RU2327990C1 - Method of respiratory active tuberculosis diagnostics - Google Patents

Abstract

FIELD: medicine; phthisiology.

SUBSTANCE: adults' pulmonary tuberculosis activity is diagnosed by IR-spectroscopy of serum blood sample analysed within 1200-1000 cm^-1 combined with evaluation of absorption band peak height with maximums 1165 cm^-1, 1150 cm^-1, 1070 cm^-1, 1025 cm^-1. Mathematical treatment of results implies correlation to reference diagnostic "image" boundaries reflecting diagnoses "active tuberculosis", "non-active tuberculosis", plane polyhedron shaped. Patient's state is diagnosed according to obtained point position.

EFFECT: diagnostics of potential activity of pulmonary tuberculosis modifications and prescription of well-timed adequate treatment combined with efficiency evaluation.

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Description

The invention relates to medicine, namely to the field of phthisiology, and can be used to diagnose potentially active pulmonary tuberculosis. Tuberculosis continues to be one of the serious socioeconomic and medical problems, 8.6 million newly sick are registered annually and more than 3 million people die. Mortality of this disease is estimated at 55% in the absence of medical care and is 15% for people who received treatment. According to statistics, more people have died from tuberculosis than from any other infectious disease worldwide (Barry R. Bloom, 2002). Due to changes in the clinic of tuberculosis, namely, more benign, but also more masked, its course, has become more complicated. the task of timely detection of the disease, which led to the role of mass fluorography, and the clarification of the activity of tuberculous changes has become one of the most difficult problems of TB. Changes that are not clinically manifested can preserve potential activity and serve in the future as a source of development of common and destructive forms. X-ray morphological signs of activity of small forms are of relative importance, since inflammatory phenomena as the main symptom of clinical activity are either not detected at all, or have an unclear, erased character (M.A. Klebanov, 1971).

The identification of potentially active tuberculosis is one of the important clinical problems, since it involves solving the issues of dispensary registration, hospitalization and the appointment of specific antibacterial therapy. Establishing a distinction between a disease and a latent state is a difficult diagnostic task. The asymptomatic course of the early period of tuberculosis infection and the early phase of this disease, the latent activity of fading foci in the body, the presence of “masks” of a specific disease create significant difficulties in distinguishing between the active and potentially active (inactive) state of tuberculous changes in the body. The relativity of clinical, radiological, and laboratory parameters should be taken into account when determining the latent activity of tuberculous changes in the body.

In the dispensary practice, the most affordable and reliable way to clarify the activity of small forms of tuberculosis with a hidden course is a therapeutic test, that is, a trial treatment with two or three first-line tuberculostatic drugs and clarification of the radiological dynamics during treatment. [Criteria for the activity of tuberculosis. Ed. Klebanova M.A., Health, Kiev, 1971, p. 107].

When performing a therapeutic test, treatment (trial chemotherapy) is carried out for 2-3, and in some cases for 6 months, while it is necessary at least once a month to carry out an x-ray examination, it is advisable to use any one method.

The disadvantages of the method include the negative effect on the body of frequent fluoroscopic studies, as well as, of course, the toxic effect of tuberculostatic drugs. It should be noted that 2/3 of patients who underwent treatment through a therapeutic test are “owners” of inactive forms of tuberculosis, which, however, is not a reason for refusing to monitor these individuals. In addition, it is necessary to note the suppressed psychological state of the patient.

A known method for diagnosing the activity of tuberculosis of the respiratory system, described in the patent of the Russian Federation No. 2219547. In accordance with the indicated method, the diagnosis is carried out according to the results of a comprehensive clinical and laboratory study, an additional sonoluminescent analysis of a portion of blood plasma in the wavelength range of 3000-7000Å in the photon counting mode is carried out, the normalized integral coefficient of plasma luminescence is calculated and the activity of the tuberculous process is diagnosed depending on its value . This method, as the closest in essence, is selected by the authors as a prototype. The method is applied to children with calcitonitis in the lung tissue and intrathoracic lymph nodes. In addition, it provides for the impact on the plasma under investigation with ultrasound of a certain frequency, during which the level of plasma glow is recorded.

The disadvantages of the proposed method include the limited circle of patients (children with calcitonitis in the lung tissue). In addition, the method involves the use of special equipment and highly qualified personnel who can work on this equipment. However, the information content of this method is not large enough to diagnose such a serious disease.

The objective of the invention is to develop an objective method for the diagnosis of potentially active pulmonary tuberculosis, eliminating these disadvantages.

The problem is solved by a method for the diagnosis of potentially active pulmonary tuberculosis in adults by means of infrared spectroscopy of a blood serum sample.

The proposed method is as follows: venous blood is taken from a patient, serum is separated and a sample is prepared by drying, grinding and suspension in liquid paraffin. Then, an infrared spectroscopic analysis of the obtained sample is performed in the region of 1200-1000 cm ^-1 , then the height of the peaks of the absorption bands with the maxima of 1165 cm ^-1 , 1150 cm ^-1 , 1070 cm ^-1 , 1025 cm ^{-1 is} determined. Then, the values of the values of the following relations are calculated: the ratio of the height of the peak with a maximum at 1165 cm ^-1 to the height of the peak with a maximum at 1025 cm ^-1 ; 1150 cm ^-1 to 1025 cm ^-1 ; 1150 cm ^-1 to 1070 cm ^-1 , these values are the coordinates along the axes X, Y and Z, respectively.

The obtained three-dimensional distribution is projected into the frontal plane to obtain two-dimensional coordinates and correlated with the boundaries of the flat reference diagnostic “images” reflecting the diagnoses of “active tuberculosis”, “inactive tuberculosis”, which are represented as flat polyhedra. Depending on the location of the obtained point, the patient's condition is determined.

The boundaries of the reference "images" are established empirically and tested on patients with an appropriate diagnosis. These "images" are presented in the form of flat polyhedra, the boundaries of which are the following values: active tuberculosis - X / Y (0.2172 / -0.3750; 0.2172 / -0.6438; 0.0609 / -0.5375; -0.0391 / -0.2375; 0.0297 / -0.1562), inactive tuberculosis - X / Y, respectively (0.2359 / -0.4031; 0.2984 / -0.2406; 0.8484 / 0.2781; 0.6672 / -0.5094; 0.4547 / -0.7031; 0.2359 / -0.4969). Diagnosis is made depending on the location of the point, the coordinates of which characterize the state of a particular patient inside the "image".

Mathematical processing of the obtained data in the proposed method is performed using a computer program created specifically for these studies. This program allows you to uniquely identify the position of the point that reflects the parameters of the patient’s blood serum and determine its belonging to a particular "image" without a lot of time.

The present invention describes the procedure with the parameters obtained after IR spectroscopy of a blood serum sample, which can be performed without the use of a computer. However, in this case, the diagnostic process will take a lot of time, the created program takes action in a short time. The program performs the following actions: calculates the values of the ratio of peak heights, as a result, for each of the groups, a point is defined that has coordinates in a three-dimensional (volumetric) dimension (X; Y; Z). It then projects this point into the frontal plane to obtain an image in a two-dimensional coordinate system (X; Y) and to identify the position of this point relative to the “images” characterizing the patient’s condition.

As a result of the implementation of the invention, the doctor receives an objective forecast of the potential activity of tuberculous changes in the lungs in patients undergoing follow-up, which allows you to prescribe a timely adequate treatment and evaluate its effectiveness.

The data of the obtained results are verified by clinical, laboratory and radiological data.

The advantages of the proposed method is the high accuracy and informativeness (at least 95%) of the diagnosis, low cost of examination, the use of standard equipment that allows this examination to be carried out on the basis of biochemical laboratories of medical institutions. The method is affordable and easy to execute. For the personnel conducting the research of the proposed method, no special training is required. Obtaining blood serum in modern conditions is not difficult. Dried whey can be stored without the use of special conditions and agents for a long time. The proposed method was previously tested by the MDLP "Tuberculosis Dispensary" of the Avtozavodsky District of Nizhny Novgorod for 170 patients of the outpatient department who are registered in the dispensary after cured tuberculosis ("III" and "0" dispensary groups). The method can be illustrated by the following examples from clinical practice.

Patient V., 21 years old, III group of dispensary registration.

Under the supervision of Avtozavodskiy district TB dispensary in May 2003, the dispensary group was registered in I “ _A ”, after a comprehensive clinical and laboratory study the diagnosis was established: “Infiltrative tuberculosis of the upper lobe of the left lung”, with bacterial excretion (MBT +). An infrared spectroscopy of a venous blood sample was carried out in accordance with the described method. A sample was prepared by drying the whey, grinding it, and then suspending it with liquid paraffin. Then, an infrared spectrometric analysis of the obtained sample was performed in the region of 1200-1000 cm ^-1 , the peak heights of absorption bands with maxima of 1165 cm ^{-1 were} determined; 1150 cm ^-1 ; 1070 cm ^-1 ; 1025 cm ^-1 .

Then, the values of the following ratios were calculated: the ratio of the peak height with a maximum at 1165 cm ^-1 to the peak height with a maximum at 1025 cm ^-1 ; 1150 cm ^-1 to 1025 cm ^-1 ; 1150 cm ^-1 to 1070 cm ^-1 , which became the coordinates along the axes X, Y and Z, respectively.

The obtained three-dimensional distribution was projected into the frontal plane to obtain two-dimensional coordinates and correlated with the boundaries of the flat reference diagnostic "images" reflecting the diagnoses of "active tuberculosis", "inactive tuberculosis". Depending on the location of the obtained point, the patient's condition was diagnosed. To facilitate the perception of the described results, a drawing obtained during the study is presented. In the illustration for example 1, the area of active tuberculosis is depicted as a dark polygon, in which points corresponding to the results of studies of IR spectroscopy are marked. The area of inactive tuberculosis is depicted by a light gray polygon. The values of the analytical parameters were X = 0.0242; Y = -0.2450 (point 1). In October 2003, after a course of specific antibacterial therapy, the patient underwent atypical resection of S _III , S _IV , S _V on the left for tuberculoma.

In November 2004, he was transferred to the III group of dispensary registration with a diagnosis of "Clinical treatment of infiltrative tuberculosis of the upper lobe of the left lung (by surgery)", X-ray control, laboratory tests without features. The results of infrared spectroscopy of a blood serum sample: X = 0.1692, Y = -0.4167 (point 2) (area of active tuberculosis). Since January 2005, being under follow-up, the patient visited a TB specialist every two months. In this case, the patient underwent X-ray monitoring and venous blood sampling for laboratory research and control using infrared spectroscopy of a serum sample of the obtained blood. Indicators of x-ray control and laboratory studies without features.

The results of IR spectrometry in January were: X = 0.1275, Y = -0.4367 (3), in March: X = 0.1142, Y = -0.3950 (4), in May: X = 0, 0875, Y = -0.3500 (5) (all points are located in the area of active tuberculosis).

In July 2005, when visiting a doctor for the next blood sampling, the patient complained of deterioration, lethargy, fever up to 38 °, laboratory data without features, no bacterial excretion, an X-ray examination revealed an infiltrate in the area of staples. The results of IR spectroscopy were X = 0.0442, -0.29950 (6) - the area of active tuberculosis, diagnosis: Infiltrative tuberculosis of the upper lobe of the left (operated) lung, was transferred to the I "B" group of dispensary registration (relapse).

The general diagnosis is “active tuberculosis”.

This example demonstrates that the proposed method allows you to set the course of the active process until it is detected by generally accepted clinical and radiological methods.

Patient X., 27 years old, III group of dispensary registration.

Under the supervision of Avtozavodskiy District Tuberculosis Dispensary, the patient since February 2001, the dispensary group was registered in I “ _A ”, after a comprehensive clinical and laboratory examination the diagnosis was made: Disseminated left lung tuberculosis in the phase of infiltration and decay, the presence of bacterial excretion (MBT +). The results of IR spectrometry at this point were: X = 0.1048, Y = -0.4404 (point 1) (area of active tuberculosis). In the drawing, the results of IR spectroscopy studies are shown in Figure 2, where the region of active tuberculosis is shown as a dark polygon and the region of inactive tuberculosis is shown as a light gray polygon.

In November 2003, after a course of specific antibacterial therapy, she was transferred to the dispensary group III group with the diagnosis: "Clinical cure with small residual changes in the form of fibrosis and dense foci in the upper lobe of the left lung." Objectively: the condition is satisfactory, no complaints. Laboratory studies without features. The results of IR spectroscopy, carried out in accordance with the proposed method: X = 0.2760, Y = -0.4192 (point 2) (area of inactive tuberculosis). The patient is observed by a TB specialist; no complaints have been expressed. X-ray monitoring and sampling of venous blood are carried out for laboratory research and control using infrared spectroscopy of a serum sample of the obtained blood. The results of infrared spectroscopy of blood taken during the doctor’s visits were respectively: January 2004 - X = 0.3337, Y = -0.4481 (3); March 2004 - X = 0.3760. Y = -0.4327 (4); May 2004 - X = 0.4260, Y = -0.4769 (5); September 2004 - X = 0.4452, Y = -0.3750 (6); December 2004 - X = 0.4798, Y = -0.4038 (7) (all points lie in the area of inactive tuberculosis). X-ray data - no features. The results of infrared spectroscopy of blood taken during visits to patients by a doctor in 2005-2006 were, respectively: April 2005 - X = 0.4990, Y = -0.4077 (8); November 2005 - X = 0.5106, Y = -0.3558 (9); April 2006 - X = 0.5452, Y = -0.3442 (10) (all points lie in the area of inactive tuberculosis). The general diagnosis is inactive tuberculosis.

Claims (1)

A method for diagnosing respiratory tuberculosis activity according to the results of a clinical and laboratory study, characterized in that pulmonary tuberculosis activity is diagnosed in adult patients through an additional study, namely an IR spectrometric analysis, in which a sample is prepared from venous blood serum by drying, grinding and suspension in vaseline oil, then operate the IR-spectroscopic analysis of the resulting sample in the region 1200-1000 cm ^-1, is then determined by the height of peaks oc absorption with maxima at 1165 cm ^-1, 1150 cm ^-1, 1070 cm ^-1, 1025 cm ^-1, and then calculating the values of the following relationships: ratio with the maximum peak height at 1165 cm ^-1 to a maximum peak height at 1025 cm ^{- 1} ; 1150 cm ^-1 to 1025 cm ^-1 ; 1150 cm ^-1 to 1070 cm ^-1 , these values are the coordinates along the axes X, Y and Z, respectively; the obtained three-dimensional distribution is projected into the frontal plane to obtain two-dimensional coordinates and correlated with the boundaries of the flat reference diagnostic “images” reflecting the diagnoses of “active tuberculosis” and “inactive tuberculosis”, which are represented as flat polyhedra, the boundaries of which are the following values: active tuberculosis - X / Y (0.2172 / -0.3750; 0.2172 / -0.6438; 0.0609 / -0.5375; -0.0391 / -0.2375; 0.0297 / -0.1562) inactive tuberculosis - X / C, respectively (0.2359 / -0.4031; 0.2984 / -0.2406; 0.8484 / 0.2781; 0.6672 / -0.5094; 0.4547 / -0 7031; 0.2359 / -0.4969); Diagnosis is made depending on the location of the point, the coordinates of which characterize the state of a particular patient inside the "image".

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