the basis of clinical, neurological and neurophysiological studies, data of ultrasonic duplex scanning of cerebral vessels and computed tomography of the brain. The level of consciousness is a stupor. Speech - sensorimotor aphasia. Paresis of the gaze, asymmetry of the facial muscles, hemiplegia are noted. In the study of venous blood in serum, the concentration of HC was determined - 18.7 μmol / L. The condition is rated as extremely serious (a score on the Orgogozo scale is 15). Despite the complex intensive care, including the treatment of cerebral edema, neuroprotectors, vasoactive drugs, antiplatelet agents and antioxidants, carried out in the intensive care unit, the death occurred on the third day.

Thus, the proposed method for assessing the severity of the condition of patients by the concentration of homocysteine in blood serum is informative, statistically significant, accessible, not laborious in practical execution. It allows you to objectively, quantitatively assess the severity of the patient's condition in the acute period of ischemic stroke and adjust the patient treatment regimen.

Claims (1)

A method for assessing the severity of ischemic stroke in people under the age of 50 years, including a venous blood test, characterized in that the blood serum content of homocysteine is determined and at a concentration of homocysteine less than 10.4 μmol / L, ischemic stroke is assessed as mild, at a concentration homocysteine in the range of 10.4-15.1 μmol / L assess ischemic stroke as moderate; if homocysteine is more than 15.1 μmol / L, ischemic stroke is assessed as severe.