RU2445915C1 - Method for prediction of risk of decreasing body resistance to acute respiratory diseases in children between ages of 3 to 7 by secretory immunoglobulin a avidity index - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely paediatrics. For the purpose of prediction of the risk of decreased body resistance to acute respiratory diseases in children between the ages of 3 to 7, an ELISA procedure is used to evaluate the saliva secretory immunoglobulin A concentration in a child between the ages of 3-7. The saliva secretory immunoglobulin A concentration is evaluated simultaneously in two samples one of which is added with urea 0.3 mole/l. The avidity index is dividing the saliva secretory immunoglobulin A concentration in the urea sample by the saliva secretory immunoglobulin A concentration in the urea-free sample. If the avidity index is less than 0.089 and more than 0.27, a child is referred to a risk group of decreased body resistance to acute respiratory diseases.

EFFECT: method provides higher evaluation of the risk of decreased body resistance to acute respiratory diseases in children between the ages of 3-7.

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Description

FIELD OF THE INVENTION

The invention relates to medicine, namely to pediatrics.

State of the art

The relevance of the development of the method is determined by the high frequency of acute respiratory infections in children of this age group [Kuchma V.R. School Hygiene and Health Guide. M .: Russian Association of Public Health, 2000. - P.18]. According to various authors, often ill preschool children account for 40 to 70%. And children often suffering from acute respiratory infections due to their significant prevalence have become not only a medical, but also a social problem [V. Albitsky, A. A. Baranov Often sick children: clinical and social aspects. Ways of healing. - Saratov, 1986. - 183 p .; Samygina G.A. Often sick children: problems of pathogenesis, diagnosis and therapy // Consilium medicum. - Application. "Pediatrics". - 2004. - No. 2. - C.3].

The modern assessment of the health status of children is based on 3 groups of factors that determine health (deviations in the onto-, intra- and early postnatal genesis (biological history); genealogical history; social and environmental history) and 5 criteria characterizing health [in accordance with the order Ministry of Health of the Russian Federation No. 621 dated 12/30/2003 "On a comprehensive assessment of the health status of children"], one of which is the level of resistance of the body.

This is an indicator characterizing the resistance (resistance) of the child's body to pathogenic effects. It is determined by taking into account the frequency of acute diseases over one year of life.

If the observation was shorter, the assessment of resistance is carried out by the index of the frequency of acute diseases (IOS). It is equal to the ratio of the number of acute diseases transferred to the number of months of observation:

Resistance is considered:

- high (0 diseases per year, Ioz - 0);

- medium (1-3 diseases per year, Ios <0.33);

- low (4-7 diseases per year, Ios - 0.33-0.6);

- very low (8 or more times a year, Ios> 0.65).

A child is often ill if he suffers 4 or more acute diseases during a year and the acute disease frequency index is 0.33 and higher [Vinogradov AF, Akopov ES, Alekseeva Yu.A., Borisova MA Children's Hospital. - Tver, 2004. - 495 p.].

As a prototype of the selected "Method for predicting acute morbidity of the nasopharyngeal tract in children" [L. Zhdanova, V. Poberskaya A method for predicting acute morbidity of the nasopharyngeal tract in children. - RF patent for the invention RU No. 2038601 C1].

The essence of the method is that the level of lysozyme in mixed saliva is determined and with an increase of more than 20 conventional units, an exacerbation of ENT pathology is predicted.

The disadvantages of this method are the following:

- lysozyme saliva activity refers to non-specific factors of local protection, the state of which depends on so many factors;

- acute respiratory infections in preschool children are not limited only to ENT pathology, quite often at this age there are recurrent bronchitis;

- the method for determining lysozyme requires a bacteriological laboratory, since it is assumed to use a culture of microorganisms;

- quantitative indicators of the state of mucosal immunity (both lysozyme and secretory immunoglobulin A have a significant range of values and, when screening, their quantitative indicators are more important when comparing the incidence of children's groups, therefore, for an individual prognosis, it is more important to search for qualitative indicators that reflect the functional state of mucosal immunity in specific child).

In the claimed method, the listed disadvantages are eliminated.

Disclosure of invention

The objective of the invention is to improve the diagnosis of health (lowering the body's resistance to acute respiratory infections) in children aged 3-7 years.

The technical result of the method is to increase the information content of a clinical and laboratory examination of a child by using a biochemical study of saliva to identify among children aged 3-7 years a risk group for reducing the body's resistance to acute respiratory diseases.

Brief Description of the Drawings

No illustrations.

The implementation of the invention

The claimed technical result is achieved by determining the secretory immunoglobulin A in parallel in two samples by the method of enzyme-linked immunosorbent assay using a set of "sIgA-IFA-BEST". The saliva of the child is collected in the morning on an empty stomach for 10 minutes after rinsing the mouth with boiled water at room temperature. Urea solution (0.3 mol / L) is added to one of the samples, which destroys fragile immune complexes, the avidity of antibodies is estimated using the calculated indicator of avidity index (IA), which is the ratio of the result of enzyme-linked immunosorbent assay of the concentration of antibodies in the sample subjected to urea , to the result of measuring the concentration of antibodies in a sample not treated with urea. The definition of avidity is the differentiation of high and low avidity antibodies. A total of 64 often (more than 6 times a year) children with acute respiratory infections of 3-7 years old and 32 children of 3-7 years old, with acute respiratory diseases 1-3 times a year and without chronic diseases were examined (control group). If the avidity index (IA) is less than 0.089 or greater than 0.27, we reliably assign the child to the risk group for lowering the body's resistance to acute respiratory diseases with a confidence rate of p <0.003.

The novelty of the proposed method lies in the fact that for the first time it is proposed to predict a decrease in the body's resistance to acute respiratory diseases in preschool children by the avidity index of secretory immunoglobulin A in saliva. That is, for the first time, the prognosis is based not on quantitative, but on qualitative characteristics of secretory antibodies. For the first time, their ability to adhere is taken into account. In all likelihood, for their normal functioning, the bond strength with the antigen should be neither too weak nor too strong. That is, 2 gradation points are determined.

Distinctive features of the method: the prognostic parameters of the avidity index of secretory immunoglobulin A are established, with a value of less than 0.089 or more than 0.27, a high risk of a decrease in the level of resistance of the child's body to acute respiratory diseases is predicted.

The studies were carried out in the research center of the State Educational Institution of Higher Professional Education "Tver State Medical Academy of Roszdrav". Statistical data processing included the use of a nonparametric method for assessing the reliability of results — the Fisher angular transformation method, the significance level was determined at p <0.05 [Gubler E.V. Computational methods for the analysis and recognition of pathological processes. - L. - 1978. - P.296].

A method for predicting the risk of reducing the body's resistance to acute respiratory infections in children aged 3-7 years by the avidity index of secretory immunoglobulin A is illustrated by the following examples.

Clinical example 1

Child, 4 years old, formalized card No. 34.

The child from the first pregnancy, the first birth, proceeding physiologically. Breastfeeding up to 6 months. I went to kindergarten from the age of 3.5, before the kindergarten I suffered from acute respiratory infections (ARI) 2-3 times a year, without complications. 2 weeks after the start of the visit to the kindergarten, he had acute respiratory infections, a month later relapse of acute respiratory infections. Directed to the immunologist. The analysis of saliva:

- secretory immunoglobulin A in the sample with urea (O1) = 2.97 mg / l,

- secretory immunoglobulin A in the sample without urea (O2) = 9.29 mg / l,

- avidity index O1 / O2 = 0.32 (more than 0.27).

Frequent incidence was predicted. The child was observed during the year. The number of acute respiratory infections per year is 8. The forecast was confirmed.

Clinical example 2

Child, 6 years old, formalized card No. 67.

The child from the second pregnancy, the first birth - cesarean section. Breastfeeding up to 2 years. I went to kindergarten from 3 years old. Until 3 years he was ill 3-4 times a year. From 3 to 6 years he was ill 5-6 times a year. Directed to the immunologist after the next ARI. The analysis of saliva:

- secretory immunoglobulin A in the sample with urea (O1) = 10.43 mg / l,

- secretory immunoglobulin A without urea (O2) = 49.7 mg / l,

- avidity index O1 / O2 = 0.21 (less than 0.27).

A favorable forecast was predicted. The child was observed during the year. During the year there were 3 acute respiratory infections. The forecast was confirmed.

Clinical example 3

Child, 6 years old, formalized card number 3.

The child from the third pregnancy, the first birth. Breastfeeding 2 weeks. I did not go to kindergarten. Sick ARI 3-4 times a year. Directed to an immunologist to resolve the issue of the opportunity to practice in the sports section (hockey). The analysis of saliva was carried out:

- secretory immunoglobulin A in the sample with urea (O1) = 2.82 mg / l,

- secretory immunoglobulin A without urea (O2) = 34.7 mg / l,

- avidity index O1 / O2 = 0.081 (less than 0.089).

Frequent incidence was predicted. The child was observed during the year. ARI 7 times. The forecast was confirmed.

Claims (1)

A method for predicting the risk of reducing the body's resistance to acute respiratory diseases in children aged 3-7 years by the avidity index of secretory immunoglobulin A, including enzyme-linked immunosorbent assay for the concentration of secretory immunoglobulin A in the saliva of a child 3-7 years old, characterized in that the concentration of secretory immunoglobulin A in saliva is determined in parallel in two samples, in one of which 0.3 mol / l urea is added, the avidity index is determined by dividing the concentration of the secretory immunog lobulin A in a sample with urea for the concentration of secretory immunoglobulin A in a sample without urea, and with an avidity index of less than 0.089 or more than 0.27, children are at risk of a decrease in the body's resistance to acute respiratory diseases.