RU2339294C1 - Method for differential diagnostics of toxic encephalopathy at chronical mercurial intoxication and discirculatory encephalopathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: eyeground examination, ultrasound Doppler sonography of head's main artery, determination of SH-glutathione level in blood, test of Spielberger and Hanin for trait anxiety, standardised multi-factory personality examination (SMPE) are carried out. Numeric values of the received rates are determined. Thereafter diagnostic coefficients F₁ and F₂ are calculated according to formulas: F₁=161.8 + 1.45·a₁ + 15.9·a₂ + 1.34·a₃ + 1.87·a₄-0.17·a₅ + 0.5·a₆ + 0.14·a₇; F₂=144.12 + 5.34·a₁ + 23.9·a₂ + 0.75·a₃ + 4.14·a₄ + 40.37·a₅ - 0.02·a₆ + 0.32·a₇; where F₁ - diagnostic coefficient for toxic encephalopathy at chronical mercurial intoxication; F ₂ - diagnostic coefficient for discirculatory encephalopathy;161.8 and 144.12 - constants; 1.45; 15.9; 1.34; 1.87; 0.17; 0.5; 0.14; 5.34; 23.9; 0.75; 4.14; 0.37; 0.02; 0.32 - discriminatory coefficients, a₁ - no pathology of eyeground vessel 1, hypertonic angiopathy of eyeground vessels 2, angiosclerosis of eyeground vessels 3; a₂ - SH-glutathione level in blood; a₃ - linear systolic blood velocity along cephalic artery according to ultrasound Doppler sonography; a₄ - linear diastolic blood velocity along cephalic artery according to ultrasound Dopper sonography; a₆ - level of trait anxiety according to method of Spielbergerer and Hanin; a₇ - values of T-scores according to 6 scale of standardised multi-factory personality examination (SMPE). If F1 is more or equal to F2 toxic encephalopathy at chronical mercurial intoxication is diagnosed, and if F1 is less then F2 discirculatory encephalopathy is diagnosed.

EFFECT: accuracy of diagnostics is enhanced.

3 ex, 1 tbl

Description

The present invention relates to medicine, namely to neurology and occupational pathology, and can be used for the differential diagnosis of toxic encephalopathy in chronic mercury intoxication and discirculatory encephalopathy.

To date, accurate methods for the differential diagnosis of toxic encephalopathy in chronic mercury intoxication and discirculatory encephalopathy have not been developed. There is a method for differential diagnosis of toxic encephalopathy from the effects of a complex of toxic substances and discirculatory (vascular) encephalopathy, carried out using the discriminant equation, where the indicators K, 3, 5, 7 based on SMIL were used as informative signs, the value of the linear blood flow velocity and resistive index by of the common carotid artery with ultrasound scan [5].

Known methods for differential diagnosis of toxic encephalopathy, including clinical neurological examination, ultrasound dopplerography (Doppler ultrasound) of the main arteries of the head, electroencephalography, rheoencephalography (REG), a psychological study of emotional-volitional and mnestic-intellectual spheres, biochemical study of lipid metabolism 3 [2 , 4, 5, 6]. However, these methods are not sufficiently accurate for the differential diagnosis of toxic encephalopathy in chronic mercury intoxication and discirculatory encephalopathy.

The closest is a method for the diagnosis of chronic mercury intoxication, including ophthalmoscopy, electroencephalography, ultrasound dopplerography of extracranial vessels, magnetic resonance imaging or computed tomography of the brain, a psychological study using a standardized multivariate personality test (SMIL) test and determining the concentration of mercury in urine [1 ]. However, the diagnosis of mercury intoxication can be difficult with concomitant vascular damage to the brain.

The objective of the invention is to improve the accuracy of the differential diagnosis of toxic encephalopathy in chronic mercury intoxication and discirculatory encephalopathy.

The problem is solved by determining the presence of fundus pathology during ophthalmoscopy, linear systolic and diastolic blood flow velocities in the common carotid artery and common carotid artery asymmetry coefficient by ultrasound dopplerography of the extracranial vessels of the head, T-scores on the 6th test scale of a standardized multivariate personality study ( SMIL), determination of blood SH-glutathione level, Spilberger-Khanin level of personal anxiety, and calculation of diagnostic coefficients ientov F, according to the formulas:

F ₁ = 161.8 + 1.45 · a ₁ + 15.9 · a ₂ + 1.34 · a ₃ + 1.87 · a ₄ -0.17 · a ₅ + 0.5 · a ₆ +0 , 14 a ₇ ;

F ₂ = 144.12 + 5.34 · a ₁ + 23.9 · a ₂ + 0.75 · a ₃ + 4.14 · a ₄ + 0.37 · a ₅ -0.02 · a ₆ +0 , 32 · a ₇ , where F ₁ is the diagnostic coefficient for toxic encephalopathy in chronic mercury intoxication,

F ₂ - diagnostic coefficient for discirculatory encephalopathy; 161.8 and 144.12 are constants,

1.45; 15.9; 1.34; 1.87; 0.17; 0.5; 0.14; 5.34; 23.9; 0.75; 4.14; 0.37; 0.02; 0.32 - discrimination factors;

a _{1, 2 ... 7} - numerical values of the indicators of the examination (a ₁ - the results of the fundus examination: 1 - pathology of the fundus vessels, 2 - hypertensive angiopathy of the fundus, 3 - angiosclerosis of the fundus, and ₂ - level SH - blood glutathione, and ₃ - linear systolic blood flow velocity in the common carotid artery with ultrasound scan, ₄ - linear diastolic blood flow velocity in the common carotid artery in ultrasound scan, ₅ - asymmetry coefficient of blood flow in the common carotid artery in ultrasound scan, and ₆ - level personal anxiety by spielb the ranger - Khanin, and ₇ - the value of T-points on the 6th scale of the SMIL test).

A comparative analysis of the proposed solution with the prototype [1] shows that the proposed method differs in that they determine the presence of fundus pathology, linear systolic and diastolic velocities and the asymmetry coefficient of blood flow in the common carotid artery by Doppler ultrasound, T-score of scale 6 according to SMIL, level SH-glutathione of blood, and additionally determine the level of personal anxiety according to Spielberger-Khanin, calculate the diagnostic coefficients F ₁ and F ₂ , and if F ₁ is greater than or equal to F ₂ , toxic encephalopathy is diagnosed in chronic mercury intoxication, with F ₁ less than F _2, dyscirculatory encephalopathy is diagnosed. Thus, the proposed technical solution meets the criteria of the invention of "novelty."

The use of the proposed complex of indicators for the diagnosis of toxic encephalopathy in chronic mercury intoxication and discirculatory encephalopathy in the available literature has not been identified. The proposed informative indicators make it possible to differentiate toxic encephalopathy in chronic mercury intoxication with a high degree of accuracy (94.5%). Thus, the proposed method meets the criterion of "inventive step".

The developed method is easy to use and can be used by doctors in clinics and hospitals, which meets the criterion of "industrial applicability".

The method is as follows:

The patient undergoes ophthalmoscopy and determines the condition of the fundus, ultrasound scan of the main arteries of the head: systolic and diastolic linear blood flow velocities and asymmetry coefficient of the common carotid artery are determined; determination of SH-tlutathione level in the blood, Spilberger-Hanin test for personal anxiety, standardized multivariate personality study test (SMIL), determine the numerical values of the obtained indicators.

Then calculate the diagnostic coefficients F ₁ and F ₂ according to the formulas:

F ₁ = 161.8 + 1.45 · a ₁ + 15.9 · a ₂ + 1.34 · a ₃ + 1.87 · a ₄ -0.17 · a ₅ + 0.5 · a ₆ +0 , 14 a ₇ ;

F ₂ = 144.12 + 5.34 · a ₁ + 23.9 · a ₂ + 0.75 · a ₃ + 4.14 · a ₄ + 0.37 · a ₅ -0.02 · a ₆ +0 , 32 · a ₇ , where F ₁ is the diagnostic coefficient for toxic encephalopathy in chronic mercury intoxication;

F ₂ - diagnostic coefficient for discirculatory encephalopathy;

161.8 and 144.12 are constants;

1.45; 15.9; 1.34; 1.87; 0.17; 0.5; 0.14; 5.34; 23.9; 0.75; 4.14; 0.37; 0.02; 0.32 - discrimination factors;

a ₁ - the results of the study of the fundus (1 - pathology of the vessels of the fundus no, 2 - hypertonic angiopathy of the fundus, 3 - angiosclerosis of the fundus);

and ₂ - level of SH - blood glutathione;

and ₃ - linear systolic blood flow velocity in the common carotid artery by ultrasound;

and ₄ - linear diastolic blood flow velocity in the common carotid artery according to USDG;

and ₅ - the coefficient of asymmetry of blood flow in the common carotid artery by ultrasound;

and ₆ - level of personal anxiety according to the method of Spielberger - Hanin;

and ₇ - the value of T-points on the 6th scale of the SMIL test.

If F _{1 is} greater than or equal to F _2, toxic encephalopathy is diagnosed in chronic mercury intoxication, when F _{1 is} less than F _2, dyscirculatory encephalopathy is diagnosed.

Diagnostic coefficients F ₁ and F _{2 are} obtained by subtracting the discriminant functions of toxic and discirculatory encephalopathy. The discriminant analysis was carried out in groups of patients with discirculatory and toxic encephalopathy in chronic mercury intoxication. The reliability of the obtained informative indicators as a result of discriminant analysis is presented in the table.

Table 1
Informative indicators of discriminant analysis of patients with toxic and discirculatory encephalopathy No. Indicators F inclusion ρ a ₁ Fundus examination result (conditional points) 5.69 0.019 a ₂ The level of SH - glutathione in the blood (μmol / ml) 8.7 0.004 a ₃ Linear systolic blood flow velocity in the common carotid artery (OSA) (cm / s) 11.3 0.001 a ₄ OCA linear diastolic blood flow velocity (cm / s) 18.3 0.00005 a ₅ The coefficient of asymmetry of blood flow 17.7 0,00007 OCA (%) a ₆ The level of personal anxiety according to Spielberger-Khanin (points) 12.8 0,0006 a ₇ Indicator on the 6th scale of SMIL (T-points) 4.19 0.04

Example 1

Patient A. (48 years old, work experience in the mercury electrolysis workshop at a chemical plant for 15 years) underwent fundus examination, biochemical blood tests, ultrasound scan of the main arteries of the head, Spilberger-Khanin and SMIL tests and their numerical values were determined:

a ₁ - according to the results of the study of the fundus - 1,

and ₂ - level of SH - blood glutathione - 1.2 μmol / ml,

and ₃ - linear systolic blood flow velocity in the common carotid artery by ultrasound scan is 36 cm / s,

and ₄ - linear diastolic blood flow velocity in the common carotid artery by ultrasound scan is 5.7 cm / s,

and ₅ - the coefficient of asymmetry of blood flow in the common carotid artery by ultrasound scan is equal to 14.9%,

and ₆ - level of personal anxiety according to Spielberger - Khanin - 60 points,

and ₇ - the value of T-points on the 6th scale of the SMIL test - 70.

F ₁ = 161.8 + 1.45 · 1 + 15.9 · 1.2 + 1.34 · 36 + 1.87 · 5.7-0.17 · 14.9 + 0.5 · 60 ++ 0.14; 70 = 278.4;

F ₂ = 144.12 + 5.34 · 1 + 23.9 · 1.2 + 0.75 · 36 + 4.14 · 5.7 + 0.37 · 14.9-0.02 · 60 + 0 , 3270 = 255.4

F1> F2.

Conclusion: Patient A. has toxic encephalopathy in chronic mercury intoxication.

Example 2

Patient D. (age 56 years, work experience in the mercury electrolysis workshop at a chemical plant for 6 years) was examined by an ophthalmologist, a biochemical blood test, a psychological examination, ultrasound scan of the main vessels of the head, their numerical values were determined:

a ₁ - according to the results of the study of the fundus - 3,

and ₂ - level of SH - blood glutathione - 1.7 μmol / ml,

and ₃ - linear systolic blood flow velocity in the common carotid artery by ultrasound scan is 29 cm / s,

and ₄ - linear diastolic blood flow velocity in the common carotid artery by ultrasound scan is 9.0 cm / s,

and ₅ - the coefficient of asymmetry of blood flow in the common carotid artery by ultrasound scan is 23.1%,

and ₆ - level of personal anxiety according to Spielberger - Khanin - 40 points,

and ₇ - the value of T-points on the 6th scale of the SMIL test - 57.

F ₁ = 161.8 + 1.45 · 3 + 15.9 · 1.7 + 1.34 · 29 + 1.87 · 9-0.17 · 23.1 + 0.5 · 40 + 0.14 57 = 272.9;

F ₂ = 144.12 + 5.34 · 3 + 23.9 · 1.7 + 0.75 · 29 + 4.14 · 9 + 0.37 · 23.1-0.02 · 40 + 0.32 57 = 285.7

F1 <F2. Conclusion: Patient D. has dyscirculatory encephalopathy.

Example 3

Patient K., age 49 years, work experience in the mercury electrolysis workshop at a chemical enterprise - 10 years, an ophthalmologist examined, carried out a biochemical blood test, a psychological examination, ultrasound examination of extracranial vessels, their numerical values were determined:

a ₁ - according to the results of the study of the fundus - 2,

and ₂ - level of SH - blood glutathione - 1.6 μmol / ml,

and ₃ - linear systolic blood flow velocity in the common carotid artery by ultrasound scan is 28 cm / s,

and ₄ - linear diastolic blood flow velocity in the common carotid artery by ultrasound scan is 7.0 cm / s,

and ₅ - the coefficient of asymmetry of blood flow in the common carotid artery by ultrasound scan is 22%,

and ₆ - level of personal anxiety according to Spielberger - Khanin - 48 points,

and ₇ - the value of T-points on the 6th scale of the SMIL test - 60.

F ₁ = 161.8 + 1.45 · 2 + 15.9 · 1.6 + 1.34 · 28 + 1.87 · 7-0.17 · 22 + 0.5 · 48 + 0.14 · 60 = 269.4;

F ₂ = 144.12 + 5.34 · 2 + 23.9 · 1.6 + 0.75 · 8 + 4.14 · 7 + 0.37 · 22-0.02 · 48 + 0.32 · 60 = 269.4

F1 = F2. Conclusion: Patient K. has toxic encephalopathy in chronic mercury intoxication.

As a result of the discriminant analysis of ultrasound scans of the blood vessels of the head, biochemical blood parameters (lipid peroxidation, antioxidant protection), psychological research (SMIL tests, Spielberger-Khanin), ophthalmoscopy, the optimal combination of 7 signs was obtained, at which the diagnostic accuracy was maximal . Therefore, for the differential diagnosis of toxic encephalopathy in chronic mercury intoxication and discirculatory encephalopathy, 7 of the above indicators were used.

Evaluation of the effectiveness of the proposed method of differential diagnosis was carried out in the training and control samples. In the training sample (35 people), the correct recognition was 100% for patients with toxic encephalopathy and 98% for patients with discirculatory encephalopathy (30 people). The control sample included 32 patients with toxic and 30 with discirculatory encephalopathy, with 88% and 92% recognition accuracy, respectively.

The proposed method makes it possible to differentiate toxic encephalopathy in chronic mercury intoxication using a minimum number of the most informative diagnostic indicators, thereby reducing the volume of paraclinical studies. A sound diagnostic method is focused on objective clinical, physiological and biochemical parameters, therefore, the diagnostic results do not depend on the competence of doctors in matters of professional pathology and angioneurology.

Literature

1. Andreeva O.K. Lesions of the nervous system in the long-term period of chronic mercury intoxication / O.K. Andreeva, V.G. Kolesov, O.L. Lakhman // Bull. VSNS SB RAMS. - 2002. - No. 3. - S. 72-75.

2. Katamanova E.V. Features of toxic encephalopathy in chronic mercury intoxication and in the long-term period of exposure to a complex of toxic substances in firefighters / E.V. Katamanova, V.G. Kolesov, O.K. Andreeva, O. I. Shevchenko, O. L. Lakhman // Bull. VSNS SB RAMS. - 2004. - No. 4. - S.68-71.

3. Lahman O.L. The course of encephalopathy in the long-term period of professional mercury intoxication / O.L. Lakhman, V. G. Kolesov, O. K. Andreeva, P. V. Kazakova, V. P. Ilyin // Occupational medicine and industrial ecology. - 2003. - No. 3. - S. 46-48.

4. Long-term consequences of chronic professional neurointoxications / V.N. Dumkin, M.N. Ryzhkova, L.E. Milkov: Method. recommendations No. 10-11 / 29. - M.: Ministry of Health of the USSR, 1987 .-- 28 p.

5. A method for differential diagnosis of toxic encephalopathy from the effects of a complex of toxic substances and discirculatory (vascular) encephalopathy. / E.V.Katamanova, V.G. Kolesov, O.L. Lakhman, V.P. Ilyin. Patent for invention No. 2271143.

6. Tarasova L.A. Occupational diseases with a predominant lesion of the nervous system: a manual ed. Izmerova N.F .: Occupational diseases. - M .: Medicine, 1996. - S.136-200.

Claims (1)

A method for differential diagnosis of toxic encephalopathy in case of chronic mercury intoxication and discirculatory encephalopathy, including ophthalmoscopy, blood biochemistry, ultrasound dopplerography (Doppler ultrasound) of extracranial vessels of the head, standardized multivariate personality examination (SMIL), characterized in that the patient has linear eye condition systolic, diastolic blood flow velocity in the common carotid artery by ultrasound scan, blood asymmetry coefficient eye on the common carotid artery by ultrasound, the T-score on the 6th scale of the SMIL test, the level of SH - glutathione in the blood, and additionally determine the level of personal anxiety by the Spilberger-Khanin test, diagnostic coefficients are calculated by the formulas: F ₁ = 161.8 + 1.45 · a ₁ + 15.9 · a ₂ + 1.34 · a ₃ + 1.87 · a ₄ -0.17 · a ₅ + 0.5 · a ₆ +0 , 14 a ₇ ; F ₂ = 144.12 + 5.34 · a ₁ + 23.9 · a ₂ + 0.75 · a ₃ + 4.14 · a ₄ + 0.37 · a ₅ -0.02 · a ₆ +0 , 32 a ₇ ; where F ₁ is a diagnostic coefficient for toxic encephalopathy in chronic mercury intoxication; F ₂ - diagnostic coefficient for discirculatory encephalopathy; 161.8 and 144.12 are constants; 1.45; 15.9; 1.34; 1.87; 0.17; 0.5; 0.14; 5.34; 23.9; 0.75; 4.14; 0.37; 0.02; 0.32 - discrimination factors; a ₁ - the results of the study of the fundus (there is no pathology of the fundus vessels, 2 - hypertensive angiopathy of the fundus, 3 - angiosclerosis of the fundus); and ₂ - level of SH - blood glutathione; and ₃ - linear systolic blood flow velocity in the common carotid artery by ultrasound; and ₄ - linear diastolic blood flow velocity in the common carotid artery according to USDG; and ₅ - the coefficient of asymmetry of blood flow in the common carotid artery by ultrasound; and ₆ - level of personal anxiety according to the method of Spielberger-Khanin; and ₇ - the value of T-points on the 6th scale of the SMIL test, and with F ₁ greater than or equal to F _2, toxic encephalopathy is diagnosed in chronic mercury intoxication, with F ₁ less than F _2, discirculatory encephalopathy is diagnosed.