RU2614141C1 - Method for prediction of parapharyngeal abscess in case of acute paratonsillitis - Google Patents

Abstract

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to field of medicine, namely to otorhinolaryngology, and can be used for prediction of abscess development in case of acute paratonsillitis. Essence of method consists in the following: examination of patient is performed 24 hours after the onset of acute tonsillitis. In case of presence of 2 clinical symptoms of disease, LIIm index from 0.5 to 2.3, C-reactive protein in amount <0.005 g/l, orosomucoid 0.4-1.3 g/l, α₁-antitrypsin 1.4-3.2 g/l, haptoglobulin 0.5-3.2 g/l, fibrinogen 1.8-3.5 g/l, albumin 37-53 g/l, prealbumin 0.25-0.45 g/l probability of abscess development constitutes 0-15%. In case of presence of 3 clinical symptoms of disease, LIIm index from 3.5 to 7.0, C-reactive protein in amount >0.05 g/l, orosomucoid >2.6 g/l, α₁-antitrypsin >6.4 g/l, haptoglobulin 0.5-3.2 g/l, fibrinogen 1.8-3.5 g/l, albumin 37-53 g/l, prealbumin 0.25-0.45 g/l probability of abscess development constitutes 40-60%. In case of presence of 4 clinical symptoms of disease, LIIm index higher than 8.0, C-reactive protein in amount >0.05 g/l, orosomucoid >2.6 g/l, α₁-antitrypsin >6.4 g/l, haptoglobulin >6.4 g/l, fibrinogen >7.0 g/l, albumin <37 g/l, prealbumin <0.25 g/l probability of abscess development constitutes 80-90%.

EFFECT: application of the method makes it possible to predict development of abscess in case of acute paratonsillitis and change of tactics of treating patients.

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Description

The invention relates to medicine, namely to otorhinolaryngology, and can be used to predict the development of a parapharyngeal abscess in acute paratonsillitis.

Purulent-inflammatory processes in the oral cavity occur in 20-50% of cases of the total morbidity of the population [Grechukhina Yu.A. et al. Features of the immune status and central hemodynamics in patients with angina depending on the level of cardiac troponin T in blood serum // Kazan Medical Journal. - 2003. - No. 2. - S. 89-97]. Parapharyngeal abscess in most cases occurs as a complication of paratonsillitis with a frequency of up to 2% of the total incidence of paratonsillitis. The disease is severe and can be fatal. Conventional diagnostic methods and predicting the occurrence of paratonsillar abscesses are not always possible in the early stages of the disease [Kononova T.V. Clinical and pathogenetic features of the formation and prognosis of paratonsillar abscess in tonsillitis: thesis ... cand. honey. Sciences: 14.00.04 - Samara, 2006. - 117 p.]. Therefore, predicting the development of parapharyngeal abscess in the early stages of the disease is very relevant in terms of timely and effective treatment of the resulting pathology in patients.

Currently, there are few reports of predicting complications in acute paratonsillitis [Angelovich S.M. Complications of tonsillitis in young adults and some issues of their prediction: Dissert. Cand. honey. sciences. L., 1989 - 144 p.]. The authors propose methods for improving the laboratory diagnosis of paratonzillitis [Izvin A.I. Paratonsillar abscesses and their treatment in the conditions of the North of Siberia: Abstract. dis. Cand. honey. sciences. Leningrad. 1989. - 24 p .; Balabanova P.M. et al. A modern view of diagnostic methods and principles of therapy for A-streptococcal pharyngeal infection // Consilium medicum. 2004, - T. 6.- No. 10. - S. 788-792] and the planning of effective treatment [Patent RU No. 21118534 C1 of 09/10/1998; Patent RU No. 2240132 C1 of November 20, 2004; Patent RU 2305843 C1 of 09/10/2007].

As a prototype, a method for scoring the tactics of treating abscesses was chosen [Patent RU No. 2408292 C1 of 01/10/2011]. The authors proposed a tactic for predicting the treatment of patients based on the determination of a point index characterizing the clinical manifestation of an infectious process. The proposed methodological approach was used to predict the possibility of developing a parfaringeal abscess in acute paratonsillitis.

The objective of the present invention is to predict in the initial period of the disease with acute paratonsillitis, during the day, to establish the possibility of developing a parapharyngeal abscess in patients.

The technical result is simple, not requiring large material costs, based on the determination of the main criteria that indicate the development of a parapharyngeal abscess, including key clinical symptoms of the disease, a laboratory study of a general blood test and determination of the concentration of acute phase (RP) proteins that respond within 24 hours from disease onset of the development of the inflammatory process in the patient’s body.

The technical result of the proposed method is achieved on the basis of the following clinical symptoms: sore throat when swallowing, swelling of the posterior arch of the tonsils, and / or side wall of the pharynx, and / or pear-shaped sinus, and / or submandibular region, determination of the leukocyte index of the body intoxication by general blood test as well as determining the concentration of acute phase proteins that respond to the development of the inflammatory process in the body: the concentration of C-reactive protein (CRP) increases by 100 and 1000 times over 6-12 hours, the concentration of rosomucoid, α ₁ -antitrypsin, haptoglobulin and fibrinogen after 24 hours increase by 2-5 times, the concentration of "negative" RP reactants: albumin and prealbumin decreases during 18 hours during the inflammatory process in the body.

Modified leukocyte intoxication index (LIIm) was determined by the following formula:

where is mts. - myelocytes;

square - plasma cells;

Yu. - young neutrophils;

p. - stab neutrophils;

from. - segmented neutrophils;

lymph - lymphocytes;

mon - monocytes;

e. - eosinophils;

b. - basophils.

The following changes in indicators were used to evaluate the leukocyte intoxication index: from 0.5 to 2.3 - indicators of a healthy person; from 2.4 to 3.5 - mild degree of endogenous intoxication (EI); from 3.5 to 7.0 - the average degree of EI; more than 8.0 - severe degree of EI.

The presence in the body of the inflammatory process for acute phase proteins was recorded at a concentration of C-reactive protein> 0.05 g / l, orozomcoid> 2.6 g / l, α ₁ antitrypsin> 6.4 g / l, haptoglobulin> 6.4 g / l, fibrinogen> 7.0 g / l and a decrease in the concentration of "negative" RP reactants: albumin <37 g / l, prealbumin <0.25 g / l.

Based on the studies, criteria for the formation of a parapharyngeal abscess are developed. In the presence of 2 clinical symptoms, LIIm index from 0.5 to 2.3, C-reactive protein in an amount of <0.005 g / l, orosomcoid 0.4-1.3 g / l, α ₁ -antitripsin 1.4 -3.2 g / l, haptoglobulin 0.5-3.2 g / l, fibrinogen 1.8-3.5 g / l, albumin 37-53 g / l, prealbumin 0.25-0.45 g / l the probability of developing an abscess is 0-15%. In the presence of 3 clinical symptoms, LIIm index 3.5 to 7.0, C-reactive protein in the amount of> 0.05 g / l, orosomcoid> 2.6 g / l, α ₁ antitrypsin> 6.4 g / l, haptoglobulin 0.5-3.2 g / l, fibrinogen 1.8-3.5 g / l, albumin 37-53 g / l, prealbumin 0.25-0.45 g / l, the probability of developing an abscess is 40-60%. In the presence of 4 clinical symptoms, LIIm index more than 8.0, C-reactive protein in the amount of> 0.05 g / l, orosomcoid> 2.6 g / l, α ₁ -antitripsin> 6.4 g / l, haptoglobulin> 6.4 g / l, fibrinogen> 7.0 g / l, albumin <37 g / l, prealbumin <0.25 g / l, the probability of developing an abscess is 80-90%.

The technical result is achieved by the fact that according to the invention, a comprehensive clinical and laboratory examination of patients is carried out 24 hours after the onset of acute paratonsillitis, which allows predicting the development of an abscess: in the presence of 2 clinical symptoms, LIIm index from 0.5 to 2.3, C reactive protein in an amount of <0.005 g / d, orosomcoid 0.4-1.3 g / l, α ₁ antitrypsin 1.4-3.2 g / l, haptoglobulin 0.5-3.2 g / l, fibrinogen 1.8-3.5 g / l, albumin 37-53 g / l, prealbumin 0.25-0.45 g / l, the likelihood of developing a parapharyngeal abscess is 0-15%; in the presence of 3 clinical symptoms, LIIm index from 3.5 to 7.0, C-reactive protein in the amount of> 0.05 g / l, orosomcoid> 2.6 g / l, α ₁ -antitripsin> 6.4 g / l, haptoglobulin 0.5-3.2 g / l, fibrinogen 1.8-3.5 g / l, albumin 37-53 g / l, prealbumin 0.25-0.45 g / l the likelihood of developing parapharyngeal abscess is 40-60%; in the presence of 4 clinical symptoms, LIIm index more than 8.0, C-reactive protein in the amount of> 0.05 g / l, orosomcoid> 2.6 g / l, α ₁ -antitripsin> 6.4 g / l, haptoglobulin> 6.4 g / l, fibrinogen> 7.0 g / l, albumin <37 g / l, prealbumin <0.25 g / l, the probability of developing a parapharyngeal abscess is 80-90%.

The proposed method is carried out in the following ways.

In patients admitted to the hospital with a diagnosis of acute paratonsillitis, a comprehensive clinical and laboratory examination of the patients is performed after 24 hours with the determination of the LIIm index, C-reactive protein, orozomcoid, α ₁ -antitrypsin, haptoglobulin, fibrinogen, albumin and prealbumin. Based on the obtained research results, the probability of developing a parapharyngeal abscess in acute paratonsillitis is determined.

Examples of practical use of the proposed method

Example 1

Patient H., 31 years old. I entered the admission department of the hospital with complaints of weakness, malaise, sore throat when swallowing more on the right, difficulty swallowing. T-37.8 ° C.

Diagnosed with Acute paratonsillitis.

After 24 hours from the onset of the disease, a comprehensive clinical and laboratory examination of the patient was performed.

Clinical symptoms: sore throat when swallowing and swelling of the back arch of the tonsils.

LIIm index 1.5, C-reactive protein in an amount of 0.002 g / l, orozomcoid 0.8 g / l, α ₁ -antitripsin 2.3 g / l, haptoglobulin 1.6 g / l, fibrinogen 2.1 g / l, albumin 47 g / l, prealbumin 0.3 g / l. The probability of developing an abscess is possible from 0 to 15%.

On the 7th day of illness, the patient was discharged in satisfactory condition. The formation of an abscess is not registered.

Example 2

Patient U., 28 years old. He was admitted with complaints of sore throat when swallowing on the left, weakness, malaise, fever - 38.3 ° C.

Diagnosis: Acute paratonsillitis on the left.

After 24 hours from the onset of the disease, a comprehensive clinical and laboratory examination of the patient was performed.

Clinical symptoms: sore throat when swallowing and swelling of the posterior arch of the tonsils and side wall of the pharynx.

LIIm index 6.5, C-reactive protein in an amount of 0.09 g / l, orozomcoid 2.8 g / l, α ₁ -antitripsin 7.4 g / l, haptoglobulin 3.0 g / l, fibrinogen 2.5 g / l, albumin 43 g / l, prealbumin 0.35 g / l. The likelihood of developing an abscess is possible in 40-60% of cases.

On the 5th day of the disease, the patient registered a complication: left-sided paratonsillar abscess.

Example 3

Patient H., 36 years old. I entered the admission department of the hospital with complaints of weakness, malaise, sore throat when swallowing more on the right, difficulty swallowing. T-37.8 ° C.

Diagnosis: Acute paratonsillitis on the right. Right parapharyngitis?

After 24 hours from the onset of the disease, a comprehensive clinical and laboratory examination of the patient was performed.

Clinical symptoms: sore throat when swallowing, swelling of the posterior arch of the tonsils, lateral wall of the pharynx and pear-shaped sinus. LIIm index 9.3, C-reactive protein in an amount of 0.12 g / l, orozomcoid 3.4 g / l, α ₁ -antitripsin 7.6 g / l, haptoglobulin 7.8 g / l, fibrinogen 8.0 g / l, albumin 27 g / l, prealbumin 0.19 g / l.

The development of an abscess is predicted in 80-90% of cases.

On the 3rd day of illness, the patient was diagnosed with Acute paratonsillitis complicated by a right-sided paratonsillar abscess.

The examples given illustrate the possibility of using this method for predicting the occurrence of an abscess in acute paratonsillitis.

The proposed method for predicting an abscess in acute paratonzillitis will allow you to change the treatment tactics of patients who have a high risk of abscesses in acute paratonsillitis, which will significantly reduce costs in patients with inpatient care.

A method for predicting an abscess in acute paratonsillitis has been tested on the basis of the infectious ward of the GBUZ TO OKB No. 1. Under observation were 18 patients aged 15-58 years. The incidence of abscesses in acute paratonzillitis corresponded to the materials presented in this application for invention.

Based on the forecasting of abscesses in 10 patients and changes in treatment tactics, the costs of treating patients decreased in the amount of 26.0 thousand rubles.

The proposed method for predicting an abscess in acute paratonzillitis is easily reproducible, does not require large material costs, in the early stages allows us to predict the possibility of developing abscesses and will be performed in medical institutions.

Claims (1)

A method for predicting a parapharyngeal abscess in acute paratonsillitis includes a comprehensive clinical and laboratory examination of patients 24 hours after the onset of acute paratonsillitis, which allows predicting the development of an abscess: in the presence of 2 clinical symptoms, LIIm index from 0.5 to 2.3, C-reactive protein in an amount of <0.005 g / l, orosomcoid 0.4-1.3 g / l, α ₁ -antitripsin 1.4-3.2 g / l, haptoglobulin 0.5-3.2 g / l, fibrinogen 1 , 8-3.5 g / l, albumin 37-53 g / l, prealbumin 0.25-0.45 g / l, the probability of developing an abscess is 0-15%; in the presence of 3 clinical symptoms, LIIm index from 3.5 to 7.0, C-reactive protein in the amount of> 0.05 g / l, orosomcoid> 2.6 g / l, α ₁ -antitripsin> 6.4 g / l, haptoglobulin 0.5-3.2 g / l, fibrinogen 1.8-3.5 g / l, albumin 37-53 g / l, prealbumin 0.25-0.45 g / l probability of developing an abscess 40-60%; in the presence of 4 clinical symptoms, LIIm index more than 8.0, C-reactive protein in the amount of> 0.05 g / l, orosomcoid> 2.6 g / l, α ₁ -antitripsin> 6.4 g / l, haptoglobulin> 6.4 g / l, fibrinogen> 7.0 g / l, albumin <37 g / l, prealbumin <0.25 g / l, the probability of developing an abscess is 80-90%.