RU2373535C1 - Diagnostic technique for psoriasis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine and can be used in dermatology for diagnostics of psoriasis. To implement the diagnostic technique, clinical signs of psoriasis are determined, and as an additional laboratory criterion, chemiluminescence (CL) of high-density lipoproteid suspension (HDLS) recovered from the patient's blood serum is evaluated. It is ensured by measuring sum of light (S) and fast flash intensity (I) and calculating the coefficient H equal to S to I relation. If H is more than 5.2, psoriasis is diagnosed for the examined patient.

EFFECT: application of the invention allows for objective diagnostics of psoriasis.

2 tbl, 1 ex

Description

The invention relates to medicine and can be used in dermatology to detect psoriasis.

In clinical practice, the following criteria are taken into account for the diagnosis of psoriasis and psoriatic arthropathy (Mathies H, 1974; Hobation M.M. et al. 1999, Institute of Rheumatology RAMS):

psoriatic skin rashes with a triad of characteristic signs (the phenomenon of stearin stain; the phenomenon of terminal film, the phenomenon of pinpoint bleeding), Kebner's isomorphic reaction, psoriasis of nail plates, psoriasis in close relatives (an indication of the presence of patients with seronegative arthritis and psoriasis among relatives).

1. Arthritis of the distal interphalangeal joints of the hands.

2. Arthritis of three joints of the same finger of the hands (axial lesion).

3. Omnidirectional lesion (subluxation of the fingers).

4. Asymmetric chronic arthritis.

5. Paraarticular phenomena.

6. Sausage configuration of the toes.

7. Parallelism of the course of skin and articular syndromes.

8. Pain and morning stiffness in the spine, which persist for at least 3 months.

9. Seronegativity by rheumatic factor.

10. Acral osteolysis.

11. Ankylosis of the distal interphalangeal joints of the hands and / or interphalangeal joints of the feet.

12. Radiological signs of a certain sacroileitis.

13. Syndesmophytes or paravertebral ossifications.

The diagnosis can be considered legitimate if the manifestations of the disease coincide with three of the above criteria, of which one of the points 1, 11 must be mandatory. If RF is detected, 5 criteria must be matched, two of which are mandatory - skin psoriatic rashes and osteolysis ( from the book Belyaev G.M., Ryzhko P.P. Psoriasis. Psoriatic arthropathy. - M .: MEDpress-iform, 2000).

The existing method is not quantitative, and the diagnosis of psoriasis is subjective.

The objective of the invention is the objectification of a method for the diagnosis of psoriasis in order to develop a laboratory criterion for psoriasis.

The essence of the proposed method lies in the fact that along with the determination of clinical signs, chemiluminescence (CL) is assessed for a suspension of high density lipoproteins (HDL) isolated from patients' blood serum, light sum (S) and fast flash intensity (Ι) are measured, and then they are calculated coefficient H, equal to the ratio of S to I, and if H is greater than 5.2, suggest the presence of psoriasis in the examined patient.

The pathogenesis of psoriasis is associated with hypersecretion of pro-inflammatory mediators, which in turn leads to cytolysis and activation of the mononuclear phagocyte system. All these processes stimulate lipid peroxidation, which leads to their molecular transformation. Therefore, with psoriasis, the nature of the chemiluminescence of serum lipoproteins changes, which became the basis of this diagnostic method.

EXAMPLE

Patient 3., 51 years old. Clinical diagnosis: psoriasis vulgaris, plaque. Arthropathy. Concomitant diagnosis: type 2 diabetes, moderate, non-insulin dependent. AH stage 3, risk 4. Diabetic macroangiopathy. Nephropathy 2 tbsp. Polyneuropathy. ICD. The diagnosis is based on:

- patient complaints of itching, a feeling of tightness of the skin, dryness, peeling, the appearance of cracks, pain in the knee, elbow joints;

- data on the medical history: the patient considers himself for 20 years, when the rash in the knee joints first appeared. Exacerbation 1 time per year (in spring). The last - May 2008. During the last exacerbation, abundant rashes appeared on the body, upper and lower extremities. It was treated on its own: sinaflan ointment, white salik. In connection with the progression of the pathological process, it is sent to the railway;

- data of an objective examination: the skin process is common, on the upper, lower limbs, scalp, around the navel. It is represented by large plaques, papules of bright red color, covered with silver-white scales. The psoriatic triad is positive. In the folds under the mammary glands, erythematous lesions. Swelling, soreness of the knee joints is also noted.

Blood from the ulnar vein was taken in the morning on an empty stomach. Blood serum was obtained by centrifugation for 15 min at 2400 g.

Serum lipoproteins were isolated by precipitation in the presence of heparin and CaCl2. To 2 ml of a 15 mM CaCl2 solution, 0.2 ml of blood serum and 0.04 ml of a 1% crystalline heparin solution were added. The tube was gently shaken. The resulting suspension after 5 minutes of incubation at room temperature was centrifuged for 5 minutes at 200 g. The supernatant consisting of HDL and proteins was pipetted into a separate tube. The precipitate was the total fraction of LDL and VLDL (Lopukhin Yu.M., Vladimirov Yu.A., Molodenkov M.N., Klebanov G.I., Sergienko V.I., Naumov A.V., Maksimov V.A., Sherstnev MP Registration of chemiluminescence of blood serum components in the presence of ferrous iron // Bulletin of experimental biology and clinical medicine. - No. 5. - 1982. - P.61-63).

The supernatant consisting of HDL and proteins in an amount of 200 μl was placed in a cuvette of a chemiluminescent installation, 200 μl of phosphate buffer (20 mM KH2PO4, 10 mM KCl, pH 7.4) was added. To initiate CL, 50 μl of FeSO4 · 7H2O was introduced, and on the 7th cycle, 100 μl of 3% H2O2 was injected (Klimkina E.I. Effect of derivatives of 3-hydroxypyridine and 4-thiosulfonic acid on the functional state of the liver during its toxic damage. Abstract of diss. Cand. Sciences. - Smolensk, 2005. - P.59-60).

CL was recorded for 20 cycles and the height of the fast flash I = 14428 cu was calculated. and the light sum S = 86739 cu After that, the coefficient H was determined, equal to the ratio of S to I, H = 86739/14428 = 6.0. Since 6.0 is greater than 5.2, the patient suffers from psoriasis.

We performed a chemiluminescent analysis of a suspension of HDL isolated from serum in 14 patients with psoriasis and 13 healthy donors according to the method described above. The research data are summarized in table 1.

In all patients with psoriasis, the H coefficient value is more than 5.2, in the group of healthy donors less than 5.2. The group-average value of the coefficient H in patients with psoriasis and healthy donors, respectively, was 6.0 ± 0.21 and 4.82 ± 0.06 (p <0.001) (Table 2).

Thus, the proposed method for the diagnosis of psoriasis is simple, objective, reliable, can be widely used in the clinic as an additional laboratory criterion in the diagnosis.

Table 1
A method for the diagnosis of psoriasis No. Psoriasis patients Healthy donors I S H I S H one 9868 80961 8,204398 20404 97056 4.756714 2 10693 75969 7,104554 15426 79008 5,121743 3 16848 99474 5,904202 19965 92745 4,645379 four 14877 99951 6,718492 22705 103842 4,57353 5 19235 100785 5,239667 19868 91263 4,593467 6 14428 86739 6,011852 23508 107733 4,582823 7 20982 112431 5.35845 22361 112956 5.051474 8 19096 108270 5,669774 25605 129543 5.059285 9 19102 100578 5,265313 22613 109056 4,822713 10 22110 121893 5.513026 17524 87195 4,975748 eleven 17982 107481 5,977144 25663 118986 4.636481 12 21450 124590 5,808392 17367 83340 4,798756 13 20747 115920 5.587314 17501 87276 4.986915 fourteen 23162 131967 5,697565

table 2 Group N (M ± m) Psoriasis patients 6.0 ± 0.21 Healthy donors 4.82 ± 0.06

Claims (1)

A method for the diagnosis of psoriasis, including the determination of clinical signs, characterized in that it further assesses the chemiluminescence (CL) of a suspension of high density lipoproteins (HDL) isolated from the blood serum of patients, measures the light sum (S) and the intensity of a fast flash (I), after which calculate the coefficient H equal to the ratio of S to I, and if H is greater than 5.2, the presence of psoriasis in the examined patient is assumed.