RU2416362C2 - Method of predicting progression of viral hepatitis course - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to hepatology, namely to viral hepatitis and can be used for prediction of viral hepatitis progression. Psychological testing is carried out: test MMPI, test 16-FPQ and Spielberg-Hanin test. Prognostic index is determined in form of discriminant function for patients with acute viral hepatitis by formula: CRF (chronisation risk factor) =- 0.051·X1+0.241·X2+0.064·X3-0.041·X4+0.575, where: X1 is index 1 of scale (test MMPI); X2 is index of category F (test 16-FPQ); X3 is level of situation anxiety (Spielberg-Hanin test); X4 is level of personality anxiety (Spielberg-Hanin test). If CRF is lower than -0.439 high risk of chronisation is predicted, if CRF is from 0.473 and higher - lower risk of chronisation. For patients with chronic viral hepatitis by formula: ARF (advance risk factor) =0.031·X1-0.044·X2-0.253·X3-0.194·X4+0.092·X5-1.317, where: X1 is. index 1 of scale (test MMPI); X2 is index 7 of scale (test MMPI); X3 is index of category G (test 16-FPQ); X5 is level of personality anxiety (Spielberg - Hanin test) If CRF is higher than 0, high risk of hepatocirrhosis development is predicted.

EFFECT: increase of self-descriptiveness by detection groups with risk of process progression for taking preventive treatment measures in due time.

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Description

The invention relates to medicine, in particular to hepatology, namely to viral hepatitis, and can be used to predict the progression of viral hepatitis.

It is known that diseases of the hepatobiliary system occupy a significant place among the causes of disability and mortality in the Russian population. In this case, a special role in the pathology of the hepatobiliary system is played by viral hepatitis, mainly with parenteral transmission of the pathogen (hepatitis B, C). In terms of breadth of distribution, level of morbidity, severity, frequency of development of chronic forms and the economic damage caused, they occupy one of the leading places in human pathology in the Russian Federation. Acute viral hepatitis is more often a favorable benign, self-resolving liver disease with a cyclic course. However, in some cases, the cyclical course can be disturbed, and this can lead to a gradual progression of the process with the development of chronic viral hepatitis and subsequent transformation into cirrhosis. The creation of methods that allow, at an early stage, to identify among patients with acute and chronic viral hepatitis groups of patients with a high risk of progression of the process for adequate and timely therapy, is currently relevant.

A known method for predicting chronic hepatitis B [Sochnev A.M., Alekseev L.P., Tananov A.T. HLA antigens in various diseases and transplantation. - Riga: Zinatze, 1987 - 86 pp.] By determining the antigenic profile of human leukocytes using the immunological method.

The known method is quite accurate, but laborious, requires certain material costs and is recommended only for the diagnosis of prediction of viral hepatitis B.

A known method for predicting the progression of viral hepatitis C, by studying the ratios of activated and non-activated subpopulations of T- and B-lymphocytes, immunological criteria for predicting chronic hepatitis C are derived [Yu.V. Lobzin Immunopathogenesis of viral hepatitis C. Immunological markers of disease progression / Yu.V. Lobzin, V.Yu. Nikitin, I.A. Sukhina, V.N. Tsygan, Yu.A. Mitin // Zhurn. microbiology, epidemiology and immunobiology. - 2007. - No. 6. - S.75-84].

Despite the obvious advantages, the disadvantage of this method is the complexity, high material costs and limited use, namely only in medical centers with a good laboratory base, which makes the known method inaccessible.

The authors developed a method for predicting the progression of viral hepatitis based on the assessment of the psychological profile of the personality of patients. The non-invasiveness and harmlessness of the method, accessibility for primary care physicians make it possible to widely use the claimed method in medical practice to identify groups among patients with acute and chronic viral hepatitis with a high risk of progression of the process.

The technical result of the proposed method is to increase the information content by identifying risk groups for the progression of the process for the timely implementation of preventive therapeutic measures.

The technical result is achieved by conducting a screening study of the psychological profile of the personality of patients with acute and chronic viral hepatitis and determining a prognostic indicator for acute and chronic viral hepatitis separately as a discriminant function according to the formulas: for acute viral hepatitis and for chronic viral hepatitis, after which they make a forecast progression of the course of viral hepatitis.

The method is as follows.

In patients with diagnosed acute and chronic viral hepatitis, psychological testing is carried out using international standardized methods. The methods are selected in such a way and in such a sequence as to most accurately and efficiently assess the psychological status of the patient against the background of the course of viral hepatitis.

First, they conduct the MMIL test (Methodology for multilateral personality research), which allows you to determine the psychological type of individual response, features of the motivational sphere, interpersonal style of behavior, level of self-esteem, emotional-dynamic shades of intellectual activity, type of reactions in stress, adaptive and compensatory abilities of an individual. The methodology provides an assessment of psychological status on 13 scales, of which the first three scales are evaluative, the remaining ten are clinical. The received data is converted to T-points. Measurement is carried out on all scales simultaneously. A graphic image of the totality of estimates is a personality profile [Berezin F.B. The methodology of multidisciplinary personality research (in clinical medicine and psychohygiene) / F.B. Berezin, M.P. Miroshnikov, R.V. Rozhanets. - M., 1976. - 123 p.].

Then, testing is carried out according to the 16-factor Kettell personality questionnaire (16-FLO test), which allows you to identify 16 personality factors. Each factor has a conditional name and has a connection with individual personality traits and is aimed at identifying personality traits that contribute to the occurrence of pathological psychological phenomena, measured in the walls [Kapustina A.N. Multifactorial personality technique of R. Kettell / A.N. Kapustin. - St. Petersburg: Speech, 2001. - 112 p.].

The study of psychological status is completed with a test for measuring anxiety on the Spilberger-Hanin Reactive and Personal Anxiety Scale. Identify personal anxiety (as a personality trait) and situational anxiety (state at a certain moment), measured in points [Khanin Yu.L. A brief guide to the use of the reactive and personal anxiety scale Ch.D. Spilberger / Yu.L. Khanin. - L .: LNIIFK, 1976. - 28 p.].

The obtained research results are processed by the discriminant analysis method using the software package Statistica 6.0 (StatSoft Inc.).

For patients with acute viral hepatitis, the most informative indicators were identified, namely, scale 1 (MMIL), factor F (16-FLO) and levels of situational and personal anxiety (Spielberger-Hanin test), which allowed us to derive the following formula for calculating the “risk coefficient Chronization "(COFI):

COX = -0.051 · X1 + 0.241 · X2 + 0.064 · X3 -0.041 · X4 + 0.575,

where the known numerical values are constant values:

X1 - indicator 1 of the scale (MMIL test);

X2 - category F indicator (16-FLO test);

X3 - level of situational anxiety (Spielberger-Hanin test);

X4 - level of personal anxiety (Spielberger-Hanin test).

With values of COFI less than -0.439, the risk of chronicity is high, with values of COFI of 0.473 and higher, the risk of chronicity is low.

For patients with chronic viral hepatitis, the most informative indicators are scales 1 and 7 (MMIL test), factor G and Q1 (16-FLO test) and level of personal anxiety (Spielberger-Hanin test), which allowed deriving the following formula for calculating the “risk coefficient progression ”(PKK):

KRP = 0,031 · X1-0,044 · X2-0,253 · X3-0,194 · X4 + 0,092 · X5-1,317,

where the known numerical values are constant values:

X1 - indicator 1 of the scale (MMIL test);

X2 - indicator 7 of the scale (MMIL test);

X3 - category G indicator (16-FLO test);

X4 - indicator of category Q1 (16-FLO test);

X5 - level of personal anxiety (Spielberger-Hanin test).

High values of CRP (above 0) indicate a high risk of liver cirrhosis.

Clinical examples:

Example 1

Patient B., 29 years old, medical history No. 343. I was on treatment with a diagnosis of Viral hepatitis B, moderate course. On examination:

X1 - indicator 1 of the scale (MMIL test) - 98.6 points; X2 - category F indicator (16-FLO test) - 7 walls; X3 - level of situational anxiety (Spielberger-Hanin test) - 50 points; X4 - level of personal anxiety (Spielberger-Hanin test) - 44 points.

CRP = -0.051 · 98.6 + 0.241 · 7 + 0.064 · 50-0.041 · 44 + 0.575 = -1.37, therefore, CRC is significantly less than -0.439, which means that the patient has a high risk of chronicity.

Example 2

Patient P., 21 years old, medical history No. 105. I was on treatment with a diagnosis of Viral hepatitis B, moderate course. On examination:

X1 - indicator 1 of the scale (MMIL test) - 51.4 points; X2 - category F indicator (16-FLO test) - 7 walls; X3 - level of situational anxiety (Spielberger-Hanin test) - 37 points; X4 - level of personal anxiety (Spielberger-Hanin test) - 27 points.

KPH = -0.051 · 51.4 + 0.241 · 7 + 0.064 · 37-0.041 · 27 + 0.575 = 1.01,

thus, COFI is significantly greater than 0.439, which means that the risk of chronicity in this patient is low.

Example 3

Patient C, 37 years old, medical history No. 101. I was on treatment with a diagnosis of Chronic viral hepatitis C, active phase, minimal activity. On examination:

X1 - indicator 1 of the scale (MMIL test) - 84.8 points; X2 - indicator 7 of the scale (MMIL test) - 83.9 points; X3 - category G indicator (16-FLO test) - 3 wall; X4 - indicator of category Q1 (16-FLO test) - 7 walls; X5 - level of personal anxiety (Spielberger-Hanin test) - 71 points.

CRP = 0.031 · 84.8-0.044 · 83.9-0.253 · 3-0.194 · 7 + 0.092 · 71-1.317 = 2.01, a positive value of CRP (above 0) indicates a high risk of liver cirrhosis.

Example 4

Patient K., 40 years old, medical history No. 216. I was on treatment with a diagnosis of Chronic viral hepatitis C, active phase, moderate activity. On examination:

X1 - indicator 1 of the scale (MMIL test) - 51.4 points; X2 - indicator 7 of the scale (MMIL test) - 51.3 points; X3 - category G indicator (16-FLO test) - 4 wall; X4 - category indicator Q1 (16-FLO test) - 5 walls; X5 - level of personal anxiety (Spielberger-Hanin test) - 38 points.

CRP = 0.031 · 51.4-0.044 · 51.3-0.253 · 4-0.194 · 5 + 0.092 · 38-1.317 = -0.47, the value of CRP (less than 0) indicates a low risk of liver cirrhosis.

The forecasting method is quite simple, informative, does not require special invasive techniques and has virtually no contraindications for use in the presence of voluntary informed consent of the patient.

The inventive method is informative, not invasive and completely harmless to the patient. The ability to calculate the coefficients for predicting the progression of the course of liver diseases leads to an improvement in the quality of diagnosis and allows the doctor to timely determine further treatment tactics, achieve stabilization of the process and extend the patient's life.

Claims (1)

A method for predicting the progression of the course of viral hepatitis by conducting psychological testing, which consists in conducting the MMIL test, the 16-FLO test and the Spilberger-Hanin test; determining a prognostic indicator in the form of discriminant function for patients with acute viral hepatitis according to the formula:
KPH = -0.051 · X1 + 0.241 · X2 + 0.064 · X3-0.041 · X4 + 0.575,
where X1 - indicator 1 of the scale (MMIL test);
X2 - category F indicator (16-FLO test);
X3 - level of situational anxiety (Spielberger-Hanin test);
X4 - level of personal anxiety (Spielberger-Hanin test), and
a value of COFI is less - 0.439 predict a high risk of chronicity, with values of COFI from 0.473 and above - a low risk of chronicity; for patients with chronic viral hepatitis according to the formula:
KRP = 0,031 · X1-0,044 · X2-0,253 · X3-0,194 · X4 + 0,092 · X5-1,317,
where X1 - indicator 1 of the scale (MMIL test);
X2 - indicator 7 of the scale (MMIL test);
X3 - category G indicator (16-FLO test);
X4 - indicator of category Q1 (16-FLO test);
X5 is the level of personal anxiety (Spilberger-Hanin test), and with a value of CRP above 0, a high risk of developing liver cirrhosis is predicted.