RU2339043C1 - Method of diagnostics of consequences of perinayal lesions of central nervous system of small degree at children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: define level of "ИЛ-1в" in blood serum and at its maintenance above 7.08 pg/ml consider confirmed presence of consequences of perinatal lesions of the central nervous system of small degree at children. The method allows quickly and with high reliability to establish diagnosis CPL CNS of easy degree that gives possibility to spend a timely and rational complex of therapeutic actions.

EFFECT: quick and reliable diagnosis.

1 ex, 1 tbl

Description

The invention relates to medicine, in particular to neurology, pediatrics, immunology, child psychiatry. It can be used in a clinic to diagnose the consequences of perinatal lesions of the central nervous system / central nervous system PPP / mild in children.

A known method for the diagnosis of mild central nervous system obstruction by clinical signs, according to which the central nervous system dysfunction is differentiated from cerebral palsy / cerebral palsy /, childhood mental illness, autonomic-dysregulatory and hypertensive-hydrocephalic syndromes due to somatic pathology or other brain diseases. Due to the large number of syndromic clinical manifestations of CNS SPT, the diagnosis requires the use of many special research methods: REG, CIG, CT of the brain, EEG, ultrasound of the brain.

These indicators, combined with the data obtained in the study of the clinical picture and anamnesis, the conclusions of an ophthalmologist, orthopedist, psychiatrist, can more accurately establish the presence of mild central nervous system obstruction as a consequence of perinatal damage to the central nervous system (Skvortsov I.A., Ermolenko I.A. systems in children are normal and pathological, M .: MEDpress-inform, 2003. - P.168).

The disadvantages of the used methods for diagnosing CNS SPT are the long duration associated with the use of a large number of techniques, the lack of clear criteria, the high cost, the involvement of consulting doctors of other specialties, the absence, in most cases, of medical documentation containing a full perinatal history; In addition, these studies are notable for their high cost.

The nervous system (NS) and the immune system (IS) have a close relationship through the production and secretion of many cellular mediators, including cytokines, integrins, chemokines, and other molecules. Nerve and immune cells are present in most visceral organs, where they are able to produce regulatory peptides and biogenic amines that are identical to the peptides synthesized in the central nervous system and IP.

The aim of the invention is to increase the efficiency of diagnosis of mild central nervous system obstruction by the level of IL-1β in blood serum, which will accelerate the diagnosis, provide cost-effectiveness, as well as timely and rational implementation of a complex of therapeutic measures.

The essence of the proposed diagnostic method is that in the blood serum of children by the method of enzyme-linked immunosorbent assay (ELISA), the level of IL-1β is determined and at a level of IL-1β above 7.08 pg / ml, the presence of mild central nervous system SPD is diagnosed.

IL-1β is a hormone-like polypeptide with a wide range of immunological and non-immunological activity. First of all, it is a pro-inflammatory cytokine, which is produced by activated immune cells in response to inflammatory stimuli. The action of IL-1β enhances the synthesis of IL-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-10 and IL-12, which leads to increased proliferation of various types of immunocompetent cells and secretion the most diverse biologically active compounds. In addition, the biological effect of IL-1β can extend to many other processes associated with the growth and differentiation of various types of non-immune cells of the body, including neurocytes. If we assume that the basis of the non-specific component of the immune response in the case of central nervous system SPP is inflammation, as the earliest and most universal cellular response to damage that does not depend on the nature of the damage and aggressive agents in the early stages, then determining the level of IL-1β as a marker of non-specific inflammation may be additional a criterion in the diagnosis of mild central nervous system PPP. The obtained data showed that with mild central nervous system PPP, the level of IL-1β in blood serum increased significantly, therefore, IL-1β can be considered a mild central nervous system PPP marker.

The method is as follows.

Patients take blood from a vein and determine the level of IL-1β by indirect enzyme-linked immunosorbent assay / ELISA / using sets of "R @ D" (USA) according to the following scheme.

Phase 1

Controls and pre-diluted patient samples are added to the microcells. Any antibodies present bind to immobilized antigens. After a 30-minute incubation, they are washed and the washing solution removes unbound serum components.

Phase 2

A solution of conjugate - anti-human - IgG or IgM - horseradish peroxidase is added to the cells to determine autoantibodies associated with immobilized antigens. After a 15-minute incubation, the excess enzyme conjugate is removed by washing solution.

Phase 3

A chromogenic substrate solution containing TMB is added to the cells. During a 15-minute incubation, the color of the solution turns blue. Color development is stopped by the addition of 1 M lactic acid as a stop solution. The solution changes color to yellow.

The color intensity is directly proportional to the concentration of IgG or IgM in the sample. The optical density is immediately measured on a reader at 450 nm.

EXAMPLE

Patient D., 4 years old, at the time of contacting a pediatric neurologist had complaints of periodic, with a frequency of 1-2 times a week, sharp headaches, accompanied by dizziness, nausea. According to the parents, headaches most often appeared after exertion, and their attacks became more frequent when the weather changed.

When collecting an anamnesis, it turned out that the child was born on time, with a mass of 3250 grams. In the process of childbirth, weakness of labor activity developed, therefore, birth control was carried out. Amniotic fluid was greenish in color. Having been born, the baby cried right away, rated on the Apgar scale of 8-9, applied to the chest on the 2nd day. The mother said that the child often and somewhat unusually threw his head back in the first months of life. In addition, he had tremor of hands and chin during crying and the action of strong sudden irritants (light, sound, etc.). A risk group for perinatal encephalopathy was exposed. The psychomotor and speech development of the child was normal.

Headaches first appeared at 3.5 years old when the child went to kindergarten. At the same time, parents drew attention to inexplicable periods of lethargy, drowsiness, during which headaches intensified, nausea appeared.

Objectively at the time of examination: the skin is pale, blood pressure 100/60 mm Hg, NPV 18 per min.

Neurological status: palpebral fissures symmetrical, D = S; pupils of normal shape and size, D = S; photoreaction saved. The movements of the eyeballs in full. Trigeminal exit points are painless. The mandibular reflex is lively. The face is symmetrical, nasolabial folds D = S. Tongue in the midline. Muscle tone S = D, not changed. Muscle strength in the limbs 4-5 points. Tendon reflexes are high, D = S; skin abdominal reflexes are inhibited. There are no pathological reflexes. No sensitive disorders have been identified. He performs dynamic coordinating tests confidently, is stable in the Romberg position, tremor of fingers of outstretched hands is noted. Dermographism is white, unstable; Hildebrant coefficient 3.5. Vegetative index Creed 17. Distal hyperhidrosis is expressed.

General blood tests, urine tests, biochemical blood tests without pathology.

Optometrist's conclusion: optic discs are pale pink, the borders are clear, the retinal arteries are narrowed.

ECG - sinus rhythm, exchange-recovery changes in the myocardium.

REG - the tone of the veins is reduced, the pulse blood supply is increased.

CIG - the initial vegetative tone - hypersympathicotonic, IN 2 = 105 (with heart rate = 90), autonomic reactivity - asymptatic.

EEG - moderate cerebral changes (closer to the lungs), of a regular nature. No interhemispheric asymmetry was detected. Epiactivity was not detected.

Conclusion on screening - vegetative tone assessment table - sympathicotonia.

CT of the brain was not performed.

The level of IL-1β determined by ELISA was 32.67 pg / ml.

Diagnosis. The consequences of perinatal damage to the central nervous system in the form of a syndrome of autonomic unspecified dysregulation.

In healthy children, the level of IL-1β does not exceed 7.08 pg / ml. The data show that IL-1β can serve as a marker of the central nervous system SPP.

A method for diagnosing the consequences of perinatal lesions of the central nervous system of mild degree in children by the level of IL-1β in blood serum was tested on 31 children with a diagnosis of mild central nervous system PPP (main group). The control group consisted of 12 children with the first health group, with a perinatal history without features.

All subjects underwent blood sampling and determination of the level of IL-1β in the above manner.

The results of the study are presented in the table. To process the obtained material and conduct statistical analysis in the studied groups, the statistical information processing program “Statgraphics Plus 5.0 for Windows XP” was used. The mean and mean error (M ± m) were calculated. Comparison in the studied groups was carried out in pairs using parametric methods, since the studied samples can be approximated by the normal distribution law. The comparison was carried out using Student's t test (t) (comparison of means) and Fisher (comparison of mean square deviations). The confidence level was evaluated by the value of "p". Differences in the comparison were considered significant with a probability of more than 95% at p <0.05.

Using the proposed diagnostic method has the following advantages:

1) high reliability in the diagnosis of PPP CNS mild;

2) quick diagnosis;

3) provides timely and rational implementation of a complex of therapeutic measures in early childhood.

Table METHOD FOR DIAGNOSIS OF CONSEQUENCES OF PERINATAL DEFEAT OF THE CENTRAL NERVOUS SYSTEM OF AN EASY DEGREE IN CHILDREN The level of IL-1β in children with consequences of perinatal damage to the central nervous system of mild degree (pg / ml) The level of IL-1β in healthy children (PG / ml) M ± m n M ± m n 58.62 ± 4.51 * 31 5.86 ± 0.61 * 12 Note: * - p <0.01 - significance of differences in groups when comparing

Claims (1)

A method for diagnosing the consequences of perinatal lesions of the central nervous system of mild, characterized in that they determine the level of IL-1β in blood serum by enzyme-linked immunosorbent assay and if the content of IL-1β is above 7.08 pg / ml, the presence of consequences of perinatal damage of the central nervous system of mild confirmed.