RU2324941C1 - Method of prediction of ischemic stroke course - Google Patents

Abstract

FIELD: medicine; neurology.

SUBSTANCE: serum and liquor are tested for uric acid on the first day of the acute stroke. If serum levels of uric acid are more than 390 mcmol/l, and liquor levels are more than 140 mcmol/l, the unfavorable course (lethal outcome) of stroke is predicted.

EFFECT: reliably predicts stroke outcome in first hours of acute onset.

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Description

The invention relates to medicine, namely to neurology, and is intended to predict the outcome in the acute period of ischemic stroke.

Ischemic brain damage resulting from its vascular diseases is one of the leading causes of morbidity, mortality and disability in the world. According to the most modern data, mortality from ischemic stroke, an extreme manifestation of cerebral ischemia, competes in the structure of overall mortality with myocardial infarction. Mortality in the acute stage of ischemic stroke reaches 35%, increasing by 12-15% by the end of the first year. Disability due to stroke is the first among all causes of primary disability, about 80% of stroke patients remain permanently disabled. The problem of effective treatment of patients with acute ischemic brain pathology seems to be very difficult, despite considerable experience. As you know, for the successful treatment of any disease, a deep understanding of the mechanisms of development and progression of the disease, the ability to predict its course and outcome is necessary. Prediction of the outcome of the disease, the development of complications and relapses is of fundamental importance for determining the optimal timing and tactics of treating patients.

In neurological practice, various methods for predicting the course of ischemic stroke are currently known. A known method for predicting the outcome of ischemic stroke by the method of RR-cardiointervalometry patent RU No. 2234852 IPC АВВ 5/0452 (1). A known method for predicting the outcome of ischemic stroke by magnetic resonance imaging of the brain (patent RU No. 2233116, IPC AB 6/00 (2). Known methods for predicting the outcome of cerebral stroke according to a study of venous blood (patent RU No. 2217754, IPC G01 33/49 , 33/49 (3), patent RU No. 2079287, IPC A61 5/00 (4). A known method for predicting the course of ischemic stroke by comparing the levels of CD95 lymphocytes on the 1st, 10th and 21st days of the disease (patent RU 2236685, IPC G 01N 33/577 (5). A known method for predicting the course of ischemic stroke by comparisons on the 1st and 21st day of the disease of the levels of anti-DNA serum of a healthy person and a patient with stroke, determined by optical density in an enzyme-linked immunosorbent assay (patent RU No. 2195672, IPC G01N 33/535, G01N 33/53, G01N 33 / 52 (6) is a prototype.

However, these methods are inaccessible in many medical institutions; carrying them out in the first days of a stroke is often impossible.

The claimed invention solves the problem of creating a method for earlier predicting the course of ischemic stroke.

The technical result is to simplify the method, improve the accuracy of predicting the course and the likely outcome of ischemic stroke.

To do this, in a method for predicting the course of ischemic stroke, including clinical and medical history data and blood test results, on the first day of acute cerebrovascular accident, venous blood and cerebrospinal fluid are analyzed for uric acid and serum uric acid is higher than 390 μmol / l, in cerebrospinal fluid above 140 μmol / l, an adverse course (lethal outcome) of ischemic stroke is predicted.

The concentration of uric acid was determined by direct spectrophotometry in an aqueous extract of a thermocoagulant of venous blood serum, cerebrospinal fluid. 0.3 ml of blood serum or cerebrospinal fluid was added to a standard glass tube. Then thermocoagulation was carried out in a boiling water bath for 5 minutes. A prerequisite was active boiling (in order to avoid defragmentation of the coagulant). After cooling at room temperature for 3 minutes, 3 ml of double-distilled water was poured into the tube. After 30 min incubation at 37 ° C, the extinction of the extract against the pure extractant (bidistilled water) was measured in a cuvette with an optical path length of 10 mm; extinction at a wavelength of 293 nm reflects the concentration of uric acid in serum in μmol / L. (8. Dawson R. Handbook of biochemist / Dawson R. [et al.]; Translated from English. - M .: Mir, 1991. - P. 411-413; Marimont JH Direct determination of uric acid byultraviolet absorption / JH Marimont , M. London // Clin. Chem. - 1964. - Vol.10, No. 10. - P.934-941.

The concentration of uric acid in the blood and cerebrospinal fluid was selected as the norm of uric acid concentration in the blood and cerebrospinal fluid, obtained by examining 140 individuals from a random sample of practically healthy people, while there was no significant effect of gender and age on these indicators. The data are presented in table 1.

Table 1 Indicators of uric acid in the blood and cerebrospinal fluid in healthy people Indicator Average values in the blood (M ± m) The limits of normal values in the blood The average values in the cerebrospinal fluid (M ± m) The limits of normal values in the cerebrospinal fluid Uric Acid, μmol / L 297 ± 3.5 213-372 62 ± 2 53-71

Example 1

Patient I., 68 years old, (number of source of illness 7668), was hospitalized from 11/20/2003 to 11/21/2003 in the angioneurological department of the Municipal Clinical Hospital "GB No. 5" with a diagnosis of Osn .: CVB: Coronary artery stem from 20.11 .2003. Osl .: Edema of the brain with a wedge in the large occipital foramen. Sop .: CHD: angina pectoris FC 3, atherosclerosis of coronary vessels, aorta, cerebral vessels, symptomatic hypertension, type 2 diabetes, COPD, emphysema.

On admission: HELL 100/60 mm Hg; body temperature 36.2; respiratory rate 28; consciousness is a stupor; the total score on the Glasgow-Pittsburgh scale is 14 (with a maximum score of 25); liquor is colorless, transparent; in the general analysis of blood - a small leukocytosis up to 8.8 × 10%; stab leukocytes up to 8%; UEG - M-echo offset no.

Upon admission: the content of uric acid (MK) in the cerebrospinal fluid is 345 μmol / L, in the blood serum - 409 μmol / L.

Death 11/11/2003. Pathological diagnosis: A brain stem infarction caused by stenotic atherosclerosis of cerebral vessels. Swelling and swelling of the brain with a wedge in the large occipital foramen.

Example 2

Patient G., 54 years old (no. Source of illness 3217), was hospitalized from 05/09/2003 to 05/16/2003 in the intensive care unit of the Municipal Clinical Hospital "GB No. 5" with a diagnosis of Osn: Repeated ischemic stroke in the left cerebral artery basin from 05/09/03 with right deep hemiparesis, total aphasia. Sop .: Rheumatism, active phase, recurrent rheumatic heart disease, combined mitral defect with a predominance of stenosis, H2B, atrial fibrillation. On admission: HELL 210/120 mm Hg; body temperature 36.0; respiratory rate 32; consciousness - coma 1; the total score on the Glasgow-Pittsburgh scale is 14 (with a maximum score of 25); liquor is colorless, transparent; in the biochemical analysis of blood - an increased content of creatinine of 300 μmol / L, UEG - there is no M-echo displacement.

On admission: the content of uric acid (MK) in the cerebrospinal fluid is 149 μmol / L, in the blood serum - 399 μmol / L.

Death May 16, 2003.

Example 3

Patient I., 63 years old, (number of source. Disease 7696), was hospitalized from 11/17/2003 to 11/27/2003 in the angio-neurological department of the Municipal Clinical Hospital "GB No. 5" with a diagnosis of Osn.: Ischemic stroke in the pool of the right SMA with left-sided hemiparesis, dysarthria from 11/17/2003. Sop .: IHD: angina pectoris FC 3, tachysystolic atrial fibrillation; GB 3.

On admission: HELL 180/140 mm Hg; body temperature 36.6; respiratory rate 24; consciousness is a stupor; the total score on the Glasgow-Pittsburgh scale is 21 (with a maximum score of 25); liquor is colorless, transparent; in a biochemical blood test - an increased content of creatinine of 300 μmol / L, UEG - there is no M-echo displacement.

On admission: the content of uric acid (MK) in the cerebrospinal fluid is 54 μmol / L, in the blood serum - 325 μmol / L. Discharged home with improvement.

Example 4

Patient E., 66 years old, (number of source of illness 7928), was hospitalized from 11/25/2002 to 10/12/2002 in the angio-neurological department of the Municipal Clinical Hospital "GB No. 5" with a diagnosis of Osnov: Ischemic stroke in the right SMA pool with left-sided hemiparesis, dysarthria from 11/25/2003. Sop .: IHD: angina pectoris FC 3, tachysystolic atrial fibrillation; GB 3.

On admission: HELL 140/90 mm Hg; body temperature 36.6; respiratory rate 24; consciousness is stunning; the total score on the Glasgow-Pittsburgh scale is 24 (with a maximum score of 25); liquor is colorless, transparent; UEG - M-echo offset no.

On admission: the content of uric acid (MK) in the cerebrospinal fluid is 70 μmol / L, in the blood serum - 266 μmol / L. Discharged home with improvement.

The claimed prediction method was tested in 348 patients with acute cerebral ischemic stroke. The relationship between the concentration of uric acid in blood serum and cerebrospinal fluid in the first day with the course and outcome of acute ischemic stroke was studied. For reliability, a comparison was made of the content of uric acid in the serum of venous blood on the third and seventh day in survivors and later dead patients with acute cerebral ischemic stroke. The data are shown in table 2.

table 2 Indicators of uric acid in serum of venous blood and cerebrospinal fluid in deceased and surviving patients with ischemic stroke Index (μmol / L) Dead, M ± m Surviving, M ± m R MK _face ^*
on the first day 159 ± 15 135 ± 16 P <0.025 MK _veins
on the first day 389 ± 54 326 ± 41 P <0.025 MK _veins
on the third day 367 ± 48 324 ± 66 p <0.05 MK _veins
on the seventh day 877 ± 219 300 ± 28 P <0.025

As can be seen from the table, the uric acid content in the blood of patients who subsequently died is both on the 1st day of the stroke and in dynamics on the seventh day higher in comparison with the indicators for survivors, and on the seventh day there was a “prohibitive” increase in the concentration of uric acid in dead, and in surviving patients, the content of uric acid in the serum of venous blood has a tendency to decrease on the seventh day.

These results suggest the use of a significantly increased content of uric acid in the cerebrospinal fluid and venous blood on the first day of a stroke as a prognostic sign of a likely fatal outcome.

From the results it is seen that the claimed method for predicting the outcome of ischemic stroke allows you to reliably determine the outcome of ischemic stroke in the first day. It is simple to execute, does not require expensive equipment, reagents, or specially trained personnel, and we will perform it in stationary conditions of medical institutions in the first hours of acute cerebrovascular accident.

Claims (1)

A method for predicting the course of ischemic stroke, including clinical and medical history data and blood test results, characterized in that on the first day of acute cerebrovascular accident, blood serum and cerebrospinal fluid are analyzed for uric acid and serum uric acid content above 390 μmol / l, in cerebrospinal fluid above 140 μmol / l, an adverse course (lethal outcome) of ischemic stroke is predicted.