RU2323442C1 - Differential diagnosis method for determining acne disease severity degree - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves determining myeloperoxidase and amylase activity in patient saliva. Myeloperoxidase activity being equal to 35.23-42.30 mcMole/mg, and amylase activity being equal to 34.88-42.88 mg/(g x ml), the third-fourth disease severity degree is diagnosed.

EFFECT: high accuracy of the method.

Description

The invention relates to medicine, to the section of dermatovenereology, and may find application in clinical practice for laboratory assessment of the severity of acne.

Acne is a common pathology and causes great moral damage to people suffering from this disease. In the practice of a doctor, the issue of assessing the severity of the disease is relevant, which leads to the right choice of treatment algorithm for each patient.

The analysis of scientific, medical and patent literature has revealed various methods for diagnosing the severity of acne. To assess the severity of acne in practical terms, the methodology proposed by the American Academy of Dermatology (Samgin MA et al. "Herald of Dermatology and Venereology". 2003, 2, pp. 31-35), in which clinical the forms are distinguished by the severity of the first, second, third, fourth.

According to this technique, the first degree is characterized by the presence of comedones and single papules, with a second degree, a papular rash and a small number of pustules are noted, with a third degree, up to five nodes are noted along with a pronounced papulopustular rash, and a fourth degree of severity is characterized by a pronounced inflammatory reaction with the formation of multiple nodes and cysts. The severity is determined by visual inspection of the patient and in clinical practice, the severity is defined as the first, second or third to fourth.

The disadvantage of this technique is subjectivity, which can lead to an erroneous diagnosis and lead to incorrect treatment.

The severity of acne can be determined by C.H. Cook et al. (Cook C.H., Center R.L., Michaels S. An acne grading method using photographic standards, Arch. Dermatol. - 1979. - Vol. 115. - P.571-575). Ha on the basis of eight gradations allocated on the proposed scale, they allow to carry out a quantitative and qualitative characteristic of the severity of the disease, taking into account the area of the lesion and the number of eruptive inflammatory and non-inflammatory elements, which is also subjective and cumbersome.

USSR author's certificate No. 936886 "Method for the examination of dermatological patients", 1982, BI No. 23, a method for diagnosing patients by examining affected skin by biophysical methods is protected by determining the diffuse reflectance of affected skin on a spectrophotometer and additionally determining the diffuse reflectance of healthy skin in the spectral range from 3500 to 7200 A, calculating the diffuse reflection index by the proposed formula. The disadvantage of this method is its complexity. In RF patent No. 2252796 “Method of therapy and monitoring the treatment of scars caused by acne” (2005, BI PM 15) it is proposed to apply an applicator containing 5-aminolevulinic acid in a concentration of 5-20%, then after exposure and removal of the applicator, the area is irradiated with light with a wavelength of 630 nm and an energy density of 10-1200 J / cm ² . The process is monitored by assessing the concentration of the photosensitizer in the affected areas by recording the fluorescence spectra.

The disadvantage of this method is the lack of appropriate equipment in the arsenal of the clinic and possible local allergic reactions from the affected skin. The closest in nature and taken as a prototype for determining the severity of acne is the method of counting all the foci of rashes in the region s of the half of the face, when the number of non-inflammatory open and closed comedones on the one hand and inflammatory foci, spots, papules, pustules, nodes and cysts on the other side of the face. With the predominance of non-inflammatory elements, a diagnosis of acne of the first or second severity is diagnosed, and with a predominance of inflammatory elements - acne of the third or fourth severity (Adaskevich V. P. “Acne vulgar and pink”, N. Novgorod, 2005, p. 62-63).

The disadvantage of this method is its complexity, inaccuracy and subjectivity.

The aim of the invention is to increase the reliability of determining the severity of the course of acne.

This goal is achieved by biochemical research of the patient's saliva, in which the activity of myeloperoxidase and amylase is determined. With a myeloperoxidase activity value of 35.23-42.30 μm mol / mg, and an amylase of 34.88-42.88 mg / (h × ml), the first or second degree of the disease is diagnosed, and with a myeloperoxidase activity value of more than 42.30 μm mol / mg and amylase activity greater than 42.88 mg / (g × ml) are diagnosed with a third or fourth severity.

The method is as follows. A patient is taken on an empty stomach with an intake of oral fluid in an amount of 3-5 ml. Amylase activity is determined by a unified aminoclastic method with persistent starch substrate according to Karavei (Steel ID, Goishvili TG "Modern methods in biochemistry". M .: - Medicine - 1977. - P.66-68). Upon interaction, amylase hydrolyzes the degradation of starch with the formation of end products that do not give a color reaction with iodine. Amylase activity is judged by a decrease in color intensity. The result is expressed in mg / (h × ml). Myeloperoxidase activity is determined according to the Klebanoff method described by M. Saffron. and Lyzlova S.N. (Shafran MG, Lyzlova SN "Issues of medical chemistry", 1975. - No. 6. - P.629-633) by combining the test material with phosphate buffer ph = 6, hydrogen peroxide, o-diodicin, after Exposure 2 minutes 20 seconds produce a study on a spectrophotometer at a wavelength of 460 nm. The result is expressed in μm mol / mg.

With a myeloperoxidase activity of 35.23-42.30 μm mol / mg, and an amylase of 34.88-42.88 mg / (g × ml), the first or second degree of disease severity was diagnosed, and with a myeloperoxidase activity of more than 42.30 μm mol / mg, and amylases greater than 42.88 mg / (g × ml) were diagnosed with a third or fourth severity of acne.

The practical feasibility of the proposed method is confirmed by practical examples.

Example 1. Patient N., 18 years old, outpatient card No. 123, applied for admission to the clinic-diagnostic center "3 health" in Rostov-on-Don with DS Vulgar acne 1-2 degrees, somatically healthy. Prior to treatment, he received vitamins of groups A, B, enzymes, externally “Skinaren” gel, physiotherapeutic treatment. During the examination, according to the claimed method, the activity of salivary myeloperoxidase was 37.26 μm mol / mg, with an amylase activity of 36.40 mg / (h × ml). The patient was diagnosed with acne of the first or second severity, so the treatment tactics, before contacting the CDC, was chosen correctly and did not need correction.

Example 2. Patient V., 20 years old, medical history No. 43, turned to the CDC "Health" with DS Acne vulgaris, papulopustular form of 1-2 severity, somatically healthy, received vitamins, enzymes, "Differin" externally. The effect of the treatment was not observed. In the study, the activity of myeloperoxidase was 44.12 μm mol / mg, and amylase 47.18 mg / (h × ml). The patient was diagnosed with acne of the third or fourth severity and antibiotics were included in the treatment regimen. After a course of antibiotic therapy, the patient experienced persistent remission.

The proposed method was examined 100 patients with acne of varying severity. The laboratory diagnosis coincided in 30%, the remaining patients had a different diagnosis and treatment tactics, which allowed achieving better results in the treatment of the patient.

Thus, compared with the prototype, the claimed methodology for determining the severity of acne provides reliable diagnosis of varying degrees of severity of the disease, which allows you to correctly select the patient management protocol and obtain a stable result.

Claims (1)

A method for differential diagnosis of the severity of acne by examining a patient, characterized in that a biochemical study of saliva is carried out, in which the activity of myeloperoxidase and amylase is determined, and when the activity of myeloperoxidase is 35.23-42.30 μm mol / mg, and amylase 34.88 -42.88 mg / (g · ml) diagnose 1-2 severity of the disease, and with myeloperoxidase activity of more than 42.30 μm mol / mg and amylase activity of more than 42.88 mg / (g · ml) diagnose 3-4 the severity of acne.