RU2546541C1 - Method for predicting rhinosinusitis polyposa in patients with bronchial asthma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention represents a method for predicting rhinosinusitis polyposa in the patients with bronchial asthma, which is implemented by analysing the patient's blood to measure endotoxemia parameters as follows: leukocytes, average weight molecules, creatinine, carbamide and erythrocyte sedimentation rate; the prediction is made by a discriminant equation: D=6.900×leukocytes(×10^9/l)+2.640×erythrocyte sedimentation rate (mm/h)+17.819×average weight molecules (absorbance units)+1.127×creatinine (mcmole/l)+24.801×carbamide(mcmole/l), wherein D is a discriminant function having a threshold value of -223.12; if D is equal or more than the limit, rhinosinusitis polyposa is predicted in the patients with bronchial asthma, and if D is less than the limit, the patients with bronchial asthma are predicted to develop rhinosinusitis polyposa.

EFFECT: provided high-accuracy prediction of rhinosinusitis polyposa in the patients with bronchial asthma.

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Description

The invention relates to medicine, namely to pulmonology. Bronchial asthma, combined with polypous rhinosinusitis, deserves special attention. Nasal polyps exacerbate asthma symptoms (8). The evidence of the role of polyposis rhinosinusitis as a trigger for bronchial asthma can be found in numerous data on the improvement of the course of the latter after treatment of polyposis rhinosinusitis (9).

Most authors consider polypous rhinosinusitis to be an infectious-allergic disease (3).

There is a suggestion of a possible etiological role of Chlamydia pneumoniae infection in the formation of nasal polyps (6). According to D.B. Conley et al. (2004) (7), in 50% of patients with chronic polypous sinusitis, specific IgE for staphillococcal exotoxin is detected. Upper respiratory tract infection is displayed in laboratory indicators of blood endotoxemia and includes biochemical (5) biophysical (4) and hematological (2) studies.

Endogenous intoxication syndrome, to a greater or lesser extent, is associated with any somatic, infectious, surgical and other diseases (2).

There is a method for predicting the development of polyposis of rhinosinusitis in patients with bronchial asthma, which consists in a biopsy of the nasal mucosa with subsequent cytological (morphological) examination (1).

This method is taken as a prototype.

The disadvantages of this method:

1. The inability to predict the development of polypous rhinosinusitis in patients with bronchial asthma.

2. A biopsy can provoke complications during bronchial asthma in the form of bronchospasm and bleeding.

3. When collecting a biopsy specimen, it is difficult to find and predict a site of a proliferatively altered mucosa.

Prediction of the development of polypous rhinosinusitis in patients with bronchial asthma allows you to choose the most optimal treatment method.

The aim of the proposed method is to predict the development of polyposis of rhinosinusitis in patients with bronchial asthma according to laboratory indicators of endotoxemia using discriminant analysis.

The goal is achieved in that the prediction of the development of polyposis of rhinosinusitis in patients with bronchial asthma, using a discriminant analysis, is carried out by determining the parameters of endotoxemia in the blood of patients - leukocytes, middle-weight molecules, creatinine, urea and erythrocyte sedimentation rate, followed by their introduction into the discriminant equation and his decision.

Studies were conducted in 42 patients of the 1st group, with bronchial asthma and polypous rhinosinusitis; in 68 patients of 2 groups, with bronchial asthma without polypous rhinosinusitis.

 The method contains the following techniques.

1. The method of counting white blood cells in the chamber.

The collection and dilution of blood produced by the test method. 0.4 ml of diluting liquid and 0.02 ml of capillary blood are added to a test tube (preferably Vidalevskaya). The resulting dilution is practically considered equal to 1:20. A 3-5% solution of acetic acid stained with methylene blue is usually used as a diluting liquid (acetic acid lyse red blood cells, methylene blue stains leukocyte nuclei). Before filling the chamber of Goryaev, the tube with diluted blood is thoroughly shaken. The chamber is filled in the same way as for red blood cell counting.

There are much fewer white blood cells than red blood cells (1-2 per large square), so for accuracy, the calculation is made in 100 large squares (undivided).

Calculation: in 100 large squares (1600 small) a leukocyte counted. Remembering that the volume of the small square is 1/4000 mm ³ and the blood is diluted 20 times, the number of leukocytes in 1 μl of blood is calculated: 4000 × 20 and divided by 1600 = a × 1/2. In practice, to obtain the actual content of leukocytes in 1 μl of blood, it is sufficient to divide the number obtained by counting in half and assign 2 zeros, (the norm is 4-9 × 10 ^ 9 / l).

2. Determination of medium weight molecules in the blood.

To determine the average molecular peptides by express method, 1.0 ml of blood is poured into a centrifuge tube, 0.5 ml of 10% trichloroacetic acid is added. This mixture is shaken and centrifuged for 30 minutes at 3000 rpm. The detection of the supernatant of the biological fluid freed from coarse proteins is carried out after preliminary dilution, in which 4.5 ml of distilled water is added to 0.5 ml of the supernatant of the biological fluid. Measurements are carried out on an SF-16 or HITACHI-557 spectrophotometer (Japan) at a wavelength of 280 nm (E280). The norm is 0.24-0.28 units of optical density (unit optical density).

3. An enzymatic method for the determination of urea in the blood.

Based on the use of the enzyme leucine dehydrogenase, which avoids interference in the reaction of endogenous ammonium. The method is based on the use of the leucine dehydrogenase enzyme that binds NH4 + ions in the reaction with the formation of L-isoleucine after urea hydrolysis with the participation of urease. The method is carried out in two stages.

The first step is the binding of endogenous NH4 +. NH4 + contained in the test sample (blood serum or urine) reacts with 2-ketoisocaproic acid in the presence of NAD (nicotinamide adenine dinucleotide) H ₂ and leucine dehydrogenase to form L-isoleucine.

Second phase. Determination of the concentration of NH4 + is carried out using the same reaction after adding the urease enzyme to the incubation medium (norm 2.5-6.4 mmol / L).

4. An enzymatic method for the determination of creatinine in the blood.

The principle of this method is that under the action of creatinine deaminase contained in the starting reagent, creatinine is converted into a stable derivative of 1-methylhydantoin with the release of an ammonia molecule. Then, under the action of glutamate dehydrogenase, NADP (nicotinamide adenine dinucleotide phosphate) N is oxidized, accompanied by a decrease in absorption at 340 nm and proportional to the concentration of ammonia in the mixture. All ammonia contained in the patient’s sample is preliminarily removed by glutamate dehydrogenase before adding a starting reagent containing creatinine deaminase.

Creatinine Deaminase

Creatinine + H ₂ O → 1-methylhydantoin + NH ₃

Glutamate dehydrogenase

NH ₃ + a-Okoglutarate + NADPH + H ⁺ → L-Glutamate + NADP ⁺ + H ₂ O

Norm: men - 53-97 mmol / l

Women - 62-115 mmol / L

The methodology for determining the sedimentation rate of Westergren erythrocytes includes the following steps:

1. venous blood is taken in vacuum tubes with K-EDTA (potassium ethylenediaminetetraacetate) (capillary blood is taken in tubes with K-EDTA);

2. mix a sample of venous (capillary) blood with 5% sodium citrate in a ratio of 4: 1;

3. to draw blood into the Westergren capillary;

4. after 1 h, measure the erythrocyte sedimentation rate by the height of the column of transparent plasma.

 Norms - men - 1-10 mm / h

Women - 2-15 mm / h

The discriminant analysis revealed the functional parameters by which the patients of the 2 groups differed from the patients of the 1 group, and to construct a prognostic discriminant equation:

D = 6,900 × leukocytes (× 10 ^ 9 / l) + 2,640 × erythrocyte sedimentation rate (mm / h) + 17,819 × medium-weight molecules (unit optical density) + 1,127 × creatinine (μm mol / l) +24,801 × urea (mmol / l)

The boundary value of the discriminant function is 223.12. When D is greater than or equal to the boundary value of the discriminant function, it is possible to predict the development of polypous rhinosinusitis in patients with bronchial asthma. When D is less than the boundary value of the discriminant function, the absence of polypous rhinosinusitis in patients with bronchial asthma is predicted.

This method examined 110 patients, including 42 patients with bronchial asthma and polyposis rhinosinusitis, 68 patients had bronchial asthma without polyposis rhinosinusitis.

The correct forecast was confirmed in 97.5% of cases.

Example 1

Patient A., 43 years old. Received complaints of asthma attacks. Clinical diagnosis: Bronchial asthma, mild persistent course. Blood counts: leukocytes - 5.2 × 10X 9 / l, erythrocyte sedimentation rate - 5 (mm / h), medium-sized molecules - 0.116 (unit optical density), creatinine - 64 (μm mol / l), urea - 2.8 (mmol / L).

The indicated parameters were introduced into the discriminant equation:

D = 6.900 × 5.2 × 10 ^ 9 / L + 2.640 × 5 (mm / h) + 17.819 × 0.116 (unit optical) + 1.127 × 64 (μm mol / L) + 24.801 × 2.8 (mmol / l)

The boundary value of the discriminant function is 192.3; D is less than the boundary value (223.12), therefore, the absence of polypous rhinosinusitis in a patient with bronchial asthma is predicted.

Example 2

Patient K., 51 years old. He entered the hospital with complaints of coughing, asthma attacks, nasal congestion. Clinical diagnosis: Bronchial asthma, mild persistent course. Blood counts: leukocytes-8.5 × 10X 9 / L (%), erythrocyte sedimentation rate - 10 (mm / h), medium-weight molecules - 0.132 (unit optical density), creatinine - 97 (μm mol / l ), urea - 7.2 (mmol / L).

The indicated parameters were introduced into the discriminant equation:

D = 6.900 × 8.5 × 10 ^ 9 / L (%) + 2.640 × 10 (mm / h) + 17.819 × 0.132 (unit optical) + 1.127 × 97 (μm mol / L) + 24.801 × 7.2 (mmol / l)

The result was greater than the boundary value of the discriminant function - 375.26, indicating the development of nasal polyps in a patient with asthma, which was confirmed by the morphological result of a biopsy study that revealed mucous-glandular polyps of the nose.

Information sources used

1. Agapov K.T. Polypous rhinosinusitis. [Text] / K.T. Agapov. - M.: MEDICINE, 1991 .-- 152 p.

2. Belyakov N.A., Miroshnichenko A.G., Malakhova M.Ya., Izotova O.G. Verification of edotoxicosis in patients with diffuse peritonitis // Efferent therapy. - 1995. - T.1, No. 2 - p. 14-19.

3. Muminov A.I., Pluzhnikov M.S., Ryazantsev S.V. Polypous rhinosinusitis. - Tashkent, 1990. - S. 67-69

4. Fedorovsky N.M., Kaperskaya K.S., Kurenkov D.V., Smolyar A.V. The binding capacity of albumin in the assessment of endotoxemia // West, intensive care. - 1998. - N4. - S. 21-23.

5. Kharkov A.L. Endogenous toxins in surgery: modern research in biology and medicine. Message II. Diagnostics // Wedge. surgery. - 1997. - N 11-12. - S. 90-93.

6. Apan T.Z. The possible association of Chlamydia pneumoniae infection with nasal polyps [Text] / T.Z. Apan, D. Alpay, Y. Alpay // Eur. Arch. Otorhinolaryngol. - 2007. - Vol. 264, No. 1. - P. 27-31.

7. Conley D.B. Chronic sinusitis with nasal polyps: staphylococcal exotoxin immunoglobulin E and cellular inflammation [Text] / D.B. Conley, A. Tripathi, A.M. Ditto, K. Reid, L.C. Grammer, R.C. Kern // Am.J. Rhinol. - 2004. - Vol. 18, No. 5. - P. 273-278.

8. Miller M.R. Standardization of spirometry [Text] / M.R. Miller, J. Hankinson, V. Brusasco [et al.] // Eur. Respir. J. - 2005. - Vol. 26. - P. 319-338.

9. Smart B.A. Is rhinosinusitis a cause of asthma? [Text] / B.A. Smart // Clin. Rev. Allergy Immunol. - 2006. - Vol. 30, No. 3. - P. 153-164.

Claims (1)

A method for predicting the development of polyposis of rhinosinusitis in patients with bronchial asthma is carried out by determining the parameters of endotoxemia in the blood of patients: leukocytes, middle-weight molecules, creatinine, urea and erythrocyte sedimentation rate; the forecast is carried out using the discriminant equation:
D = 6,900 × leukocytes (× 10 ^ 9 / l) + 2,640 × erythrocyte sedimentation rate (mm / h) + 17,819 × medium-weight molecules (unit optical density) + 1,127 × creatinine (μmol / l) + 24,801 × urea (mmol / l),
where D is the discriminant function with a boundary value equal to - 223.12; when D is equal to or greater than the boundary value, the development of polypous rhinosinusitis in patients with bronchial asthma is predicted, and when D is less than the boundary value, the absence of polypous rhinosinusitis in patients with bronchial asthma is predicted.