RU2526154C2 - Method for evaluating intensity of body reactivity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to therapy, and can be used for evaluation of a body reactivity. That is ensured by blood sampling from IVth left and right fingers and determining a leukocyte count and an erythrocyte sedimentation rate (ESR). In average, the 1^st degree of intensity of the body reactivity corresponds to the leukocyte count within the range from 7.0×10⁹ to no more than 9.0×10⁹, and the ESR of 10-14 mm/h in males and 15-19 mm/h in females. The 2^nd degree of intensity is characterised by the leukocyte count of 9.0×10⁹, no more than 10.0×10⁹, the ESR of 15-19 mm/h in males and 20-24 mm/h in females. The 3^rd degree of intensity is characterised by the leukocyte count of more than 10.0×10⁹, no more than 14.9×10⁹, the ESR of 20-30 mm/h in males and 25-30 mm/h in females. The 4^th degree of intensity is shown by the leukocyte count of 15.0×10⁹ and more, and the ESR of more than 30 mm/h.

EFFECT: using the given method enables evaluating a stage of involvement of the immune system into a pathological process, as well as an intensity of the tissue injury accompanying arterial hypertension and comorbid cardiovascular diseases.

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Description

The invention relates to medicine, namely to therapy, cardiology, neurology and laboratory diagnostics, and can be used to assess the body's reactive response by an extensive blood test in patients with arterial hypertension and concomitant cardiovascular pathology.

In medicine, the standard of clinical and laboratory diagnostics is a detailed blood test, including a leukogram, an erythrogram, platelet count, ESR [Belenkov Yu.N. Guidelines for outpatient cardiology. M., 2007].

The body’s reactive response is the response of the immune and circulatory system to any pathological process, is an important indicator of the course of the disease and the effectiveness of the therapy, since the immune and circulatory systems are highly sensitive to the effects of damaging, antigenic, foreign factors.

A method for predicting postoperative thromboembolic complications of endoprosthetics in patients older than 45 years with degenerative-dystrophic lesions of the hip joint (RF Patent No. 2394245, G01N 33/98, 07/10/2010) is based on the determination of ESR and hematocrit by an extensive blood test, followed by calculation by the canonical formula coefficient and conclusion about the risk of thrombotic complications. The disadvantage of this method is a one-sided approach exclusively to determining the risk of thrombotic complications without taking into account the reactive state of the body, that is, involvement in the immune system and circulatory process, as well as the lack of evidence for the use of the method in patients with arterial hypertension.

Another method, which consists in predicting inflammation of postoperative purulent-septic complications (RF Patent No. 2320274, АВВ 10/00, 10.06.2006), including clinical, amnestic and laboratory data, including ESR, allows to determine the risk of complications after cesarean section. The disadvantage of this method is the complexity and adaptability exclusively to operations for caesarean section.

There is a method for predicting the life expectancy of cancer patients after radical operations (RF Patent No. 2101704, G01N 33/49, 01/10/1998), which consists in determining indicators of a biochemical detailed blood test, in particular leukocytes, lymphocytes, ESR, using polynomial mathematical formulas. The disadvantage of this method is the complexity, time and adaptation to cancer patients.

The known method "System and method for the management and control of cardiovascular diseases such as hypertension" ("System and Method for the Management or Control of Cardiovascular Related Diseases, Such as Hypertension", US 2008294021 A1, 11/27/2008), including monitoring leukocyte formulas, determining the involvement of the parasympathetic nervous system in the pathological process and making a prognosis of the development of damage to target organs. The disadvantage of this method: its complexity and the need to use the calculation formula, as well as the need to analyze the expanded leukogram.

Closest to the claimed: "A method for preclinical diagnosis of reducing the reactive-protective potential of the body of adolescent children" (RF Patent No. 2234699, G01N 33/48, 08/20/2004), which consists in quantifying leukocytes, lymphocytes, monocytes, neutrophils in peripheral blood with subsequent calculation of the coefficient of cell-phagocytic protection and specific immune lymphocytic-monocytic index. In this case, the obtained values of all indicators are compared with their critical values depending on age and gender. If the values are below critical, a decrease in the reactive-protective potential of the body is diagnosed. The disadvantage of this method is the lack of ESR, as an important indicator of the state of the body and the development of pathological processes, as well as the adaptability of the method only for adolescent children, the use of formulas is time-consuming and time-consuming.

The objective of the proposed method is the rapid assessment of the reactive response of the body to damaging factors in patients with arterial hypertension and concomitant cardiovascular pathology.

The task is carried out due to the fact that blood sampling is carried out simultaneously from the fourth finger of the left and right hands and the number of leukocytes and the erythrocyte sedimentation rate (ESR) are determined to determine the degree of the body’s reactive response: a statistically average 1st degree of the body’s reactive response corresponds to the leukocyte count from 7.0 × 10, but not more than 9.0 × 10, and ESR 10-14 mm / h in men and 15-19 mm / h in women; 2nd degree - white blood cells over 9.0 × 10 ⁹ , but not more than 10.0 × 10 ⁹ , ESR 15-19 mm / h in men and 20-24 mm / h in women; 3rd degree - white blood cells over 10.0 × 10 ⁹ , but not more than 14.9 × 10 ⁹ , ESR 20-30 mm / h in men and 25-30 mm / h in women; 4th degree - white blood cells from 15.0 × 10 ⁹ or more, ESR more than 30 mm / h; the higher the degree of reactive response, the more pronounced the pathological process in the tissues and the higher the activation of the immune system.

Blood sampling is carried out simultaneously from the fourth finger of the left and right hands of a patient with a cardiovascular disease after 30 minutes of rest in a warm room (+ 20 ° C - + 22 ° C) and the absence of medication in the next 6 hours by puncture with a scarifier needle ( type “Lancet Acti-Lance 1.5 mm for capillary blood sampling” to reduce tissue injury and error results) after processing the finger with a disinfectant medical tool. The first drop of blood is removed with a dry cotton swab. First, blood is drawn into a sterile Pasteur pipette to determine ESR, then to another sterile Pasteur pipette to determine the number of white blood cells. To calculate ESR and the number of leukocytes, a clinical laboratory hematological analyzer is used, which determines the content of leukocytes in terms of 1 liter of blood and the erythrocyte sedimentation rate in mm / h. The final result of ESR and the number of leukocytes is the sum of the average blood count from the fourth finger of the patient’s left and right hands. Blood sampling from a finger is carried out in the morning on an empty stomach (if necessary, blood sampling can be performed at any time of the day, since the error will not be high and statistically significant), then the content of leukocytes in terms of 1 liter of blood and the erythrocyte sedimentation rate in mm / h are determined on a hemoanalyzer .

Using the data of an extensive blood test, the degree of the body's reactive response is determined: the statistically average 1st degree of the body's reactive response corresponds to a white blood cell content of 7.0 × 10 ⁹ , but not more than 9.0 × 10 ⁹ , and an ESR of 10-14 mm / h in men and 15-19 mm / h in women; 2nd degree - white blood cells over 9.0 × 10 ⁹ , but not more than 10.0 × 10 ⁹ , ESR 15-19 mm / h in men and 20-24 mm / h in women; 3rd degree - white blood cells over 10.0 × 10 ⁹ , but not more than 14.9 × 10 ⁹ , ESR 20-30 mm / h in men and 25-30 mm / h in women; 4th degree - white blood cells from 15.0 × 10 ⁹ or more, ESR more than 30 mm / h; the higher the degree of reactive response, the more pronounced the pathological process in the tissues and the higher the activation of the immune system.

According to the results of the degree of reactivity of the organism, the data in table 1 judge the severity of the pathological process and activation of the immune system: the higher the degree of reactive response, the more pronounced the pathological process in tissues and the higher the activation of the immune system. The degree of reactive response with a difference in leukocyte and ESR is determined by the highest value.

Table 1 The severity of a reactive response according to the results of a detailed blood test The severity of the reactive response ESR level White blood cell count men women Norm 1-10 mm / h 1-15 mm / h 4.0 × 10 ⁹ to 7.0 × 10 ⁹ Degree 1 10-14 mm / h 15-19 mm / h from 7.0 × 10 ⁹ , but not more than 9.0 × 10 ⁹ Grade 2 15-19 mm / h 20-24 mm / h over 9.0 × 10 ⁹ , but not more than 10.0 × 10 ⁹ Grade 3 20-30 mm / h 25-30 mm / h over 10.0 × 10 ⁹ , but not more than 14.9 × 10 ⁹ Grade 4 more than 30 mm / h more than 30 mm / h from 15.0 × 10 ⁹ and more

We examined patients of both sexes aged 30-65 years, who are hospitalized in the neurological department for acute ischemic cerebrovascular accident on the background of hypertension (110 people), as well as patients of the corresponding age-gender composition, observed in the clinic with diagnosed with hypertension (50 people). All patients with acute cerebrovascular accident had blood taken from the fourth finger of the left and right hands to conduct a detailed blood test at admission and before discharge from the hospital (20th day of hospitalization), and for patients with hypertension, a blood test was performed once during the examination. The degree of reactive response was higher on the day of hospitalization compared with the day of discharge from the hospital. In the group of patients with hypertension, primarily 1 degree of a reactive response was recorded. The control group consisted of healthy volunteers of the appropriate age and gender composition (30 people). Table 2 presents the average data on the occurrence and severity of the reactive response in patients with acute cerebrovascular accident (stroke), hypertensive disease and in the control group.

table 2 The distribution of patients in the main and control groups according to the severity of the reactive response according to the results of a detailed blood test ONMK in 1 day (%, n = 110) ONMK on day 20 (%, n = 110) Hypertension (%, n = 50) Control group (%, n = 30) Norm 0 0 38.2 ± 0.03 *** 92.0 ± 1.3 Degree 1 31.03 ± 6.13 *** 67.31 ± 6.57 *** 37.8 ± 0.1 *** 8.0 ± 3.2 Grade 2 25.86 ± 5.79 ** 23.08 ± 5.89 *** 24.0 ± 0.06 *** 0 ± 6.5 Grade 3 15.52 ± 4.79 *** 3.85 ± 2.69 ** 0 ± 7.4 0 ± 6.5 Grade 4 27.59 ± 5.92 *** 5.77 ± 3.27 * 0 ± 7.4 0 ± 6.5 Average degree 2.39 ± 0.16 *** 1.48 ± 0.12 ** 1.02 ± 0.06 * 0.2 ± 0.2 The table presents data in the percentage of patients in relation to the total number of examined patients in the corresponding group, reliably in relation to the control group: * - p <0.05, * - p <0.01; ** - p <0.001.

The statistics we obtained indicate the uniqueness of the same pathological process in different people, which is expressed in varying degrees of involvement of the immune system and tissue damage, which means that the degree of reactive response in each individual patient is highly significant, which makes it possible to develop and evaluate further the effectiveness of drug approaches, as well as to predict the course of the disease.

Example 1

A 60-year-old patient was admitted to the neurological department with a diagnosis of stroke-related ischemic type in the pool of the left midbrain artery with right-sided hemiparesis. Background: Hypertension III, risk 4.

On admission: serious condition, blood pressure 220/140 mm RT. Art., sinus rhythm with a heart rate of 80 per min. According to computed tomography of the brain (CT), the focus of ischemic stroke is determined near the left lateral ventricle with a size of 42 × 30 mm.

Biochemical analysis of blood: dyslipidemia due to an increase in the content of low density lipoproteins, hypercoagulation.

According to a detailed blood test (sampling was carried out from the fourth finger of the left and right hands, the values were calculated statistically average): leukocytes 13 × 10 ⁹ , ESR 20 mm / h, which corresponds to the 3rd degree of the body's reactive response.

Conducted standard neurotropic therapy. Antihypertensive therapy included perindopril 4 mg, 1 tab. × 2 times a day, hypothiazide 12.5 mg in the morning.

After 20 days: satisfactory condition, blood pressure 130/80 mm RT. Art., heart rate 68 per minute, nerve function restored.

According to a detailed blood test: leukocytes 6.5 × 10 ⁹ , ESR 10 mm / h, which corresponds to the 1st degree of a reactive response: the higher the degree of reactive response, the more pronounced the pathological process in the tissues and the higher the activation of the immune system. The degree of reactive response with a difference in leukocyte and ESR is determined by the highest value.

Based on the data obtained, we conclude that the activation of the immune system in response to the occurrence of ischemic stroke was expressed on the first day of hospitalization, while the destruction of the tissues of the affected focus was quite pronounced, however, against the background of the prescribed therapy, the body’s reactive response returned to normal (1 degree) which indicates the right treatment and a favorable prognosis for the patient.

Example 2

Patient I., 53 years old, was admitted with a diagnosis of stroke of ischemic type in the pool of the right midbrain artery with gross left-side hemiparesis. Background: hypertension III, risk 4.

On admission: serious condition, blood pressure 160/100 mm RT. Art., sinus rhythm with a heart rate of 70 per minute; dysarthria, gaze to the right, deviation of the tongue to the left, paresis of the face to the left, gross left-side hemiparesis.

Due to the severity of the state of the CT scan of the brain was not performed.

Biochemical analysis of blood: hypercholesterolemia (9.2 mmol / L), dyslipidemia, hyperfibrinogenemia (7.4 mg / liter), hypertrombinemia, inhibition of fibrinolysis.

An extensive blood test: white blood cells 16 × 10 ⁹ , ESR 35 mm / h, which corresponds to the 4th degree of the body's reactive response.

Intensive neurotropic therapy was prescribed, through a gastric tube - enalapril 10 mg, 1 tab. × 2 times a day, hypothiazide 12.5 mg in the morning.

After 7 days: the condition is extremely serious, neurological status - stunning III degree, blood pressure 150/90 mm RT. Art., heart rate 95 per minute.

An extensive blood test on day 7 showed: white blood cells 14.5 × 10 ⁹ , ESR 35 mm / h, which corresponds to the 4th degree of a reactive response, since ESR is more than 30 mm / h.

The patient died on the 13th day of hospitalization. Pathological and anatomical diagnosis: cerebral infarction in the right hemisphere, edema and dislocation of the brain stem. Generalized atherosclerosis of the arteries.

The data obtained indicate an extreme degree of tissue destruction and significant activation of the immune system, which, against the background of inadequate pathogenetic therapy, has led to a progressive deterioration of clinical and laboratory parameters and the development of complications in the form of edema and dislocation of the brain. A decrease on the 7th day of leukocytes with a simultaneous increase in the erythrocyte sedimentation rate is explained by the symptom of “scissors or crosshairs,” its development is based on a decrease in leukocytes in the blood due to their migration to the focus of inflammation, while ESR remains high due to the high content of acute proteins phase. The symptom of “scissors” indicates the progression of the disease.

Example 3

Patient U., 51 years old, is on an outpatient treatment with a diagnosis of Hypertension II, risk 3.

Constantly receives Noliprel 8 mg in the morning, Egilog 50 mg 1 tab. × 2 p / d.

Biochemical blood test and electrocardiogram - without abnormalities.

Echocardiography - hypertrophy of the interventricular septum, aortic calcification.

Bicycle ergometry is a hypertonic type of reaction, ischemia is not detected.

According to a detailed blood test: leukocytes (4.5 × 10 ⁹ ) and ESR (5 mm / h) are within normal limits, which indicates the 1st degree of the body's reactive response, the immune system adapts to the pathological process and a favorable prognosis of the course with no development cardiovascular catastrophes in the near future.

Using the proposed method allows to evaluate the degree of involvement of the immune system in the pathological process and the severity of tissue damage in arterial hypertension and concomitant cardiovascular diseases on the basis of determining the severity of the reactive response from a detailed blood test, which is important in the choice of drug approaches and evaluating their effectiveness, and also allows you to predict the development of complications.

Claims (1)

A method for assessing the severity of a reactive response of an organism, including a detailed blood test, characterized in that blood sampling is carried out simultaneously from the fourth finger of the left and right hands and the number of leukocytes and erythrocyte sedimentation rate (ESR) are determined to determine the degree of an organism's reactive response: statistically average 1- the degree of a reactive response of the body corresponds to a white blood cell count of 7.0 × 10 ⁹ , but not more than 9.0 × 10 ⁹ , and an ESR of 10-14 mm / h in men and 15-19 mm / h in women; 2nd degree - white blood cells over 9.0 × 10 ⁹ , but not more than 10.0 × 10 ⁹ , ESR 15-19 mm / h in men and 20-24 mm / h in women; 3rd degree - white blood cells over 10.0 × 10 ⁹ , but not more than 14.9 × 10 ⁹ , ESR 20-30 mm / h in men and 25-30 mm / h in women; 4th degree - white blood cells from 15.0 × 10 ⁹ or more, ESR more than 30 mm / h; the higher the degree of reactive response, the more pronounced the pathological process in the tissues and the higher the activation of the immune system.