RU2331365C1 - Diagnostic technique of intrauterine fetus growth retardation syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to obstetrics. Technique allows diagnosing intrauterine fetus growth retardation with high accuracy, sensitivity and specificity in complex with traditional clinical and U-S methods of research, which allows for taking necessary complex of therapeutic-preventive measures. Content of allantoin in blood of pregnant woman is determined in the second trimester of pregnancy (15-16 week) and, value of its concentration being from 2.9 to 5.8 micromole/l, syndrome of intrauterine fetus growth retardation is diagnosed.

EFFECT: highly accurate diagnostic technique of intrauterine fetus growth retardation.

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Description

The invention relates to medicine, namely to obstetrics.

Diagnosis of intrauterine growth retardation syndrome (IUGR) is based on the use of ultrasound equipment (Sidelnikov V.M. Miscarriage by pregnancy. - M .: Medicine. - 1986, p. 70-71), color Doppler mapping method (RF patent No. 2204329, IPC A61B 8/08), which requires expensive equipment.

Laboratory methods for the diagnosis of SZVUR are based on the determination of an increased concentration of creatine in erythrocytes of pregnant women (RF patent No. 2079841, IPC G01N 33/70), an increased content of CD11b-positive lymphocytes (RF patent No. 2188421, IPC G01N 33/53), an increase in the absolute number B lymphocytes and the relative content of neutrophils having receptors for the C3 component of complement (RF patent No. 2086981, IPC G01N 33/53, 33/48), and are not highly specific.

As a prototype, the method for determining the state of the fetus was selected according to the patent of the Russian Federation No. 2079841, in which the concentration of creatine in the blood erythrocytes of the pregnant woman was determined, and if its value was 510 μmol / L and higher, the fetal condition was determined. The known method requires the allocation of red blood cells, which limits its use. Creatine is not a specific metabolite of pregnancy, which casts doubt on the specificity of the method. In addition, the possibility of extrapolating the results obtained in the study of erythrocytes of pregnant women to the state of similar fetal indicators due to differences in blood circulation, the degree of differentiation of red blood cells, and the properties of hemoglobin is doubtful.

The objective of the present invention is to develop a simpler, cheaper and more specific method for diagnosing intrauterine growth retardation to determine the tactics of pregnancy and the timely implementation of the necessary complex of therapeutic and preventive measures.

The essence of the invention lies in the fact that during a biochemical study of the blood of a pregnant woman in the second trimester (15-16 weeks), the content of allantoin is determined and at a concentration of 2.9 to 5.8 μmol / l, intrauterine growth retardation syndrome is diagnosed.

According to the invention, the product of uric acid degradation, allantoin, is used as an indicator of biochemical analysis. In the human body, due to the evolutionary loss of activity of the uricase enzyme, allantoin practically does not form (Oda M., Satta Y., Takenaka O., Takahata N. Loss of Urate Oxidase Activity in Hominoids and its Evolutionary Implications. // Molecular Biology and Evolution. - 2002 . - V.19. - P.640-653). However, during pregnancy, its level increases significantly in the blood serum of pregnant women, which allows us to consider allantoin as a specific biochemical marker of pregnancy.

The use of allantoin as an indicator of a biochemical blood test for the diagnosis of IUGR is not known to the authors.

The studies conducted by the authors showed an unexpected result, namely that in healthy pregnant women in the second trimester of pregnancy, the level of allantoin is 19.8-26.0 μmol / L, and in the presence of a syndrome of fetal development retardation, the level of allantoin in the blood is significantly reduced and is 2.9-5.8 μmol / L.

Diagnosis of IUGR was carried out on 30 pregnant women in the II trimester, of which 15 patients with physiological pregnancy and 15 with the presence of IUGR syndrome verified by dynamic ultrasound fetometry.

The method is as follows.

Blood is taken from the ulnar vein in the morning on an empty stomach. Allantoin content in the blood serum is determined by spectrophotometric method (Chen X.B., Gomes M.J. Estimation of microbial protein supply cattle based on urinary excretion of purine derivates - an overview of the technical details, UK, 1992, 21). In this method, allantoin is hydrolyzed in a slightly alkaline medium to allantoic acid, which is further split in an acidic medium to urea and glyoxylate, which, when reacted with phenylhydrazine hydrochloride, forms phenylhydrazone glyoxylate. The latter product forms an unstable color complex with potassium ferricyanide, the extinction of which is measured at 522 nm.

The data obtained indicate that in the blood serum of pregnant women with intrauterine growth retardation syndrome, verified by ultrasound diagnosis and confirmed by the study of hormonal status, the allantoin content was significantly reduced (see table).

The method is highly specific, easy to perform, does not require the use of expensive equipment.

Example 1

Patient I., 23 years old, turned to a antenatal clinic. Diagnosed uterine pregnancy. Period for menstruation is 15 weeks. Dynamic ultrasonic fetometry of deviations from the gestational period did not reveal. The level of hCG is 24,471 IU / L. The concentration of allantoin is 22.15 μmol / L.

Was diagnosed with Pregnancy 15 weeks.

Example 2

Patient A., 26 years old, was admitted to the gynecological department of the hospital with complaints of drawing pains in the lower abdomen. Surveyed. Diagnosed uterine pregnancy. The period of pregnancy for menstruation is 16 weeks. Dynamic ultrasound fetometry revealed a delay in fetal development by 2 weeks compared with gestational age. The level of hCG is 12,452 IU / L. The concentration of allantoin is 3.8 μmol / L.

The diagnosis was made: fetal retardation of the 1st degree, in connection with which the pregnant woman was hospitalized in the pregnancy pathology department of the maternity hospital at the place of residence, where the corresponding treatment of this pathology was carried out.

Indicator The content of allantoin in the serum of pregnant women with physiological pregnancy (μmol / l) The serum allantoin content in pregnant women with intrauterine growth retardation syndrome (mcmol / l) M ± m 22.26 ± 0.96 3.48 ± 0.75 * Min - max 19.8-26.0 2.9-5.8 Note: * - significance of differences p <0.001

Claims (1)

A method for the diagnosis of intrauterine growth retardation syndrome, including a biochemical blood test, characterized in that in the second trimester (15-16 weeks) in the blood of a pregnant woman, the content of allantoin is determined and at a concentration of 2.9 to 5.8 μmol / l, the syndrome is diagnosed intrauterine growth retardation.