RU2539190C2 - Method for detecting microcirculatory disorders following suffered infectious vasculitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and aims at detecting microcirculatory disorders following suffered infectious vasculitis. A laser Doppler flowmetry is used to measure erythrocyte flow factors by means of sensors attached to a patient's back of foot. If the average values M are more than 3-4 perf. units, and the root-mean-square deviation is more than 0.25-0.36 perf. units, a disturbed venous outflow is stated.

EFFECT: method provides more reliable diagnostic technique, reduces the length of examination and makes it applicable in paediatrics with no need for a thermal assay to be conducted.

2 tbl, 2 ex

Description

The invention relates to medicine and is intended for the determination of microcirculatory disorders after infectious vasculitis in both adult patients and children.

There is a method for predicting immunological disorders in chronic dermatitis in children, which consists in the fact that the contactless method of LDF determines the microcirculation index in the lesions and at the highest figures of the microcirculation index in the lesions from 12.00 to 30.00 prf.ed. predicting a violation of the processes of differentiation of T-lymphocytes, and at the lowest numbers, microcirculation indices in foci from 2.00 to 5.00 pr. predict dysfunction of T-suppressors [1].

The main significant disadvantage of this method is the relatively low reliability of forecasting and the duration of the forecast itself.

The closest analogue to the claimed method, selected as a prototype, is the clinical and functional diagnosis of vasculitis of infectious etiology, which consists in using the LDF apparatus to measure microcirculation at four points on the surface of the body: on the skin of the inner surface of the wrist, on the border of the upper and middle one third of the inner surface of the forearm, on the skin of the abdomen and on the front surface of the lower leg, and then the capillary reserve is determined at the same points by the obtained indices with a thermal test th flow, reflecting the presence of microvascular disorders of the skin [2].

The main significant disadvantage of the known prototype method is the duration of the study, the use of thermal tests in children's practice can cause difficulties in contact with the child.

The main objective of the proposed invention as a method is to obtain reliable results in a shorter period and its widespread use in pediatrics.

The problem is solved in the invention by measuring with the help of sensors installed on the back of the patient’s foot, indicators of the erythrocyte flow and subsequent construction of an LDF diagram on them and the average values of M and RMS measure the degree of violation of the venous outflow, while the measurement is carried out in two stages: at the first - at the time of the patient’s admission to the hospital, and at the second - on the last day of discharge from the hospital, and the indicators M and RMS are set after physiotherapy and injection nnyh procedures.

To characterize the mechanisms of active and passive modulation of tissue blood flow, we did not use the absolute values of the amplitudes of the rhythmic components of flaxmotions, but their normalized values, a number of indicators were determined mathematically. To characterize the active mechanism of tissue blood modulation in the microcirculation system, the indicators of myogenic and neurogenic activity of precapillary vasomotors (ALF / M) and microvascular tone (CKO / ALF) were calculated. To assess the passive regulation mechanism, the values of cardiac (ACF / CKO) and respiratory (AHF / CKO) fluctuation rhythms were determined. The ACF / M ratio determined the intravascular resistance. The phloxmotion index (IFM) was calculated, which characterizes the ratio of active and passive regulation mechanisms, or the efficiency of blood flow regulation in the microcirculation system (ALF / (AHF + ACF)).

There are still no generally accepted normative indicators of microcirculation. Most researchers use the data obtained in various control groups. In our studies of skin microcirculation in healthy individuals, the average PM was 3-4 pfed, standard deviation - 0.25-0.36 pfed, Kv - 4-9%.

In the process, at each studied point (skin locus), information on regional blood flow was displayed in the form of 9 absolute and 11 normalized values. Comparison of data in different areas was carried out according to the basic indicator of microcirculation (PM), which characterizes the overall perfusion of tissues in the probed area.

It was found that an increase in M is due to more intensive functioning of the mechanisms of active control of microcirculation. At the same time, the excessively high fluctuation of the erythrocyte flow indicates pathological processes in the microvasculature. In our studies, a high level of M indicates that the spasm of microvessels predominates in the group of patients, which leads to a violation of the venous outflow.

In the above essence of the proposed method, all of the essential features listed are new. Neither from the patent technical literature nor from experience in the field of dermatology are we aware of a method for determining microcirculatory disorders after infectious vasculitis with a similar set of significant differences, which confirms the compliance of the claimed solution with the novelty criterion for the invention. The set of essential features of the proposed solution - significant differences associated with a causal relationship with obtaining a technical effect in the implementation of the invention. In it, each sign is necessary, and taken together are sufficient to obtain a technical effect: the creation of a simple and informative way to identify the degree of violation of the venous outflow in patients with infectious vasculitis, including children.

In this case, the essential features are the reason for the consequence - to obtain a technical result in the implementation of the invention. Hence the conclusion that the proposed solution meets the criterion of "inventive step"

The claimed solution can be repeatedly used with the essential features inherent in the method without additional inventions, which indicates the compliance of the proposed method with the criterion of "industrial applicability".

The inventive method was tested on patients (adults and children) in the Ministry of Health of the Astrakhan Region State Healthcare Institution of the Regional Infectious Clinical Hospital named after A.M. Nothing.

The following are the results of this test:

Example 1: Patient M., 8 years old, and / b No. 7738, Dz: Astrakhan rickettsial fever. She was hospitalized in the 6th department of AOIKB on the 6th day of illness with complaints of severe headaches, common moderate arthromyalgia, fever, skin rash. She fell ill acutely, on the very first day she felt increasing heat, chills, headaches and joint pains, dizziness. On day 4, disseminated rashes appeared simultaneously, pains in the muscles of the lower extremities joined. A few days before the onset of a fever, she noticed a tick on her leg, which she brushed away. At the initial examination, a polymorphic rash was noted on the skin of the face, trunk, and extremities. A multiple medium-sized roseola of pale pink color was localized on the face, on the trunk (mainly on the hips, abdomen, chest and shoulders). In a moderate amount of rash, light purple type purpura was recorded on the legs. Single papules were noted on the skin of the shoulders. In the middle third of the left lower leg, primary affect 0.5 × 0.5 cm in size was localized. Dermographism is unstable red. The general condition was moderate. Consciousness is clear. Temperature - 38.6 ° C. The mucous membrane of the pharynx, palate and conjunctiva is bright red. Vesicular respiration, frequency 19 per minute, no rales. Heart sounds are rhythmic, frequent, clear. Pulse - 76 beats / min, satisfactory filling and voltage. Blood pressure - 90/70 mm Hg The abdomen is soft, painless. The liver and spleen are not palpable. On the 7th day of the disease, bleeding gums appeared. Received treatment: antibacterial drugs, desensitizing therapy. In OAK on day 7 of the disease: red blood cells - 3.4 × 10 ¹² / l; hemoglobin - 106 g / l; platelets - 254.2 × 10 ⁹ / l; white blood cells - 4.02 × 10 ⁹ / l; ESR - 11 mm / h. Coagulogram: GRP - 170 sec; TPG - 9 min; IPT - 98%. Weakness, arthromyalgia, and headache resolved by day 8 of illness. The temperature returned to normal on the 10th day of the illness. Resolution of roseol and papules began from 6 days, and hemorrhagic elements from 8 days of the disease with the formation of rapidly disappearing light brown pigmentation. In OAK on the 12th day of illness: red blood cells - 3.9 × 10 ¹² / l; hemoglobin - 116 g / l; platelets - 268.4 × 10 ⁹ / l; white blood cells - 4.6 × 10 ⁹ / l; ESR - 8 mm / h. Discharged on day 16 of the disease (bed-day 12).

LDF testing was carried out on the 1st and 12th day of hospital stay. The device "LAKK" was installed in the patient’s room. Sensors were located on the back of the feet. Within 10 minutes, testing was conducted and an LDF-gram was built on the computer. The obtained results were compared before treatment and at discharge, so, before the start of treatment, a high M was recorded - 5.28 prof.ed., and at discharge - 4.5 prof.ed. It was concluded that there are congestion in the microcirculatory link.

Table 1 The average value of tissue perfusion with blood in a patient with Astrakhan rickettsial fever Indicators Control group Indicators at the time of admission to the hospital Indicators at the time of discharge M, pr.ed. 3-4 5.18 4.20 SKO, pr.ed. 0.25-0.36 0.80 0.40

Thus, it was shown that after treatment, in spite of the positive dynamics of clinical symptoms, the patient retains quite pronounced changes in basal perfusion parameters of blood tissues (M and RMS). This indicates the existence of hidden disorders of the microvasculature as a whole in the patient upon discharge from the hospital, even with positive clinical symptoms during early convalescence, which require a certain amount of time to resolve.

Example 2: Patient E., 6 years old, and / b No. 7716, Dz: Enterovirus infection. She was hospitalized with complaints of fever, chills, weakness, dizziness, a rare dry cough, and a diminished skin rash. She fell ill acutely 3 days ago when weakness, fever and chills appeared. In the last days, these symptoms increased and arthromyalgia joined, a skin rash was detected on the day of admission to the hospital. Epidanamnesis - consumed unwashed fruits. On examination, the state of moderate severity. Temperature - 39.0 ° C. Consciousness is clear, but motor activity has been reduced. On the skin of the trunk and extremities, a multiple symmetrical roseolous rash of pale pink color was noted. Spotted exanthema on the mucous membranes of the mouth. Vesicular respiration, frequency 22 per min, no rales. Heart sounds are rhythmic, frequent, clear. Pulse - 88 beats / min, satisfactory filling and voltage. Blood pressure - 80/60 mm Hg The abdomen is soft, painless. The liver and spleen are not palpable. Received treatment: antiviral drugs, detoxification treatment and vitamin therapy. OAK on day 9 of the disease erythrocytes - 3.4 × 10 ¹² / l; hemoglobin - 105 g / l; platelets - 250 × 10 ⁹ / l; white blood cells - 12.04 × 10 ⁹ / l; ESR - 15 mm / h. Coagulogram: GRP - 120 sec; TPG - 12 min; PTI - 89. On day 8, the intensity of joint and muscle pain decreased, weakness decreased, fever and chills disappeared, body temperature returned to normal, rose-colored rash was completely resolved. OAK on day 14 of the disease erythrocytes - 3.28 × 10 ¹² / l; hemoglobin - 110 g / l; platelets - 258.1 × 10 ⁹ / l; white blood cells - 9.04 × 10 ⁹ / l; ESR - 10 mm / h. Discharged on day 19 of the disease (bed-day 16).

LDF testing was carried out on the 1st and 16th day of hospital stay. The device "LAKK" was installed in the patient’s room. Sensors were located on the back of the feet. Within 15 minutes, testing was conducted and an LDF-gram was built on the computer. The obtained results were compared before treatment and at discharge, so, before the start of treatment, a high M was recorded - 4.14 prof.ed., and at discharge - 3.12 prof.ed. The positive dynamics consisted in improving the clinical well-being, the objective state of the patient according to laboratory research methods.

table 2 The average value of the perfusion of tissue with blood in a patient with enterovirus infection Indicators Control group Indicators at the time of admission to the hospital Indicators at the time of discharge M, pr.ed. 3-4 4.14 3.12 SKO, pr.ed. 0.25-0.36 0.6 0.31

The results of dynamic LDF testing confirmed the results of traditional control methods and showed a significant improvement in the work of peripheral microcirculation, which was expressed in the predominance of active microcirculation mechanisms over passive ones after a course of treatment.

The advantages of the proposed method in comparison with analogues and prototype are:

- no special facilities, as well as pre-test preparation are required;

- the method is not invasive;

- the method is operational in time of the studies at the stages: 10-20 minutes;

- the method is convenient for use in pediatrics;

- the method is more reliable.

 Information sources

[1] Application of the Russian Federation for invention No. 2004121727/15 of 15.07.2004. Application publication date: 12/20/2005.

[2] Sadretdinov R.A. Clinical and functional diagnosis of vasculitis of infectious etiology. Abstract. for a job. part Ph.D. M., 2011

Claims (1)

A method for determining microcirculatory disorders after transferred infectious vasculitis based on the use of laser-Doppler flowmetry, characterized in that the red blood cell flow is measured using sensors installed on the back of the patient’s foot and with an average M of more than 3-4 prf.ed. and SKO more than 0.25-0.36 prf.ed. establish violation of venous outflow.