RU2553359C2 - Method for detecting endogenous intoxication symptoms and associated respiratory disorders - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to oncology, and can be used for detecting endogenous intoxication (EI) symptoms in the patients suffering colorectal cancer. That is ensured by studying the complete blood count and deriving an integral intoxication index (III) by formula: $$EI=\frac{\left(\mathrm{Im}+St+Seg+Myel+Plas\right)*10}{\left(Bas+Eos+Lym+Mon\right)*Er*CC},$$

wherein III is the integral intoxication index; Im is immature leukocytes, %; St is stab neutrophils, %; Seg is segmented neutrophils, %, Myel is myelocytes, %; Plas is plasma cells, %; Bas is basophiles, %; Eos is eosinophils, %; Lym is lymphocytes, %; Mon is monocytes, %; Er is absolute erythrocytes to the power of 10¹²; CC is an absolute colour characteristics.

EFFECT: invention provides diagnosing the absence (III=4,6) or presence (III=10,4) of the EI symptoms and associated respiratory disorders and enables assessing the therapy efficacy.

Description

The invention relates to medicine, in particular to surgery, and can be used to detect endogenous intoxication and associated respiratory disorders in patients suffering from colorectal cancer.

Endogenous intoxication syndrome (SEI) is a typical systemically dynamically developing pathological process, prone to progression. SEI can occur due to a combination of several factors: increased formation of tissue decomposition products with their subsequent resorption, as a result of a shift in the metabolic balance towards catabolism and the accumulation of a large number of secondary metabolites in the body; while suppressing the functional activity of natural detoxification systems; due to the difficulty in eliminating and delaying tissue excreta, disruption of the elimination of the final metabolic products from the body; as a result, the accumulation of toxins and waste products of infectious agents [4,5]. It has been reliably established that the development of SEI in patients leads to the development of disorders of the hemostatic system, hemodynamic disorders, accompanied by a decrease in the level of oxygen delivery to tissues, the development of disturbances in energy metabolism in the cell and, as a result, the development of tissue hypoxia, metabolic acidosis, which cannot but affect the prognosis of treatment of this category of patients [1, 2, 7].

Therefore, it is important to identify SEI and respiratory disorders in the patient, assess their severity and timely adequate therapy. Currently, integral indices are used for this, based on hematological indices [8].

So, the leukocyte intoxication index (LII) is widely used, which is determined by the formula Y. Ya. Kalf-Kalifa [3.8]. This index shows a quantitative expression of the shift of the leukocyte formula towards neutrophils, while in practice this shift is estimated by doctors approximately and only ascertained as such, often without a quantitative characteristic. Such an assessment of the neutrophilic shift is very subjective, which reduces the value of this method [6]. In addition, LII does not take into account the total number of leukocytes, depersonalizes the hemoglobin level and the number of red blood cells, which characterize the body's reaction to the presence of toxins in the blood, which indicates the severity of EI. At the same time, an increase in the number of leukocytes and ESR does not always coincide with an increase in LII [8].

In this regard, the modified leukocyte intoxication index (LIIm) is currently gaining more importance [6]. This index is more acceptable and reliable, since it uses the ratio of the level of all blood cells that rises and falls in inflammatory diseases without any additional factors, which objectively reflects the essence of the processes [8]. This method was used by us as a prototype.

However, this method of assessing SEI does not take into account the parameters of oxygen transport and utilization, which depend on the oxygen capacity of the blood, changes in which are, in turn, observed in the presence of symptoms of EI, as well as their negative relationship with oxygen homeostasis.

The objective of the invention is to develop a method that provides high-precision, sensitive detection of EI taking into account hematological parameters, including blood oxygen capacity, which allows to assess the development, severity, course of inflammation, endogenous intoxication and respiratory disorders developing against this background, to evaluate the effectiveness of the therapy and determine a strategy for further treatment correction to achieve a therapeutic effect.

The task is achieved by calculating the integrated intoxication index (IPI), which includes, along with the data necessary for calculating the modified leukocyte intoxication index, the number of red blood cells and color index. Due to the fact that the results obtained most often have values less than unity, a correction factor of 10 was introduced to facilitate the interpretation of this indicator. Moreover, with an IPI of 4.6 there are no symptoms of endogenous intoxication, and with an IPI of 10.4 there are symptoms of endogenous intoxication

IPI is determined by the developed formula:

where Yun - young white blood cells (%),

Pal - stab neutrophils (%),

Seg - segmented neutrophils (%),

Myel - myelocytes (%),

Plasma - plasma cells (%),

Baz - basophils (%),

Eos - eosinophils (%),

Lim - lymphocytes (%),

Mon - monocytes (%),

Er - red blood cells (at 10 ¹² ),

CPU - color indicator.

Performed clinical testing of the proposed method.

The study was conducted in 73 patients operated on in the Amur Regional Center for Coloproctology GBUZ JSC AOKB in 2010 - 2013. about colorectal cancer, mainly distal localization (T3-T4 stage). The study of a clinical blood test was performed on a Drew D3 apparatus (UK) with the calculation of the cell formula by light microscopy. The calculation of the modified leukocyte intoxication index (LIIm) was carried out using the developed program based on the MS Office Excel 2007 software package. For all patients upon admission to the hospital, the gas composition of arterial and venous blood was evaluated. Arterial blood was taken from the femoral artery, mixed venous from the subclavian vein after its catheterization. Analysis of the gas composition of the blood was carried out on a gas analyzer AVL - 995 HB (Austria). The following parameters were determined: partial pressure of oxygen in arterial and venous blood (paO2, pvO2), partial pressure of carbon dioxide in arterial and venous blood (paCO2, pvCO2), saturation of hemoglobin with oxygen (SaO2, SvO2), alveoloarterial oxygen gradient (DA-aO2 ) The calculation of the oxygen status parameters was carried out according to the formulas using the application we created (MS Excel 2007): to evaluate the parameters of the function of external respiration and gas diffusion through the alveolocapillary membrane, the oxygenation index (IO), ventilation-perfusion ratio (V / Q), and the level of arteriovenous shunt were calculated (QsQt), oxygen content in arterial and venous blood (CaO2, CvO2). At the stage of delivery (DO2) and oxygen consumption (VO2), the arteriovenous oxygen difference (ABP) and the oxygen utilization coefficient (KOO2) were calculated. The cardiac output index (SV) was calculated according to the Starr formula (1954) in the modification of Zabolotskikh IB, Stanchenko IA, Skopets AA (2002).

Depending on the level of LIIm, all patients were divided into 2 groups: I - in which an increase in this index was registered, II - LIIm was within normal limits.

Statistical processing of the data was carried out using Microsoft Office Excel 2007 and SPSS Statistics 17.0. The mean value, standard deviation (SD - for groups of parameters with a normal distribution), 95% confidence interval (CI - for the distribution of parameters other than normal) were calculated, non-parametric statistics methods were used to compare groups (calculation of the Mann-Whitney criterion for independent samples , Friedman's criterion - to determine the significance of differences in dependent groups), a correlation analysis was carried out with the calculation of the Spearman criterion, regression analysis - the construction of a linear regression model with calculation of the coefficient ienta avtokorellyatsii Durbin-Watson. Significant values were taken at p <= 0.05.

After calculating the hematological intoxication indices, we found that in 58.9% (43 people) of the examined group I patients registered an increase in LIIm to 3.15 (CO - 1.54; 95% CI from 2.68 to 3.63) , which was more than in patients of group II - 1.37 (SD - 0.3; 95% CI from 1.25 to 1.48). Moreover, in patients of groups I and II, statistically significant differences were revealed not only in “white sprout” cells, the content of which is taken into account when calculating the index parameters of intoxication, but also in the number of red blood cells, the level of hemoglobin, CP and ESR. The IPI value in the 1st group of patients was 10.4, SD - 6.19, in the II group - 4.6, SD - 3.44.

Having performed a correlation analysis of the IPI with oxygen status parameters, a high negative relationship between the IPI and CaO2 (-0.725, p <0.001) and a noticeable negative relationship with the DO2 level (-0.429, p = 0.023) were revealed in group II of the study. In the group of patients with EI symptoms, the level of a statistically significant negative relationship of the proposed indicator with the parameters of oxygen homeostasis was higher than that of LII and LIIm: a noticeable relationship with CaO2 (-0.610, p <0 <001), VO2 (-0.532, p <0.001 ), moderate association with VQ (-0.462, p = 0.002), DO2 (-0.344, p = 0.026), KyO2 (-0.398, p = 0.009).

As can be seen from the foregoing, the proposed integral indicator of endogenous intoxication allows us to accurately assess the degree of EI, which correlates with indicators of the gas composition of the blood and reflects the degree of respiratory distress.

The technical result of the use of the invention is a high-precision, sensitive, quantitative assessment of the severity of EI taking into account hematological parameters, including oxygen capacity of the blood, which allows to assess the development, severity, course of inflammation of endogenous intoxication and respiratory disorders developing against this background, evaluate the effectiveness of the therapy and determine a strategy for further treatment correction to achieve a therapeutic effect.

Bibliography

1. Alles V.F. Pathophysiological mechanisms of delivery, consumption, oxygen extraction in critical conditions. Methods of their intensive care / V.F. Alles, N.A. Stepanova, O.A. Galdi // Vestn. Intense therapy. - 1998. No. 2. S.8-13.

2. Hirsch A.O. About the conjugacy of endotoxicosis, immunoreactivity, central hemodynamics and oxygen transport in patients with diabetes mellitus with diffuse purulent peritonitis / A.O. Hirsch, O.A. Malkov, V.N. Lukac // Intensive care. - 2005. No. 3. S.75-78.

3. Kalf-Kalif Y. Ya. On the leukocyte intoxication index and its practical significance // Medical practice. - 1941. No. 1. S.31-35.

4. Karyakina E.V. Medium-weight molecules as an integral indicator of metabolic disorders (literature review) / E.V. Karyakina, S.V. Belova // Clinical laboratory diagnostics. 2004. No3. C.3-8.

5. Malakhova M.Ya. Endogenous intoxication as a reflection of the compensatory restructuring of metabolic processes in the body / M.Ya. Malakhova // Efferent therapy. 2000. T. 6. №4. S.3-14.

6. Ostrovsky V.K., Mashchenko A.V., Yangolenko D.V., Makarov S.V. Blood counts and leukocyte intoxication index in assessing severity and determining prognosis for inflammatory, purulent and purulent-destructive diseases // Klin. lab. diagnostics. - 2006. No. 6. S.50-53.

7. Smolyakova R.M. Evaluation of endogenous intoxication and prediction of purulent-inflammatory complications in cancer patients by laboratory parameters of blood / P.M. Smolyakova // Abstract of thesis. Medical Science - Minsk, 2005. S.5-6.

8. Speransky II, Samoilenko G.E., Lobacheva M.V. General blood test - are all its possibilities exhausted? Integral intoxication indices as criteria for assessing the severity of endogenous intoxication, its complications and the effectiveness of the treatment // Health of Ukraine.-2009. No. 6 (19). S.51-57.

Claims (1)

A method for identifying symptoms of endogenous intoxication, including the study of a clinical blood test of patients suffering from colorectal cancer, with the calculation of the cell formula by light microscopy and the data on the cell composition, including the measurement in percent (%) of young leukocytes, stab neutrophils, segmented neutrophils, myelocytes, plasma cells, basophils, eosinophils, lymphocytes, monocytes, erythrocytes (in absolute value of 10 ^12), as well as blood color index calculated integrals ny intoxication indicator (IPI) by the formula:

where youn are young white blood cells
Pal - stab neutrophils,
Seg - segmented neutrophils,
Myel - myelocytes,
Plasma - plasma cells,
Baz - basophils,
Eos - eosinophils,
Lim - lymphocytes,
Mon - monocytes,
Er - red blood cells,
CPU - color indicator
with an IPI of 4.6, there are no symptoms of endogenous intoxication, and with an IPI of 10.4, there are symptoms of endogenous intoxication.