RU2597797C2 - Method for prediction of risk of cardiovascular diseases in patients with neurocirculatory dystonia with signs of connective tissue dysplasia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to a method for prediction of probability of developing cardiovascular diseases in patients with neurocirculatory dystonia with symptoms of connective tissue dysplasia. Method consists in the fact that collagen antibodies of second and third type are examined in venous blood and prediction coefficient of probability of developing cardiovascular diseases is calculated by formula. If the coefficient K varies from 0.6 to 1.59 a minimum probability of hypertensive heart disease exists, if varies from 1.6 to 2.59 it means a probability of developing hypertension, exceeding 2.6 means a probability of developing ischemic heart disease.

EFFECT: using the declared method enables more effective prediction of risk of cardiovascular diseases in patients with neurocirculatory dystonia with symptoms of connective tissue dysplasia.

1 cl, 4 tbl, 3 ex

Description

The invention relates to medicine, namely to cardiology, in particular to preventive medicine, and can be used to predict the development of cardiovascular diseases in patients with a history of neurocirculatory dystonia and signs of undifferentiated connective tissue dysplasia.

Diseases of the cardiovascular system occupy a leading place in the structure of morbidity and mortality in most economically developed countries, including Russia [Yatsenko MK, Prokofieva TV, Voronina LP, Polunina OS Correction of microcirculatory disorders in patients with coronary heart disease // Astrakhan Medical Journal. - 2009. - No. 3. - S. 93-96]. Health largely depends on the life position and efforts of a person who is able to actively regulate his own condition, taking into account the individual characteristics of his body [Galtsev S.S. Problems of a healthy lifestyle in Russian public opinion // Astrakhan Medical Journal. - 2011. No. 4. - S. 90-94]. The main goal of state policy in the field of healthcare reform is to improve the health status of the population [Samsonova O.V. Social policy of the state in the field of preserving the health of the nation // Astrakhan Medical Journal. - 2009. - No. 3. - S. 161-167].

A known method for predicting the course of neurocirculatory dystonia (NDC) in men (patent No. 2432111, publ. 10/27/2011), where it is proposed to carry out daily monitoring of the ECG and calculate the circulatory index of heart rate. In this case, the heart rate variability index LF / HF is additionally determined and the integral coefficient is calculated by the formula K = CIn / ln (LF / HF), where CIn is the circadian heart rate index, ln (LF / HF) is the logarithmic LF / HF indicator. When the coefficient value is less than 0.8, an adverse course of NDC is predicted.

The main disadvantage of this method: forecasting the course of NDC is carried out without taking into account tender differences and outcomes.

A known method for predicting the occurrence of arterial hypertension (patent No. 2332934, publ. 10.09.2008) by determining risk factors. Each factor is evaluated at 1 point, then a risk indicator is calculated.

However, the known method has disadvantages: the peculiarities of metabolic processes in undifferentiated connective tissue dysplasia (NDST) are not taken into account, only arterial hypertension is predicted to develop without taking into account the history of NDC and the possibility of developing other nosological forms.

A known method for assessing the total risk of developing cardiovascular disease (CVD), specific to the Russian population (patent No. 2352258, publ. 04/20/2009), where they calculate the absolute risk of CVD according to the original mathematical formula.

However, there are drawbacks: the presence of phenotypic signs of NDCT in patients is not taken into account, the total risk of CVD without calculating nosological forms is calculated.

The invention is aimed at the primary prevention of hypertension and coronary heart disease in patients with NDC with signs of connective tissue dysplasia.

The specified technical result is achieved by the fact that in the venous blood determine the level of antibodies to collagen of the second and third type, then calculate the forecast coefficient for the likelihood of developing diseases of the cardiovascular system according to the formula

K - coefficient for predicting the likelihood of developing diseases of the cardiovascular system

0,326483 - Beta coefficient;

0.170443 - Beta coefficient for AT2;

AT2 is a digital expression of a semi-quantitative assessment of the degree of activity of antibodies to type 2 collagen;

0.643938 - value of the standardized Beta coefficient for AT3;

АТ3 - a digital expression of a semi-quantitative assessment of the degree of activity of antibodies to type 3 collagen and when K is from 0.6 to 1.59, the minimum probability of developing hypertension and coronary heart disease in a patient is predicted;

at K from 1.6 to 2.59, the likelihood of developing hypertension is predicted;

at K above 2.6, the likelihood of developing coronary heart disease is predicted.

The approbation of this method was carried out 72 patients on the basis of the non-governmental medical institution "Health Unit". The diagnosis of connective tissue dysplasia was based on criteria proposed by experts of the All-Russian Scientific Society of Cardiology in 2012 (at least six small external and / or visceral signs of DST).

The amount of antibodies was determined using a test system for determining human antibodies to type II and type III collagen by ELISA (IMTEK, Moscow). The method is based on an immunological reaction between antibodies to collagen and collagen immobilized on the inner surface of the holes of a plastic tablet, followed by detection of the formed complex using a peroxidase conjugate of rabbit antibodies to total human immunoglobulins, the enzymatic activity of which is determined by the color change of the substrate mixture. The amount of peroxidase bound is proportional to the number of antibodies in the sample. The determination of optical density (OD) was carried out on a Multiscan spectrophotometer (manufactured by Thermo Fisher Scientific), directly in the tablet at a wavelength of 450 nm. Background indicators were within 0.2 units.

When ELISA was performed in wells with a positive control, an intense yellow-orange color was observed, and wells with negative serum remained colorless or slightly stained. The appearance of color in the wells with the test samples meant the presence of antibodies in the sample. The degree of AT activity was determined in units of optical density (EOP), depending on the indicators it was designated as “low” (1-1.5 EOP), “medium” (1.6-2.0 EOP), “high” (2, 1-2.5 EOP) and "very high" (more than 2.6 EOP). Less than 1.0 EOP was regarded as the absence of antibodies to type II and type III collagen.

Patients were distributed according to the total number of NDC syndromes (Total NDC), which looked as follows: 1 syndrome - 22.3% of patients, 2 syndromes - 67.59% of patients, 3 syndromes - 8.37% of patients, 5 syndromes - 1 , 74% of patients.

In a similar way, we distributed patients according to the number of different symptom complexes of DST. Most of the patients of the main group with NDC at the time of the study or with the transition to cardiovascular diseases - GB or IHD had 2 (26.3%) or 3 (31.3%) signs of lesions of the osteoarticular system, 1 (31.3 %) or 2 (46.4%) signs of damage to the cardiovascular system, 1 (52.5%) sign of skin lesions and 1 (71.5%) sign of damage to the organ of vision.

Having carried out a correlation analysis, direct and sufficient correlations were revealed between the risk of CVD and symptom complexes of total NDC (r = + 0.5547, p <0.05), general C&C (r = 0.6805, p <0.05), total skin (r = + 0.5363, p <0.05).

To determine the degree of contribution of the above symptom complexes to the formation of CVD, a regression analysis was performed with them (where the risk of CVD was an independent indicator, the dependent ones were general NCD, general CSiS, common skin). The following data were obtained: for general NDC Beta = 0.180399, p <0.05; for general CCS Beta = 0.175484, p <0.05; for total leather Beta = 0.069985, p> 0.05. Therefore, when predicting risk, the indicators of total NCD and general CSiC should be taken into account, while high risks of developing future cardiac pathology will be with a combination of 3 or more symptoms of their indicated symptom complexes or a combination of 2 symptoms from both symptom complexes (risk> 50%). The general skin symptom complex is supportive in nature and in calculating risks its use is inappropriate.

To assess the risks of developing GB and IHD from the degree of activity of antibodies to type 2 and 3 collagen, a regression analysis method was used. This method allows one to consider the one-way dependence of a random dependent variable on several independent variables. Independent variables are called factors or predictors, and a dependent variable is called an effective attribute or response.

Tab. 1 contains standardized (Beta) and non-standardized (B) regression coefficients (weights), their standard errors, t-test values (t) and significance levels (P).

As a dependent variable, the model included an indicator reflecting the main cardiovascular nosology, as independent - AT2 and AT3. The value of the beta coefficients allows you to compare the contributions of each predictor to the prediction of the response. As can be seen from the table. 1, the predictor AT3 makes the greatest contribution to the development of cardiovascular pathology. The value of the standardized Beta coefficient for AT3 is 0.643938, its significance level is p <0.000001. A positive sign of the coefficient means that with an increase in the level of AT3, the prognosis for cardiovascular disease worsens (from NDC to CHD). A slightly smaller contribution is made by the predictor AT2. The value of the Beta coefficient for AT2: 0.170443, its significance level: p = 0.002370. The sign of the coefficient is positive, which also means that with an increase in the level of AT3, the prognosis for cardiovascular disease worsens (from NDC to CHD).

The constructed regression equation has the form:

The coefficient for predicting the likelihood of developing diseases of the cardiovascular system (K) in NDC patients with DST syndrome = 0.326483 + 0.643938 × AT3 + 0.170443 × AT2,

where AT2 and AT3 are a digital expression of a semi-quantitative assessment of the activity of antibodies to collagen type II and III,

at K from 0.6 to 1.59, the minimum probability of developing hypertension and coronary heart disease in a patient is predicted to be minimal;

at K from 1.6 to 2.59, the likelihood of developing hypertension is predicted;

at K above 2.6, the likelihood of developing coronary heart disease is predicted.

In the table. 2 summarizes statistics - indicators of the adequacy of the constructed linear model.

Multiply. R ² is the coefficient of determination. The value of R ² is an indicator of the degree of fit of the model to the data. A value of R ² close to 1 (0.906735) indicates that the model adequately describes the effect of predictors on the response.

Multiply. R is the multiple correlation coefficient. It characterizes the tightness of the relationship between predictors and response, and is also an estimate of the quality of the prediction. A value of R close to 1 (0.978432) indicates a high degree of adequacy of the regression model.

Since the significance level of the Fisher criterion (F) is less than 0.05 (p = 0.00000), the value of R ^{2 is} significantly different from 0. The data in table. 2 statistics indicate satisfactory adequacy of the model.

Tab. 3 contains beta coefficients, partial correlation coefficients, semi-partial correlation coefficients, tolerance values, determination coefficients (R ² ), and significance levels (P).

Partial correlation coefficients show the degree of influence of one predictor on the response under the assumption that the remaining predictors are fixed at a constant level, i.e. their influence on the response is controlled. Private correlation coefficients, like standardized beta coefficients, allow ranking of predictors according to the degree of their influence on the response. In addition, partial correlation coefficients are widely used in solving the problem of selecting predictors. So, the advisability of including one or another predictor in the model is determined by the value of the partial correlation coefficient. As can be seen from the table. 3, the predictor АТ2 is most desirable for inclusion in the model - partial correlation coefficient: 0.648691, significance level: p <0.00001, followed by АТ3 - partial correlation coefficient: 0.500635, significance level: p <0.00001.

The semi-fast correlation is the correlation of the predictor and response under the assumption that the influence of other predictors on this predictor is controlled, but the influence of predictors on the response is not controlled. If the semi-partial correlation is relatively small, while the partial correlation is relatively large, then the corresponding predictor can have an independent “part” in explaining the variability of the dependent variable - the response, i.e. “Part” that is not explained by other predictors. From the table. 3 it can be seen that the indicator AT3 has the indicated property, i.e. This indicator makes an independent contribution to the development of cardiovascular pathology in patients with NDC with DST syndrome.

The coefficient of determination (R-squared) is the squared coefficient of multiple correlation between this variable and all other variables included in the regression equation. From the table. 3 it follows that both indicators have a strong relationship with each other (0.75 and above).

In the table. Figure 4 shows the initial values of the response “cardiovascular pathology” and the predicted response value according to the regression model for the first 10 patients with NDC with DST syndrome. By the number of discrepancies, one can judge the adequacy of the model for predicting the severity. After 67 observations, there was not a single discrepancy between the initial and predicted cardiovascular nosology, which once again emphasizes the adequacy of the model and indicates the advisability of using it to predict the outcome of NDC in patients with DST syndrome.

Thus, when conducting a regression analysis, it was possible to build a fairly simple and at the same time adequate model that allows to accurately predict the outcomes of NDC in patients with DST syndrome.

Below are the results of testing.

Example No. 1. Patient X., 48 years old, was hospitalized in the cardiology department of the NUZ MSCh from 05/25/2012 to 06/08/2012 with a diagnosis of

Primary: Hypertension 2 stages, 2 degrees of hypertension (normotension achieved). Risk 2.

Concomitant diagnosis: Mitral valve prolapse of 1 degree. Additional chord of the left ventricle.

Received with complaints of headache, pain in the temporal areas with increased blood pressure, weakness.

From the anamnesis: NDC since 1984 proceeded with a predominance of hypertonic and tachycardial syndromes. Regularly consulted the therapist at the place of residence. Since 2008, blood pressure began to rise to 165/100 mm Hg. Adapted to blood pressure 120/80 mm Hg Since 2009, he has been taking Concor in a dose of 2.5 mg × 2 r. per day.

Hereditary history: in the mother - prolapse MK, crowded teeth.

Objective data. Anthropometric parameters: height 182 cm, weight 66 kg, body mass index of 20.0 kg / m ² body surface area of 1.9 m ^2, arm span / height 1.02, the ratio of the upper and lower body segments 0,89. On examination, the type of constitution is asthenic, scoliotic deformity of the spine, arachnodactyly, hypermobility of joints of the 1st degree, atrophic striae.

General condition is satisfactory. In consciousness, contact, answers questions correctly. Subcutaneous fat layer is weakly expressed. The skin of physiological color, normal humidity, skin turgor is normal. Musculoskeletal system: soreness in the cervical spine associated with its movement. Palpation of paravertebral and parasternal points in the thoracic spine is moderately painful. Peripheral lymph nodes (submandibular, cervical, axillary, inguinal) are not enlarged, are not fused with the surrounding tissues, the skin above them is not changed. The thyroid gland is homogeneous, not enlarged, the isthmus is palpated. The chest is the right shape. Percussion above the lungs - pulmonary sound. Auscultatory: vesicular breathing, no rales. NPV = 16 in 1 min. The area of the heart is not changed. Borders of relative cardiac dullness: right - along the right edge of the sternum; upper - 3 rib; left - on the left midclavicular line. Heart sounds are slightly muffled, the rhythm of cardiac activity is correct. Ps = 72 in 1 min, heart rate = 72 in 1 min. ADD = AD8 = 150/80 mmHg The tongue is moist, moderately coated with a white coating. The abdomen on palpation is soft, painless. Active peristalsis is heard. Symptoms of peritoneal irritation are negative. The liver is not enlarged. The "tapping" symptom is painless on both sides. No swelling of the lower extremities. Urination is free, painless. The chair is regular, decorated.

Survey conducted:

General (clinical) blood test detailed: Red blood cells (RBC) 4.05 × 10 * 12 / L (3.5-5.7). Hemoglobin (HGB) 126 g / l (120-164). Hematocrit (HCT) 37.2 (34-48). Platelets (PLT) 291 × 10 * 9 / L (180-320). White blood cells (WBC) 6.9 × 10 * 9 / L (4.0-10.0). Lymphocytes (LY%) 30.9 (28-38). Neutrophils (NE%) 61.8 (45-75). Eosinophils (ЕО%) 1.4, (1.0-5.0). Basophils (VA%) 0.4 (0.2-1). Monocytes (MO%) 5.5 (3.0-10.0). The erythrocyte sedimentation rate of 10 mm / h (2-12).

General urine analysis: Amount 50.0 ml (10-250). The color is straw yellow, transparent, the reaction is acidic. The specific gravity is 1.016 (1.018-1.024). The protein is negative. Sugar is negative. The epithelium is flat 1-0-2 in the field of view (0-5). White blood cells negative.

Biochemical analysis of blood: Total protein 78.3 g / l (63-87). Albumin (ALB) 42.5 g / l (35-50). Urea (UREE) 7.5 mmol / L (1.7-8.3). Creatinine (CREAT) 85 μmol / L (44-115). Glucose (GLU) 5.95 mmol / L (4.2-6.4). B-lipoproteins 40 conv. units (35-55). Cholesterol (CHOL) 4.2 mmol / L (3.9-5.7). Triglycerides (TRIGLY) 3.90 mmol / L (0.46-1.88). HDL cholesterol 1.00 mmol / L (1.03-1.55). Total bilirubin (BILIT) 9.7 μmol / L (0.1-20.5). Direct bilirubin (BILID) 2.1 μmol / L (0-3.4). ACT (ASAT) 16 u / l (6-37). ALT 20 units / l (1-42). Sodium 140 μmol / L (132-152). Potassium 3.7 μmol / L (3.4-5.0). LDL 2.69 mmol / L (2.59-4.14).

ECG: Sinus rhythm, correct. EOS is located vertically. Heart rate - 63 per minute. Moderate disturbances of the processes of repolarization in the lateral region. Slowing the electrical systole of the ventricles

Ultrasound of the kidneys: the left kidney is 111 × 54 mm / Ν up to 120 × 60 mm /, the parenchyma is 17 mm, it is usually located, the contour is clear and even. CLS is not expanded. In the upper segment at the border of the sinus and parenchyma, fluid inclusion with a diameter of 11 mm. Calculi are not located;

the right kidney is 116 × 56 mm / Ν up to 120 × 60 mm /, the parenchyma is 17 mm, it is usually located, the contour is clear and even. CLS is not expanded, in the middle segment liquid inclusion with a diameter of 14 mm. Calculi are not located. Conclusion: Liquid structures on both sides.

ABP protocol: Conclusion: Stable systolic-diastolic hypertension during the day. Violations of the circadian blood pressure profile were not detected (type of curve - dipper).

Protocol Echo: Conclusion: An abnormally located chord in the cavity of the left ventricle. Dilatation of the left atrium. Concentric hypertrophy of the left ventricle (ASE). Violations of local contractility have not been identified. Prolapse of the anterior cusp of the mitral valve, I st. Diastolic dysfunction of the left ventricle type I. Mitral regurgitation of the I-II degree.

Blood test for the presence of antibodies to collagen 2 type "++",

Blood test for the presence of antibodies to collagen 3 type "++".

The prediction coefficient for the likelihood of developing diseases of the cardiovascular system in a 48-year-old patient with a history of NDC and signs of connective tissue dysplasia, the presence of antibodies to type II collagen (high activity) and type III (medium activity) is calculated by the formula

A blood test to determine the degree of activity of antibodies to type 2 and 3 collagens and calculating the prognosis coefficient of the risk of developing cardiovascular diseases when a patient seeks medical help at the time of NDC would predict the development of hypertension and carry out primary prevention of this disease.

The result obtained corresponds to the cardiovascular pathology present in the patient (hypertension).

Example No. 2. Patient M., 52 years old, was hospitalized in the cardiology department of the NUZ MSCh from 12/11/2012 to 12/23/2012 with a diagnosis of

Primary: CHD: exertional angina, FC 2, as an outcome of progressive angina pectoris. Atherosclerosis of the aorta, brachiocephalic arteries (hemodynamically insignificant). XCHI. FC NYHA 2.

Concomitant diagnosis: Mitral valve prolapse of 1 degree. An abnormally located chord in the cavity of the left ventricle. Expansion of the ascending aorta.

He entered with complaints of increased pain in the sternum of a pressing nature that occurs during passage on a flat surface of less than 500 m, ascent to the 3rd floor. The pains are stopped by the cessation of physical activity, by taking nitroglycerin.

From the anamnesis: at the age of 20 years, NDC was registered, which proceeded according to a mixed type with a predominance of cardiological and tachycardial syndromes. He was treated by a general practitioner with sedatives and adaptogens. From the age of 48, angina attacks appeared with intense physical exertion. From the age of 50, he noted a decrease in exercise tolerance (there were pains when climbing to the 3rd floor, walking about 500-800 m). Over the past year, regularly observed by a cardiologist, constantly taking metoprolol 50 mg × 2 p. per day, cardiomagnyl 75 mg per day, rosuvastatin 10 mg per day.

Hereditary history: father died at a young age from myocardial infarction.

Objective data. Anthropometric parameters: height 196 cm, weight 70 kg, body mass index 18.2 kg / m ² , body surface area 1.95 m ² , arm span / height 1.04, ratio of upper and lower body segments 0.91. The type of constitution is asthenic, dolichocephaly, scoliotic spinal deformity, funnel chest, arachnodactyly, joint hypermobility of 1 degree.

General condition is satisfactory. In consciousness, contact, answers questions correctly. The subcutaneous fat layer is scarce. The skin is clean, normal humidity, turgor of the skin is normal. The thyroid gland is homogeneous, not enlarged, the isthmus is palpated. Percussion above the lungs - pulmonary sound. Auscultatory: vesicular breathing, wheezing is not heard. NPV = 17 in 1 min. The area of the heart is not changed. Borders of relative cardiac dullness: right - along the right edge of the sternum; upper - 3 rib; left - on the midclavicular line. Heart sounds are slightly muffled, the rhythm of cardiac activity is correct. Ps = 64 in 1 min, heart rate = 64 in 1 min. ADC = AD8 = 130/80 mmHg The tongue is moist, moderately coated with a white coating. The abdomen on palpation is soft, painless. Active peristalsis is heard. Symptoms of peritoneal irritation are negative. The liver is not enlarged. The "tapping" symptom is painless on both sides. No swelling of the lower extremities. Ripple on the vessels of the lower extremities is determined, slightly weakened. Urination is free, painless. The chair is regular, decorated.

Survey conducted:

General (clinical) blood test detailed: Red blood cells (RBC) 5.2 × 10 * 12 / L (3.5-5.7). Hemoglobin (HGB) 138 g / l (120-164). Hematocrit (HCT) 38.1 (34-48). Platelets (PLT) 216 × 10 * 9 / L (180-320). White blood cells (WBC) 7.8 × 10 * 39 L (4.0-10.0). Lymphocytes (LY%) 32.1 (28-38). Neutrophils (NE%) 58.1% (45-75). Eosinophils (ЕО%) 2.8 (1.0-5.0). Basophils (VA%) 0.7 (0.2-1). Monocytes (MO%) 6.3 (3.0-10.0). The erythrocyte sedimentation rate is 8 mm / h (2-12).

General urine analysis: Amount 70.0 ml (10-250). The color is straw yellow, transparency is a complete acidic reaction. The specific gravity is 1.022 (1.018-1.024). The protein is negative. Sugar is negative. Flat epithelium 1-0-2 units. in the field of view (0-5). Urine leukocytes 1-2-2 in the field of view (0-8).

Biochemical analysis of blood: Total protein 79.1 g / l (63-87). Albumin (ALB) 40.1 g / l (35-50). Urea (UREE) 5.4 mmol / L (1.7-8.3). Creatinine (CREAT) 92 μmol / L (44-115). Glucose (GLY) 4.82 mmol / L (4.2-6.4). B-lipoproteins 42 srvc. units (35-55). Cholesterol (CHOL) 5.2 mmol / L (3.9-5.7). Triglycerides (TRIGLY) 1.67 mmol / L (0.46-1.88). HDL cholesterol 1.15 mmol / L (1.03-1.55). Total bilirubin (BILIT) 12.8 μmol / L (0.1-20.5). Direct bilirubin (BILID) 2.7 μmol / L (0-3.4). ACT (ASAT) 17 u / l (6-37). ALT 24 units / liter (1-42). Sodium 145 μmol / L (132-152). Potassium 4.2 μmol / L (3.4-5.0). LDL 3.2 mmol / L (2.59-4.14).

ECG: Sinus rhythm, correct. EOS is located vertically. Heart rate - 64 per minute. Diffuse disturbances of repolarization processes.

ABP protocol: Conclusion: Day: Stable systolic hypertension with high systolic pressure variability. At night: Transient systolic hypertension. Violations of the circadian profile of blood pressure were not detected (curve type - dipper).

Protocol Echo: Conclusion: Compaction of the walls of the aortic root. Pathological expansion of the ascending aorta. An abnormally located chord in the cavity of the left ventricle. Dilatation of the left atrium. Eccentric non-dilated left ventricular hypertrophy (calculated by ASE). Violations of local contractility have not been identified. Sealing of the valves of the aortic and mitral valves. Aortic regurgitation, I-II art. Tricuspid regurgitation of I-II Art.

The treatment was carried out: nitrate intravenously, fraxiparin subcutaneously, bisoprolol, mexicor, cross, aspirin.

A blood test for the presence of antibodies to collagen 2 type "+++",

Blood test for the presence of antibodies to collagen 3 type "+++".

The prediction coefficient for the likelihood of developing diseases of the cardiovascular system in patient M., 52 years old, with a history of NCD and signs of connective tissue dysplasia, the presence of antibodies to type II collagen and type III high activity was calculated by the formula

A blood test to determine the degree of activity of antibodies to type 2 and 3 collagens and calculate the prognosis coefficient of the risk of developing cardiovascular diseases when a patient seeks medical help at the time of NDC, would predict the development of coronary heart disease and carry out primary prevention of this disease.

The result obtained corresponds to the cardiovascular pathology present in the patient (coronary heart disease).

Example No. 3. Patient M., 28 years old, is observed by a therapist in a polyclinic of the NIH MSC with a diagnosis of

Primary: Cardiological neurocirculatory dystonia.

03/25/2013, I went to the reception with complaints of frequent stitching pains in the left half of the chest, more associated with physical and emotional stress, weakness, fatigue.

From the anamnesis: NDC from 16 years old, proceeded according to the cardialgic type. Treated with sedatives. Periodically takes magnesium preparations. The hereditary history is not burdened.

Objective data. Anthropometric parameters: height 193 cm, weight 72 kg, body mass index 19.4 kg / m ² , body surface area 1.96 m ² , arm span / height 1.03, ratio of upper and lower body segments 0.93. On examination, the type of constitution is asthenic, scoliotic spinal deformity, myopia.

General condition is satisfactory. In consciousness, contact, answers questions correctly. Proper physique, subcutaneous fat layer is poorly expressed. The skin is clean, skin turgor is normal. The palms and soles are wet, cold. Persistent, red, fast, diffuse dermographism. The chest is the right shape. Percussion above the lungs - pulmonary sound. Auscultatory: vesicular breathing, wheezing is not heard. NPV = 18 in 1 min. The area of the heart is not changed. Borders of relative cardiac dullness: right - along the right edge of the sternum; upper - 3 rib; left - 1 cm inwards from the left midclavicular line. Heart sounds are loud, splitting of the 2nd tone at all points. The rhythm of cardiac activity is correct. Ps = 82 in 1 min, heart rate = 82 in 1 min. ADD = AD8 = 110/70 mm Hg The tongue is wet, clean. The abdomen on palpation is soft, painless. Active peristalsis is heard. Symptoms of peritoneal irritation are negative. The liver is not enlarged. The "tapping" symptom is painless on both sides. No swelling of the lower extremities. Ripple on the vessels of the lower extremities saved. The chair is regular, decorated.

Survey conducted.

General (clinical) blood test detailed: Red blood cells (RBC) 4.8 × 10 * 12 / L (3.5-5.7). Hemoglobin (HGB) 142 g / l (120-164). Hematocrit (HCT) 37.5 (34-48). Platelets (PLT) 223 × 10 * 9 / L (180-320). White blood cells (WBC) 6.4 × 10 * 9 / L (4.0-10.0). Lymphocytes (LY%) 28.7 (28-38). Neutrophils (NE%) 58.1% (45-75). Eosinophils (EO%) 1.75 (1.0-5.0). Basophils (VA%) 0.7 (0.2-1). Monocytes (MO%) 3.1 (3.0-10.0). The erythrocyte sedimentation rate of 5 mm / h (2-12).

General urine analysis: Quantity 150.0 ml (10-250), color straw yellow. The urine is clear, the reaction is acidic. The specific gravity is 1.020 (1.018-1.024). The protein is negative. Sugar is negative. The epithelium is flat 1-1-2 in the field of view (0-5). White blood cells in sight (0-8).

Biochemical analysis of blood: Total protein 81.4 g / l (63-87). Albumin (ALB) 42.5 g / l (35-50). Urea (UREE) 3.8 mmol / L (1.7-8.3). Creatinine (CREAT) 76 μmol / L (44-115). Glucose (GLU) 5.2 mmol / L (4.2-6.4). B-lipoproteins 37 conventional units (35-55). Cholesterol (CHOL) 4.8 mmol / L (3.9-5.7). Triglycerides (TRIGLY) 1.3 mmol / L (0.46-1.88). HDL cholesterol 1.2 mmol / L (1.03-1.55). Total bilirubin (BILIT) 7.2 μmol / L (0.1-20.5). Direct bilirubin (BILID) 1.5 μmol / L (0-3.4). ACT (ASAT) 15 u / l (6-37), ALT (ALAT) 14 u / l (1-42). Sodium 137 μmol / L (132-152). Potassium 3.8 μmol / L (3.4-5.0). LDL 3.8 mmol / L (2.59-4.14).

ECG: Sinus rhythm, correct. EOS is located vertically. Heart rate - 68 per minute.

ABP protocol: Conclusion: No systolic-diastolic hypertension was detected. High variability of systolic pressure during the day. Violation of the circadian profile of SBP by the type of excessive nighttime decline (curve type - over dipper).

Protocol Echo: Conclusion: An abnormally located chord in the cavity of the left ventricle. The heart chambers are not expanded. Violations of local contractility have not been identified. Prolapse of the anterior cusp of the mitral valve, I st. Pathological flows are not registered.

VEM: Conclusion:

- The test is negative

- Tolerance to physical activity: high

- Maximum load - 150 W

- Type of vascular reaction - normotonic

- Double product - 262.

Blood test for the presence of autoantibodies to collagen 2 type "+".

Blood test for the presence of autoantibodies to collagen 3 type "+".

The coefficient for predicting the likelihood of developing diseases of the cardiovascular system in a patient M. 28 years old with NDC and signs of connective tissue dysplasia was calculated by the formula

The result allows us to predict the minimum likelihood of developing hypertension and coronary heart disease in a patient.

The proposed method is achieved:

- the ability to predict the risk of developing hypertension and coronary heart disease as outcomes of neurocirculatory dystonia in patients with undifferentiated connective tissue dysplasia;

- early diagnosis of emerging hypertension or coronary heart disease;

- primary prevention of hypertension or coronary heart disease;

- reduction of disability and mortality;

- improving the quality of life.

The proposed method is recommended to be used in medical institutions to predict the transition of neurocirculatory dystonia in patients with undifferentiated connective tissue dysplasia into hypertension or coronary heart disease, their early diagnosis and prevention.

Claims (1)

A method for predicting the risk of developing cardiovascular diseases in patients with neurocirculatory dystonia with signs of connective tissue dysplasia, namely, that the level of antibodies to collagen of the second and third type is determined in venous blood, and then the prediction coefficient for the likelihood of developing diseases of the cardiovascular system is calculated by the formula
K = 0.326483 + 0.170443 × AT2 + 0.643938 × AT3,
where K is the coefficient for predicting the likelihood of developing diseases of the cardiovascular system;
0,326483 - Beta coefficient;
0.170443 - Beta coefficient for AT2;
AT2 is a digital expression of a semi-quantitative assessment of the degree of activity of antibodies to type 2 collagen;
0.643938 - value of the standardized Beta coefficient for AT3;
AT3 is a digital expression of a semi-quantitative assessment of the degree of activity of antibodies to type 3 collagen, and when K is from 0.6 to 1.59, the minimum probability of developing hypertension and coronary heart disease in a patient is predicted;
with K from 1.6 to 2.59, the likelihood of developing hypertension is predicted;
with K above 2.6, the likelihood of developing coronary heart disease is predicted.