RU2461827C1 - Method for prediction of developing cholelithiasis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention aims at prediction of developing cholelithiasis. The patients are questioned for amnestic history taking. A body weight index and a body type are measured. Levels of bile acids and cholesterol in hepatic and cystic bile fractions; lipid metabolism; levels of cortisol, gastrin and insulin in blood serum; contractile gall bladder function; state and trait anxiety, and depression are evaluated. Each factor is accompanied with calculating a prognostic coefficient score, and total score is used to predict a risk level of developing cholelithiasis.

EFFECT: method enables predicting the presence of a risk of cholelithiasis for purposes of preclinical research.

1 tbl, 3 ex

Description

The invention relates to medicine, namely to gastroenterology, and can be used in predicting the development of gallstone disease.

A known method for predicting the development of gallstones in patients with chronic cholecystitis using a study of bile chemiluminescence (patent No. 2289812, RU, G01N 33/487), which consists in examining luminol-dependent iron-induced chemiluminescence of the model system on a citrate-phosphate buffer, determine the luminosum of the glow, then re-register the chemiluminescence of the model system with the addition of bile of the examined patient with chronic cholecystitis in remission, and then compare the luminosum a model system.

The disadvantage of this method is its low accuracy, due to the fact that there is no examination of the patient himself, they work only with bile and the low availability of the method, due to the need to use a chemiluminomer.

A known method for predicting the development of cholelithiasis (patent No. 2324944, RU, G01N 33/92), taken as a prototype, which consists in determining the level of total cholesterol and cholesterol of low density lipoproteins (cholesterol-LDL) in the blood serum, the level of conjugated bile acids in the cystic fractions of duodenal bile, body mass index and patient age.

However, the known method is not accurate due to the use of a limited amount of medical history data to identify predisposing stone formation factors in bile in patients, in addition, contractile function of the gallbladder, hormonal profile and psychological status of the patient are not taken into account.

The objective of the claimed invention is to improve the accuracy of predicting the development of gallstone disease.

The problem is solved in that according to a method for predicting the development of gallstone disease, including determining bile acids in the gallbladder fraction of bile, the level of total cholesterol and cholesterol of low density lipoproteins in the blood serum, body mass index and age, the levels of bile acids and cholesterol in the liver fraction are additionally determined bile, triglyceride levels, high density lipoprotein cholesterol and very low density lipoprotein cholesterol, cortisol, gastrin and insulin levels blood serum, contractile function of the gallbladder, levels of reactive, personal anxiety and depression, the presence of chronic diseases of the gastrointestinal tract, malnutrition, smoking, alcohol consumption, stress, hereditary predisposition to gallstone disease, physical inactivity, number of pregnancies (for women), type constitution, then for each factor calculate the prognostic coefficient (PC) in points, while in the presence of lithogenic bile, the PC is set equal to (-25), and in its absence equal to (+12), p and gallbladder normotonicity, set the PC to equal (-12), with hypertonicity - equal to (-9), with hypotension - equal to (+14), in the presence of chronic diseases of the gastrointestinal tract, set the PC to (+11), in their absence - equal to (-6), in case of malnutrition, the PK is set equal to (+10), in the absence of a history of malnutrition - equal to (-4), when the cortisol content in the blood serum is less than 480.0 nmol / l, the PC is set to (-10) , when the content is from 480.0 nmol / L to 660.0 nmol / L, the PC is set to (-4), when the content is from 660.1 nmol / L to 840.0 nmol / L set the PC to (+1), with a content of more than 840.0 nmol / L - equal to (+7), when the content of triglycerides in the blood serum is less than 0.3 g / l, set the PC to (-5), with a content of triglycerides from 0 , 3 g / l to 1.0 g / l set the PC to (-4), with a content of 1.1 g / l to 1.7 g / l set the PC to (+1), with a content of 1.8 g / l up to 2.4 g / l set the PC equal to (+4), with a content of more than 2.4 g / l set the PC equal to (+15), with an atherogenic coefficient of less than 1.0 units. set the PC to (-6), with a value of atherogenic coefficient of 1.0 units. up to 3.0 units set the PC to equal (-4), with a value of the atherogenic coefficient of 3.1 units. up to 5.0 units set the PC to (+1), with a value of atherogenic coefficient of 5.1 units. up to 7.0 units set the PC to equal (+4), with a value of the atherogenic coefficient of more than 7.0 units. set the PC to equal (+13), when smoking, the PC is set to (+8), and for non-smokers, the PC is set to (-2), in the presence of stress, the PC is set to (+8), and in the absence of history of stress, to equal (- 2), in the presence of heredity aggravated by gallstone disease, the PC is set equal to (+8), and in its absence - equal to (-2), with a sedentary lifestyle, the PC is set to (+8), in the absence of physical inactivity - equal to (-2) , with the level of reactive anxiety less than 40 units. set the PC to equal (-5), with a reactive anxiety level of 40 units. up to 60 units set the PC to (+1), with a reactive anxiety level of more than 60 units. set the PC to equal (+5), with a level of personal anxiety of less than 40 units. set the PC to equal (-4), with a level of personal anxiety of 40 units. up to 60 units set the PC to equal (+2), with a level of personal anxiety of more than 60 units. set the PC to equal (+5), for normostenics set the PC to (-3), for asthenics - equal to (-1), for hypersthenics - equal to (+3), when drinking alcohol, set the PC to (+7), for not consuming alcohol PC is set equal to (-1), when the insulin content in the blood serum is less than 11.0 mcd. / ml set the PC is equal to (-3), when the insulin content in the blood serum is from 11.0 mcd / ml to 18.0 mcd ./ml set the PC to equal (+2), when the insulin content in the blood serum is more than 18.0 mcd. / ml set the PC to (+4) if the body mass index is it is less than 25.0 kg / sq.m, set the PC to equal (-2), if the body mass index is from 25.0 kg / sq.m to 35.0 kg / sq.m, set the PC to (+2), if the body mass index is from 35.1 kg / sq.m to 45.0 kg / sq.m, the PC is set equal to (+4), if the body mass index exceeds 45.0 kg / sq.m, the PC is set to (+ 8), when the content of gastrin in the blood serum is less than 30.0 pg / ml, the PC is set to (+2), when the content of gastrin in the blood serum is more than 30.0 pg / ml, the PC is set to (-2) if the level of depression is less than 60 units, set the PC to (-2), if the level of depression exceeds 60 units, mustache set the PC to equal (+2), if the patient is less than 55 years old, set the PC to (-1) if the patient's age is from 55 years to 75 years old, set the PC to (+1), if the patient's age is more than 75 years old, set PC equal (+2) and with a value of the amount of PC (-13 or less) points, a low possibility of developing gallstone disease is predicted, with a value of the amount of PC (from -12 to +12), the average risk of developing gallstone disease is predicted, with a value of the amount of gallstone +13 or more) points predict a high risk of developing gallstone disease.

Using the claimed method will improve the accuracy of predicting the development of gallstone disease for all age groups. The method is available, taking into account not only the physical but also the mental state of the patient, as well as his hormonal profile. Using the proposed method, you can identify the risk of gallstone disease for the implementation of timely preventive measures to prevent the formation of calculi.

The method is as follows.

Questioning of patients is carried out according to the test questionnaire.

1. Age.

2. Weight

3. Growth

4. Do you smoke?

- Yes

- no

5. Do you drink alcohol?

- Yes

- no

6. Do you have relatives with gallstone disease?

- Yes

- no

7. Do you have stressful situations (at work, at home)?

- Yes

- no

8. Your lifestyle is predominantly

- movable

- sedentary

9. Your attitude to the diet:

- adhere to

- don't stick

10. Your attitude to fatty, fried, spicy foods, eggs:

- I use often

- try to limit

11. Do you suffer from any diseases of the gastrointestinal tract?

- Yes

- no

Then, in the cystic and hepatic fractions of bile obtained by duodenal sounding, the levels of cholesterol and bile acids are determined, thereby solving the question of the lithogenicity of bile. Dynamic cholecystography determines the contractile function of the gallbladder. Serum levels of triglycerides, total cholesterol, low and very low density lipoprotein cholesterol, high density lipoprotein cholesterol are determined and the atherogenic coefficient is calculated. In the blood serum, hormonal indicators are also determined: cortisol, insulin, gastrin. Using psychological tests, the levels of reactive and personal anxiety, the level of depression are determined. Using data on the weight and height of patients, we calculate the body mass index; with an objective study of patients, we determine the type of constitution.

Next, for each factor, the prognostic coefficient in points is calculated in accordance with the table below.

categories the presence or level of the trait being studied points one lithogenic bile no -25 there is 12 2 contractile function of the gallbladder normotonus -12 hypertonicity -9 hypotonus fourteen 3 chronic diseases of the gastrointestinal tract no -6 there is eleven four malnutrition no -four there is 10 5 cortisol (nmol / l) <480.0 -10 480.0-660.0 -four 660.1-840.0 one > 840.0 7 6 triglycerides (g / l) <0.3 -5 0.3-1.0 -four 1.1-1.7 one 1.8-2.4 four > 2.4 fifteen 7 atherogenic coefficient (units) <1.0 -6 1.0-3.0 -four 3.1-5.0 one 5.1-7.0 four > 7 13 8 smoking no -2 Yes 8

9 stress no -2 Yes 8 10 hereditary burden of gallstone disease no -2 there is 8 eleven physical inactivity no -2 Yes 8 12 reactive anxiety (unit) <40 -5 40-60 one > 60 5 13 personal anxiety (unit) <40 -four 40-60 2 > 60 5 fourteen constitution normostenik -3 asthenic -one hypersthenic 3 fifteen alcohol abuse no -one Yes 7 16 insulin (mced / ml) <11.0 -3 11.0-18.0 2 > 18.0 four 17 body mass index (kg / sq.m) <25.0 -2 25.0-35.0 2 35.1-45.0 four > 45.0 8 eighteen gastrin (pg / ml) <30.0 2 > 30.0 -2 19 depression level (units) <60 -2

> 60 2 21 Age (years) <55 -one 55-75 one > 75 2

The total score is determined, with a score of -13 or less, a low possibility of developing gallstone disease is judged, a total score of between -13 and 13 indicates an average risk of developing gallstone disease, a total score of 13 or more indicates a high risk of developing gallstone disease .

The method is confirmed by the following examples.

Example 1

Patient Peninsula, 49 years old. Received complaints of discomfort in the right hypochondrium, bitterness in the mouth. On examination of increased nutrition, normostenik. The patient was questioned according to the test questionnaire, a number of necessary laboratory and instrumental studies. The obtained factors are listed in the forecast table. The calculated total score (+11) indicates that the patient is at risk for the development of cholelithiasis. The patient was given recommendations on diet, lifestyle, medication prescribed. The course of treatment prevented the development of gallstone disease.

Example 2

Patient St., 35 years old. Received with complaints of nausea, flatulence, loose stools. When examining a normal diet, asthenic constitution. The patient was questioned on the test questionnaire, a number of necessary laboratory and instrumental studies. The obtained factors are listed in the forecast table. The calculated score (-18) indicates that the possibility of developing cholelithiasis is extremely low. Upon further examination, the patient was diagnosed with ulcerative colitis, which is associated with the presence of the above complaints. The patient is prescribed appropriate therapy. Subsequent follow-up after 2 years also did not reveal the presence of stones in the gallbladder.

Example 3

L-patient, 56 years old. Received complaints of pain in the right hypochondrium of a pressing character, nausea, loose stools. On examination of increased nutrition, hypersthenic constitution. The patient was questioned on the test questionnaire, a number of necessary laboratory and instrumental studies. The obtained factors are listed in the forecast table. The calculated total score (+26) allowed us to diagnose cholelithiasis. The diagnosis was confirmed by further examination, the patient underwent cholecystectomy.

Claims (1)

A method for predicting the development of gallstone disease, including the determination of bile acids in the gallbladder fraction of bile, the level of total cholesterol and cholesterol of low density lipoproteins in the blood serum, body mass index and age, characterized in that it further determines the levels of bile acids and cholesterol in the hepatic fraction of bile triglycerides, high density lipoprotein cholesterol and very low density lipoprotein cholesterol, serum cortisol, gastrin and insulin levels, reduce gallbladder function, levels of reactive, personal anxiety and depression, the presence of chronic diseases of the gastrointestinal tract, malnutrition, smoking, alcohol consumption, stress, hereditary predisposition to gallstone disease, physical inactivity, type of constitution, then a prognostic coefficient is calculated for each factor ( PC) in points, while in the presence of lithogenic bile, PC is set equal to (-25), and in its absence equal to (+12), with normotonicity of the gallbladder, PC is set to (-12), with hyp atertone - equal to (-9), with hypotension - equal to (+14), in the presence of chronic diseases of the gastrointestinal tract, establish a PC equal to (+11), in their absence - equal to (-6), in case of malnutrition, the PC is set to ( +10), in the absence of a history of malnutrition - equal to (-4), when the cortisol content in the blood serum is less than 480.0 nmol / L, the PC is set to (-10), when the content is from 480.0 nmol / L to 660, 0 nmol / L set the PC to (-4), with a content of 660.1 nmol / L to 840.0 nmol / l set the PC to (+1), with a content of more than 840.0 nmol / L - equal m (+7), when the content of triglycerides in the blood serum is less than 0.3 g / l, the PC is set to (-5), when the content of triglycerides from 0.3 g / l to 1.0 g / l, the PC is set to (-4 ), when the content is from 1.1 g / l to 1.7 g / l, the PC is set to (+1), when the content is from 1.8 g / l to 2.4 g / l, the PC is set to (+4), when the content is more than 2.4 g / l, the PC is set to (+15), when the atherogenic coefficient is less than 1.0 units, the PC is set to (-6), when the value of the atherogenic coefficient is from 1.0 units to 3.0 units, the PC is set equal to (-4), with the value of the atherogenicity coefficient and from 3.1 units to 5.0 units set the PC to (+1), with an atherogenic coefficient of 5.1 units to 7.0 units set the PC to (+4), when the atherogenic coefficient is more than 7.0 set the PC to equal (+13), when smoking, the PC is set to (+8), and for non-smokers, the PC is set to (-2), in the presence of stress, the PC is set to (+8), and in the absence of history of stress, to equal (- 2), in the presence of heredity aggravated by gallstone disease, establish a PC equal to (+8), and in its absence - equal to (-2), with a sedentary no PCs are set equal to (+8), in the absence of physical inactivity - equal to (-2), with a reactive anxiety level of less than 40 units, a PC is set to (-5), with a reactive anxiety level of 40 units to 60 units, a PC is set to (+1 ), at a level of reactive anxiety of more than 60 units, set the PC to equal (+5), at a level of personal anxiety of less than 40 units, set the PC to (-4), at a level of personal anxiety from 40 units to 60 units, set the PC to (+2), with a level of personal anxiety of more than 60 units, set the PC to equal (+5), for normostenics set they set the SC equal to (-3), for asthenics - equal to (-1), for hypersthenics - equal to (+3), when drinking alcohol, set the SC to equal (+7), for non-alcohol users, set the SC to equal (-1), when keeping serum insulin levels of less than 11.0 mcd / ml set the PC to equal (-3), when the insulin content in the blood serum is from 11.0 mcd / ml to 18.0 mcd / ml, the PC is set to (+2), when the insulin content serum over 18.0 mU / ml PC is set equal to (four) when BMI is less than 25.0 kg / m ² PC set to be (-2) when the index m ssy body from 25.0 kg / m ² to 35.0 kg / m ² is set equal to the PC (2) if a BMI of 35.1 kg / m ² to 45.0 kg / m ² is set equal to a PC ( +4), if the body mass index exceeds 45.0 kg / m ² set the PC to equal (+8), when the gastrin content in the blood serum is less than 30.0 pg / ml, set the PC to equal (+2), when the gastrin content in the serum blood counts greater than 30.0 pg / ml set the PC to equal (-2), if the level of depression is less than 60 units, set the PC to (-2), if the level of depression exceeds 60 units set the PC to (+2), with the patient's age less than 55 establish PC equal to (-1), if the patient's age is from 55 years to 75 years, set the PC to equal (+1), if the patient's age more than 75 years, set the PC to equal (+2) and when the value of the sum of the PC (-13 or less) points predict a low possibility of developing gallstone disease, with a value of PC (from -12 to + 12) predict the average risk of developing gallstone disease, with a value of the amount of PC (from +13 or more) points predict a high risk of gallstone disease.