RU2348043C1 - Method for prediction of senile macular degeneration transition from predisciform to disciform stage in patients with hypertension - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention is related to medicine, in particular to ophthalmology. Method is characterised by the fact that concentration of IFN-α is determined in blood serum and tear in patients with hypertension, and if its value is accordingly less than 4.3 pkg/ml and more than 212.4 pkg/ml, transition of disease from predisciform stage to disciform stage is predicted.

EFFECT: improved diagnostics of disease.

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Description

The invention relates to medicine, in particular to ophthalmology, and can be used in medical practice to predict the transition of senile macular degeneration (SMD) from the pre-scis form to the disc-form stage in patients with hypertension.

The literature examines in detail the epidemiology, risk factors for the development of the disease, pathogenesis mechanisms, describes the clinical manifestations of the stages of the pathological process, as well as the methods of clinical and instrumental diagnosis [Egorov EA et al., 2004; Ziangirova G.G., Antonova O.V., 2004; Lysenko B.C. et al., 2001; Neroev V.V., 2006; Polunin G.S. et al., 2006; Algvere P. V., Seregard S., 2002; Beatty S. et al., 2001; De La Paz M., 1996; Spraul C.W., Grossniklaus H.E., 1997]. An important role of hypertension in the etiopathogenesis of SMD was noted [Realini T., 2006; Schmidt S. et al., 2005].

A known method for predicting the course of the initial stage of age-related macular degeneration based on a mathematical model (Prokopieva M.Yu., abstract of dissertation of the Candidate of Medical Sciences: "Clinical and hemodynamic criteria for predicting the course of the initial stage of age-related macular degeneration." - Chelyabinsk, 2007. - 24 s.), which is taken as a prototype. Prediction of disease progression is based on clinical and hemodynamic criteria (visual acuity, localization and size of drusen, resistance index in the orbital artery and posterior short ciliary arteries). However, triplex scanning of the eye and orbit recommended for the study of hemodynamic values is possible not in every hospital, which brings technical inconvenience when examining the patient, and complex mathematical calculations are also required.

The technical result is an improvement in the quality of diagnosis of SMD by predicting the transition of the pre-onciform stage to the disciform one in patients with hypertension.

The specified technical result is achieved by a method for predicting the course of the pre-form stage of senile macular degeneration, characterized in that in patients with hypertension the concentration of IFN-α in the blood serum and in the lacrimal fluid is determined and when its value is respectively less than 4.3 pcg / ml and more than 212, 4 pkg / ml predict the transition of the disease from the pre-scis form to the disc-form stage.

Confirmation of the reliability of the proposed forecast method is the concentration of IFN-α in the blood serum of less than 4.3 pcg / ml and lacrimal fluid of more than 212.4 pcg / ml in patients with hypertension in 60% of cases.

The proposed method is as follows.

Blood sampling without anticoagulant to obtain serum is carried out on an empty stomach from the cubital vein of the subjects. Tear fluid for research is collected from the conjunctival sac using a micropipette.

Determination of the concentration of IFN-α in the blood serum and lacrimal fluid of patients is carried out by the solid-phase enzyme-linked immunosorbent assay according to the standard method using test systems "Vector - Best" (Novosibirsk).

When the concentration of IFN-α in the blood serum is less than 4.3 pg / ml and the lacrimal fluid is more than 212.4 pg / ml in patients with hypertension, the transition of the precisciform stage of senile macular degeneration to the disciform stage is predicted.

According to the proposed method, 46 patients with a pre-form stage of SMD at the age of 45 to 85 years were examined, of which 33 had long-term results (1.5 years). The transition to the disciform stage was observed in 16 people (48.4%), of them with hypertension in 9 (56.3%). It was revealed that the presence of hypertension in 1.4 times increases the risk of progression of SMD (52.9% versus 43.8% without hypertension, OR = 1.4). The control group included 10 people with hypertension, but without changes in the fundus. The results are presented in the table.

According to the formula x≤M ± 2m≤x ¹ in the control group, the extreme borders are deduced: at the system level less than 4.3, and at the local level - more than 212.4. An analysis of the results showed that when the content of IFN-α in the blood serum is less than 4.3 pg / ml and in the lacrimal fluid more than 212.4 pg / ml, in patients with hypertension there is a 3-fold increase in the risk of the transition of SMD from the pre-scis form to the disciform ( 60% versus 33.3% without changing the level of IFN-α, OR = 3.0).

The proposed method is illustrated by the following clinical examples.

Example 1. Patient B., born in 1934 (m / a 2886-2006), went to the clinic complaining of a decrease in central vision.

In the history of the patient's life there is no hypertension.

At the time of admission, visual acuity was OD - 0.05 sc + 4.5D = 0.2, OS - 0.05 sc + 4.0D = 0.2; Tn15.0 / Tn13.0. Objectively: OU - the cornea is transparent, the anterior chamber is deep, the pupil is round, incomplete opacification of the lens, floating opacities in the vitreous. The ophthalmoscopic picture of the fundus - optic nerve discs are pale pink with glaucomatous excavation, the borders are clear, the arteries are sclerotic, the veins are full-blooded, in the macular region are solid druses, pigment redistribution, and the retinal periphery of both eyes are without features.

Diagnosed with: OU - Senile macular degeneration, pre-form stage. Open-angle glaucoma II a. Immature age-related cataract. Hypermetropia of moderate degree.

Therapist's opinion: IHD. Angina pectoris. FC III.

After the course of treatment, vision improved to OD - 0.08 sc + 4.5D = 0.3, OS - 0.09 sc + 4.0D = 0.3.

The level of IFN-α in serum was 5.0 PCG / ml, in the tear - 198.3 PCG / ml.

When examining the patient after 1 year, there was no decrease in vision, the fundus picture was unchanged.

Example 2. Patient H., b. 1946 (m / k 1815-2006), went to the clinic with complaints of decreased vision in both eyes. There is no history of hypertension in the patient’s life history.

At the time of admission, visual acuity was OD - 1 / ∞plc, OS - 1 / ∞plc; Tn19.0 / Tn13.0. Objectively: OU - the cornea is transparent, the anterior chamber is deep, the pupil is round, complete clouding of the lens, the fundus is not visible.

Diagnosed with OU - Mature age-related cataract.

Therapist's opinion: IHD. Arrhythmic variant of ventricular extrasystole (bigimenia). Tax Code I Art. Osteochondrosis of the lumbar spine. Chronic pancreatitis, without exacerbation.

After the course of treatment (OD - cataract extraction + IOL + conservative treatment), the fundus of the eye OD is visible - optic discs are pale pink with physiological excavation, the borders are clear, the arteries are sclerotized, the veins are full-blooded, in the macular area there are solid druses, redistribution of the pigment, the periphery of the retina - without features. Visual acuity at discharge: OD - 0.4 nk, OS - 1 / ∞plc.

Final diagnosis: OU - Mature age-related cataract. OD - Senile macular degeneration, pre-form stage.

The level of IFN-α in the blood serum was 2.1 pkg / ml, in the tear - 46.9 pg / ml.

When examining the patient after 1 year, no significant changes were observed.

Example 3. Patient D., born in 1940 (m / k 2682-2006), he went to the clinic complaining of a decrease in central vision in his right eye, and a decrease in vision in his left. The patient has a history of hypertension.

At the time of admission, visual acuity was OD - 0.03 nk, OS - 1 / ∞plc; Tn20.0 / Tn19.3. Objectively OU: - the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, OD is the incomplete opacification of the lens, OS - the crystalline lens is diffusely turbid, floating opacities in the vitreous. OD - Ophthalmoscopic fundus picture - DZN pale pink with physiological excavation, clear borders, arteries sclerotized, veins full-blooded, in the macular region solid drusen, pigment redistribution, retinal periphery - without features. OS - fundus is not visible.

Diagnosed with OS - Mature Age-related Cataract. OD - Immature age-related cataract. OD - Senile macular degeneration, pre-form stage.

Therapist's opinion: IHD. Atherosclerosis. Cardiosclerosis Cerebrosclerosis Hypertension 2 tbsp., 2 tbsp., Risk 4. Osteochondrosis of the lumbar spine.

After the course of treatment (OS - cataract extraction + IOL + conservative treatment), the fundus is visible - optic discs are pale pink with physiological excavation, the borders are clear, the arteries are sclerotized, the veins are full-blooded, in the macular area of the drusen, pigment redistribution, the retinal periphery are without features. Visual acuity at discharge: OD - 0.03 nk, OS - 0.2 nk.

Final diagnosis: OS - Mature age-related cataract. OD - Immature age-related cataract. OU - Senile macular degeneration, predisformal stage.

The level of IFN-α in the blood serum was 1.0 pcg / ml, in the tear - 906.4 pcg / ml.

After 1 year 3 months, the patient goes to the hospital with complaints of decreased vision of the right eye and metamorphopsia. At the time of examination, visual acuity was OD - 0.01 nk, OS - 0.2 nk. Objectively: OD - the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, artifact, floating opacities in the vitreous. The fundus of the eye is a pale pink optic nerve disc with physiological excavation, the borders are clear, the arteries are sclerotic, the veins are full-blooded, in the macular area, exudative detachment of the pigment epithelium, hemorrhage, and the periphery of the retina are without features.

Diagnosed with: OU - Senile macular degeneration, OD - disciform stage, OS - precisiform stage. OD - Immature age-related cataract. OS - Artifakia.

Example 4. Patient S., born in 1933 (m / k 2682-2006), went to the clinic complaining of a decrease in central vision in the right eye, and a decrease in vision in the left. The patient has a history of hypertension.

At the time of admission, visual acuity was OD - 0.3 ck + 1.5D = 0.5, OS - 1 / ∞plc; Tn18.0 / Tn14.0. Objectively, OU is a cornea transparent, the anterior chamber is of medium depth, the pupil is round, OD is the incomplete opacification of the lens, OS is the diffusely turbid crystalline lens, OD is the floating opacities in the vitreous. The fundus of the eye is a pale pink optic nerve disc with physiological excavation, the borders are clear, the arteries are sclerosed, the veins are full-blooded, in the macular region there are hard drusen, redistribution of the pigment, and the periphery of the retina - without features. OS - The fundus is not visible.

Diagnosed with OS - Mature Age-related Cataract. OD - Immature age-related cataract. OD - Senile macular degeneration, pre-form stage.

Therapist's opinion: IHD. Atherosclerosis. Cardiosclerosis Cerebrosclerosis Hypertension 2 tbsp., 2 tbsp., Risk 4. Osteochondrosis of the lumbar spine.

After the course of treatment (OS - cataract extraction + IOL + conservative treatment), the fundus of the OS is visible - optic discs are pale pink with physiological excavation, the borders are clear, the arteries are sclerotized, the veins are full-blooded, in the macular region there are solid druses, redistribution of the pigment, the periphery of the retina - without features. Visual acuity at discharge: OD - 0.3 SC + 1.5D = 0.5, OS - 0.02 SC + 11.0D = 0.1.

Final diagnosis: OS - Mature age-related cataract. OD - Immature age-related cataract. OU - Senile macular degeneration, predisformal stage.

The level of IFN-α in the blood serum was 0.1 pcg / ml, in the tear - 3037.5 pcg / ml.

After 11 months, the patient turned to the hospital with complaints of visual impairment of the left eye and metamorphopsia. At the time of the examination, visual acuity was OD - 0.3 ck + 1.5D = 0.5, OS - 0.01 nk. Objectively: OS - the cornea is transparent, the anterior chamber is of medium depth, the pupil is round, artifact, floating opacities in the vitreous. The ophthalmoscopic picture of the fundus of the eye is a pale pink optic disc with physiological excavation, the borders are clear, the arteries are sclerosed, the veins are full-blooded, in the macular region, exudative detachment of the pigment epithelium, hemorrhage, and the periphery of the retina are without features.

Diagnosed with: OU - Senile macular degeneration, OD - pre-form stage, OS - disc stage. OD - Immature age-related cataract. OS - Artifakia.

Thus, the proposed method for predicting the transition of senile macular degeneration from the precisciform stage to the disciform one allows us to evaluate the nature of the course of this disease by the content of IFN-α in blood serum and lacrimal fluid in the presence of hypertension.

METHOD FOR FORECASTING THE TRANSITION OF Senile Macular Degeneration From The Pre-Form Stage To The Discrete In Patients With Hypertensive Disease

Table
The results of a study of patients with pre-sciatic stage of SMD suffering from hypertension. Pre-form stage of SMD The number of patients, n Test cytokines, PCG / ml Blood serum Tear fluid IFN-α IFN-α no progression 8 3.4 ± 1.8 389.6 ± 134.1 with progression 9 0.9 ± 0.5 * 658.8 ± 214.4 * the control 10 14.9 ± 5.3 122.8 ± 44.7 * - significance of differences with control (p <0.05)

Claims (1)

A method for predicting the course of the precisciform stage of senile macular degeneration, characterized in that in patients with hypertension, the concentration of IFN-α in the blood serum and in the lacrimal fluid is determined and if its value is less than 4.3 pkg / ml and more than 212.4 pkg / ml, respectively Predict the transition of the disease from the pre-onciform stage to the disciform.