RU2361509C1 - Method of differential diagnostics of polyneuropathy of vibration genesis and diabetic polyneuropathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely, to neurology and professional pathology. Electroencephalography (EEG) with registration of long-latent acoustic induced potentials (LAIP), electroneuromyography (ENMG), algesimetry are performed and diagnostic index for polyneuropathy of vibration genesis (F₁) and diagnostic index for diabetic polyneuropathy (F2) are calculated by formulas: F₁=-5.40+3.63·A₁+1.67·A₂-5.89·A₃-1.33·A₄+0.31·A₅-0.57·A₆+0.39·A₇·0.5·A₈+0.73·A9-0.61·A₁₀; F₂=-15.53-5.39·A₁-12.32·A₂+5.69·A₃-8.98·A₄ 1.69·A₅+4.97·A₆+2.09·A₇+1.32·A₈-0.91·A₉+0.76·A₁₀, where -5.40 and -15.53 - constants; 3.63; 1.67; 5.89; 1.33; 0.31; 0.57; 0.39; 0.5; 0.73; 0.61; 5.39; 12.32; 5.69; 8.98; 1.69; 4.97; 2.09; 1.32; 0.91; 0.76 - discrimination coefficients; A₁ - index of algesimetry on second phalanx of second finger of right hand in mm; A₂ - amplitude of sensory response of tibial nerve in mcV; A₃ - amplitude of sensory response of ulner nerve in mcV; A₄ - motor rate on section wrist-elbow of ulner nerve in m/sec; A₅ - presence or absence of low-amplitude EEG in LAIP recording present - 1; absent - 0; A₆ - sensory rate of tibial nerve in m/sec; A₇ - index of amplitude P2-N2 of LAIP in right temporal lead, A₈ - index of delta activity at LAIP registration in per cent; A₉ - left-side asymmetry in tetta-subrange in frontal leads present - 0; absent - 1; A₁₀ - index of amplitude P2-N2 of LAIP in left temporal lead If F₁ is larger or equal F₂ polyneuropathy of vibration genesis is diagnosed, if F₁ is less than F₂ diabetic polyneuropathy is diagnosed.

EFFECT: extension of arsenal of means for differential diagnostics of polyneuropathy of vibration genesis and diabetic polyneuropathy

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 polyneuropathy of vibrational origin and diabetic polyneuropathy.

To date, accurate methods for the differential diagnosis of polyneuropathy of vibrational origin and diabetic polyneuropathy have not been developed. There are methods for differential diagnosis of polyneuropathy of vibrational genesis, including clinical neurological examination of patients with pain and vibration sensitivity, algesimetry, limb thermometry, determination of muscle strength and endurance, electroneuromyography, radiography of joints of the upper extremities, registration of auditory and somatosensory evoked potentials [1, 2 , 3, 4, 5].

Closest to the proposed solution is a method for diagnosing vibrational disease, including electromyography, determination of calcium in the blood, electrography, psychometric study of the level of psychoemotional tension, rheovasography, radiography or densitometry, followed by calculation of indices of disturbances and integral indicators and evaluating the results [6].

However, these techniques are not sufficiently accurate for differential diagnosis between polyneuropathy of vibrational origin and diabetic polyneuropathy.

The objective of the invention is to improve the accuracy of diagnosis.

The task is achieved by the fact that the patient is tested: electroencephalography (EEG) with registration of long latent auditory evoked potentials (DSWP), electroneuromyography (ENMG), algesimetry and diagnostic coefficients F are calculated according to the formulas:

F _{1 =} -5.40 + 3.63 · A ₁ + 1.67 · A ₂ -5.89 · A ₃ -1.33 · A ₄ + 0.31 · A ₅ -0.57 · A ₆ + 0.39 · A ₇ + 0.5 · A ₈ + 0.73 · A ₉ -0.61 · A ₁₀ ;

F ₂ = -15.53-5.39 · A ₁ -12.32 · A ₂ + 5.69 · A ₃ -8.98 · A ₄ -1.69 · A ₅ + 4.97 · A ₆ + 2.09 · A ₇ + 1.32 · A ₈ -0.91 · A ₉ + 0.76-A ₁₀ ,

where F ₁ is a diagnostic coefficient for polyneuropathy of vibrational origin,

F ₂ is a diagnostic coefficient for diabetic polyneuropathy;

-5.40 and -15.53 are constants,

3.63; 1.67; 5.89; 1.33; 0.31; 0.57; 0.39; 0.5; 0.73; 0.61; 5.39; 12.32; 5.69; 8.98; 1.69; 4.97; 2.09; 1.32; 0.91; 0.76 - discrimination factors;

And _{1.2 ... 10} - gradations and numerical values of the indicators of the survey

(A ₁ is the indicator of algesimetry on the 2nd phalanx of the 2nd finger of the right hand, A ₂ is the amplitude of the sensory response of the tibial nerve, A ₃ is the amplitude of the sensory response of the ulnar nerve, And ₄ is the motor speed in the wrist-elbow of the ulnar nerve, A ₅ - the presence or absence of a low-amplitude EEG during recording (auditory evoked potentials) of SVP, A ₆ - sensory speed of the tibial nerve, A ₇ - an amplitude indicator of DSVP (P2-N2) in the right temporal leads, A ₈ - indicator of delta activity during registration of DSVP, A ₉ - the presence or absence of left-sided minutes asymmetry in theta-subband in frontal leads, and ₁₀ - figure DSVP amplitude (P2-N2) in the left temporal leads).

Diagnostic coefficients F ₁ and F _{2 are} calculated, and when F ₁ is greater _than or equal to F ₂ , polyneuropathy is diagnosed due to vibration exposure, and when F _{1 is} less than F _2, diabetic polyneuropathy is diagnosed.

A comparative analysis of the proposed solution with the prototype [6] shows that the proposed method differs in that using the EEG with registration of long-latent auditory evoked potentials, ENMG, algesimetry, diagnostic coefficients F ₁ and F _{2 are} calculated by the proposed formulas, and when a value of F ₁ greater _than or equal to F ₂ is diagnosed with polyneuropathy of vibrational origin, and with F ₁ less _than F ₂ , diabetic polyneuropathy 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 differential diagnosis of polyneuropathy of vibrational origin and diabetic polyneuropathy in the literature available to us has not been identified. The proposed informative indicators allow differential diagnosis of polyneuropathy of vibrational genesis with a high degree of accuracy (100%). 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 is performed: algesimetry on the 2nd phalanx of the 2nd finger of the right hand and determine the algemometry indicator, electroneuromyography and determine the amplitude of the sensory response of the tibial and ulnar nerves, motor speed in the wrist-elbow of the ulnar nerve, sensory speed of the tibial nerve ; EEG with registration of long-latent auditory evoked potentials and determine the absence or presence of a low-amplitude EEG when recording DSLP, the amplitude of DSLP (P2-N2) in the right and left temporal leads, the delta activity when registering DSLP, the absence or presence of left-side asymmetry in the tetta sub-band in the frontal leads ; then calculate the diagnostic coefficients F ₁ and F ₂ according to the formulas:

F ₁ = -5.40 + 3.63 · A ₁ + 1.67 · A ₂ -5.89 · A ₃ -1.33 · A ₄ + 0.31 · A ₅ -0.57 · A ₆ + 0.39 · A ₇ -0.5 · A ₈ + 0.73 · A9-0.61-A ₁₀ ;

F ₂ = -15.53-5.39 · A ₁ -12.32 · A ₂ + 5.69 · A ₃ -8.98 · A ₄ -1.69 · A ₅ + 4.97 · A ₆ + 2.09 · A ₇ + 1.32 · A ₈ -0.91 · A ₉ + 0.76 · A ₁₀ ,

where F ₁ is a diagnostic coefficient for polyneuropathy of vibrational origin,

F ₂ is a diagnostic coefficient for diabetic polyneuropathy; -5.40 and -15.53 are constants,

3.63; 1.67; 5.89; 1.33; 0.31; 0.57; 0.39; 0.5; 0.73; 0.61; 5.39; 12.32; 5.69; 8.98; 1.69; 4.97; 2.09; 1.32; 0.91; 0.76 - discrimination factors;

And _{1.2 ... 10} - gradations and numerical values of the indicators of the survey:

And ₁ is an indicator of algesimetry on the 2nd phalanx of the 2nd finger of the right hand;

And ₂ is the amplitude of the sensory response of the tibial nerve;

And ₃ - the amplitude of the sensory response of the ulnar nerve;

And ₄ - motor speed on the wrist-elbow of the ulnar nerve;

And ₅ - the presence of low-amplitude EEG when recording SVP-1; lack of low-amplitude EEG when recording SVP-0;

A ₆ - sensory speed of the tibial nerve;

And ₇ is an indicator of the amplitude of DSVP (P2-N2) in the right temporal leads;

And ₈ is an indicator of delta activity during the registration of DSA;

And ₉ - left-side asymmetry in the tetta sub-band in the frontal leads (yes - 0; no - 1);

And ₁₀ is an indicator of the amplitude of DSVP (P2-N2) in the left temporal leads; and with a value of F ₁ greater _than or equal to F ₂ , diagnose polyneuropathy of vibrational origin, and with F ₁ less _than F ₂ , diagnose diabetic polyneuropathy.

Diagnostic coefficients F ₁ and F ₂ obtained by subtracting the discriminant functions. The discriminant analysis was carried out in groups of patients with vibrational disease from the effects of local vibration and patients with diabetic polyneuropathy. The reliability of the obtained informative indicators as a result of discriminant analysis is presented in the table.

Informative indicators of discriminant analysis in patients with polyneuropathy of vibrational origin and diabetic polyneuropathy

No. Indicators F-inclusions R A ₁ Algesimetry on the 2nd phalanx of the 2nd finger of the right hand 41.71 0.000001 A ₂ the amplitude of the sensory response of the tibial nerve 41.78 0.000001 A ₃ amplitude of the ulnar nerve sensory response 23.80 0.000008 A ₄ motor speed on the wrist-elbow of the ulnar nerve 13.92 0,000431 A ₅ low-amplitude EEG when recording DSVP 4,58 0,036431 A ₆ sensory speed of the tibial nerve 9.18 0,003617 A ₇ DSVP amplitude (P2-N2) in the right temporal leads 2,53 0.116770 A ₈ delta activity during registration 5.44 0,023046 A ₉ the presence of left-side asymmetry in the tetta sub-range in the frontal leads 3.77 0.056852 A ₁₀ DSVP amplitude (P2-N2) in the left temporal leads 2.78 0,100180

Example 1

Patient L., age 46, work experience as a miner of a face at a mine in the Sakhalin Region for 21 years, complains of numbness of the fingers, coldness of the hands, paresthesia, pain in the hands of an aching character, especially after work, intensified at night, due to this can not sleep, whitening of the fingers in the cold. Neurological examination revealed distal sensory impairment, (+) Paly and white spot symptoms, hyperhidrosis, hypothermia of the hands, limitation of movements in the elbow joints to FN1 on both sides. The following studies were performed: algesimetry on the 2nd phalanx of the 2nd finger of the right hand, electroneuromyography, electroencephalography with registration of long-latent auditory evoked potentials, indicators were obtained:

A ₁ - an indicator of algesimetry on the 2nd phalanx of the 2nd finger of the right hand - 1 mm;

And ₂ - the amplitude of the sensory response of the tibial nerve - 3 μV;

And ₃ - the amplitude of the sensory response of the ulnar nerve - 2.76 μV;

And ₄ - motor speed in the wrist-elbow of the ulnar nerve - 41.34 m / s;

And ₅ - the presence of low-amplitude EEG when recording DSVP - 1;

A ₆ - sensory speed of the tibial nerve - 42 m / s;

And ₇ is an indicator of the amplitude of DSVP (P2-N2) in the right temporal leads - 1.34 μV;

And ₈ is an indicator of delta activity during the registration of DSWP - 8%;

And ₉ - the presence of left-side asymmetry in the tetta sub-range in the frontal leads - 0;

And ₁₀ is an indicator of the amplitude of DSVP (P2-N2) in the left temporal leads of -2.44 μV.

F ₁ = -5.4 + 3.63 · 1 + 1.67 · 3-5.89 · 2.76-1.33 · 41.34 + 0.31 · 1-0.57 · 42 + 0, 39 · 1.34-0.5 · 8 + 0.73 · 0-0.61-2.44 = -96.58.

F ₂ = -15.53-5.39 · 1-12.32 · 3 + 5.69 · 2.76-8.98 · 41.34-1.69 · 1 + 4.97 · 42 + 2, 09 · 1.34 + 1.32 · 8-0.91 · 0 + 0.76 · 2.44 = -191.15.

F ₁ > F ₂ ,

Conclusion: Patient L. has a polyneuropathy of vibrational origin.

Example 2. Patient P., aged 48 years old, suffers from type 2 diabetes for 10 years. A patient is diagnosed with diabetic limb polyneuropathy for 5 years. Research results:

A ₁ - an indicator of algesimetry on the 2nd phalanx of the 2nd finger of the right hand - 0.2 mm;

And ₂ - the amplitude of the sensory response of the tibial nerve - 1.32 μV;

And ₃ - the amplitude of the sensory response of the ulnar nerve - 3 μV;

And ₄ - motor speed on the wrist-elbow of the ulnar nerve - 32 m / s;

And ₅ - the presence of low-amplitude EEG when recording DSVP - 1;

And ₆ - sensory speed of the tibial nerve - 45.07 m / s;

And ₇ is an indicator of the amplitude of DSVP (P2-N2) in the right temporal leads - 5.52 μV;

And ₈ is an indicator of delta activity during the registration of DSA - 16%;

And ₉ - the presence of left-side asymmetry in the tetta sub-range in the frontal leads - 0;

And ₁₀ is an indicator of the amplitude of DSVP (P2-N2) in the left temporal leads - 2.68 μV.

F ₁ = -5.4 + 3.63 · 0.2 + 1.67 · 1.32-5.89 · 3-1.33 · 32 + 0.31 · 1-0.57 · 45.07 + 0.39 · 5.52-0.5 · 16 + 0.73 · 0-0.61 · 2.68 = -95.56.

F ₂ = -15.53-5.39 · 0.2-12.32 · 1.32 + 5.69 · 3-8.98 · 32-1.69 · 1 + 4.97 · 45.07 + 2.09 · 5.52 + 1.32 · 16-0.91 · 0 + 0.76 · 2.68 = -46.17.

F ₁ <F ₂ .

Conclusion: Patient P. has diabetic polyneuropathy.

Example 3

Patient S., age 46 years, work experience as a mine tuner in Khakassia 18 years, complaints of numbness of the hands, decreased strength in the hands, whitening of the fingers in the cold, pain in the elbow joints. A neurological examination revealed sensory disturbances in the arms according to the distal type, (+) symptoms of Palya and white spot, hyperhidrosis, hypothermia of the hands, restriction of movements in the elbow joints of the left and right sides of FN1. From the anamnesis: suffering from type 2 diabetes for 9 years.

Research results:

A ₁ - an indicator of algesimetry on the 2nd phalanx of the 2nd finger of the right hand - 1 mm;

And ₂ - the amplitude of the sensory response of the tibial nerve - 1.28 μV;

And ₃ - the amplitude of the sensory response of the ulnar nerve - 3.9 μV;

And ₄ - motor speed in the wrist-elbow of the ulnar nerve - 40.3 m / s;

And ₅ - the presence of low-amplitude EEG when recording DSVP - 1;

And ₆ - sensory speed of the tibial nerve - 48.3 m / s;

And ₇ is an indicator of the amplitude of DSVP (P2-N2) in the right temporal leads - 2.1 μV;

And ₈ is an indicator of delta activity during the registration of DSA - 15%;

And ₉ - the presence of left-side asymmetry in the tetta sub-range in the frontal leads - 0;

And ₁₀ is an indicator of the amplitude of DSVP (P2-N2) in the left temporal leads - 2.6 μV.

F ₁ = -5.4 + 3.63 · 1.0 + 1.67 · 1.28-5.89 · 3.9-1.33 · 40.3 + 0.31 · 1-0.57 · 48.3 + 0.39 · 2.1-0.5 · 15 + 0.73 · 0-0.61 · 2.6 = -111.6

F ₂ = -15.53-5.39 1.0-12.32 1.28 + 5.69 3.9-8.98 40.3-1.69 1 + 4.97 48.3 + 2.09 · 2.1 + 1.32 · 15-0.91 · 0 + 0.76 · 2.6 = -111.6.

F ₁ = F ₂

Conclusion: Patient S. has a polyneuropathy of vibrational origin.

As a result of the discriminant analysis of the indicators, a combination of 10 indicators was obtained, in which the diagnosis accuracy was maximum.

Evaluation of the effectiveness of the proposed method of differential diagnosis was carried out in the training and control samples. In the training sample (40 people), the correct recognition was 100% for patients with polyneuropathy of vibrational origin and 100% for patients with diabetic polyneuropathy (30 people). The control sample consisted of 25 patients with polyneuropathy of vibrational origin and 25 patients with diabetic polyneuropathy with a recognition accuracy of 97.5% and 98.6%, respectively.

The proposed method makes it possible to differentiate the polyneuropathy of vibrational genesis in the study of the minimum number of the most informative diagnostic indicators, thereby contributing to a decrease in the volume of paraclinical studies.

Literature

1. Hecht B.M. Electromyography in the diagnosis of neuromuscular diseases / B.M. Geht, L.F. Kasatkina, M.I. Samoilov, A.G. Sanadze // Taganrog: Publishing house TRTU. - 1997, - 370 s.

2. Gurieva I.V. Diabetic peripheral sensorimotor neuropathy: Methodological recommendations / Department of Endocrinology and Diabetology of the Russian Medical Academy of Postgraduate Education. - M., 2004, - 30 s.

3. Zenkov L.R. Clinical electroencephalography with elements of epileptology / L.R. Zenkov // - M .: MEDpress-inform, 2001, - 368 p.

4. Izmerov N.F. Manual on occupational diseases / N.F. Izmerov. - M .: Publishing house "Medicine", 1996. - T. 2. - S.141-161.

5. N.V. Kartapoltseva. Features of damage to the nervous system under the stressful effects of physical factors of the working environment / Kartapoltseva N.V., Katamanova E.V., Rusanova D.V. // Occupational medicine and industrial ecology. - 2007. - No. 6. - S. 43-47.

6. A method for diagnosing vibrational disease: Pat. 2123279 C1 / V.A. Kiryakov, E.N. Yanshina, N.D. Ovchinnikov, Yu.P. Syromyatnikov. Declared June 4, 1997. Published December 20, 1998, IPC.

Claims (1)

A method for the differential diagnosis of polyneuropathy of vibrational origin and diabetic polyneuropathy, including electrophysiological studies followed by analysis of indicators, characterized in that they perform electroencephalography (EEG) with registration of long-latent auditory evoked potentials (DSVP), electroneuromyography (ENMG), and algesimetry is calculated by F and formulas:
F ₁ = -5.40 + 3.63 · A ₁ + 1.67 · A ₂ -5.89 · A ₃ -1.33 · A ₄ + 0.31 · A ₅ -0.57 · A ₆ + 0.39 · A ₇ · 0.5 · A ₈ + 0.73 · A9-0.61 · A ₁₀ ;
F ₂ = -15.53-5.39 · A ₁ -12.32 · A ₂ + 5.69 · A ₃ -8.98 · A ₄ -1.69 · A ₅ + 4.97 · A ₆ + 2.09 · A ₇ + 1.32 · A ₈ -0.91 · A ₉ + 0.76 · A ₁₀ ,
where F _{1 is the} diagnostic coefficient for polyneuropathy of vibrational origin;
F ₂ - diagnostic coefficient for diabetic polyneuropathy; -5.40 and -15.53 are constants;
3.63; 1.67; 5.89; 1.33; 0.31; 0.57; 0.39; 0.5; 0.73; 0.61; 5.39; 12.32; 5.69; 8.98; 1.69; 4.97; 2.09; 1.32; 0.91; 0.76 - discrimination factors;
where A ₁ - an indicator of algesimetry on the 2nd phalanx of the 2nd finger of the right hand in mm;
And ₂ is the amplitude of the sensory response of the tibial nerve in μV; And ₃ is the amplitude of the sensory response of the ulnar nerve in μV; And ₄ - motor speed in the wrist-elbow of the ulnar nerve in m / s; A ₅ - the presence or absence of a low-amplitude EEG when recording DSWP is - 1, no - 0; And ₆ - sensory speed of the tibial nerve in m / s; A _{7 is an} indicator of the amplitude of P2-N2 DSVP in the right temporal lead, A ₈ is an indicator of the delta activity when registering DSVP in percent; And ₉ - left-side asymmetry in the tetta sub-band in the frontal leads is - 0; no - 1; A ₁₀ - an indicator of the amplitude of P2-N2 DSVP in the left temporal lead; diagnostic coefficients F ₁ and F _{2 are} calculated, and when F _{1 is} greater than or equal to F _2, polyneuropathy of vibrational origin is diagnosed, and when F _{1 is} less than F _2, diabetic polyneuropathy is diagnosed.