RU2626718C1 - Method of detecting early symptoms of loss of the nervous system under the impact of local and common vibration - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: measure the vibration sensitivity at a frequency of 125 Hz on the zygomatic bone and the first toe. The parameters of the amplitude P2 of the long-latent visual evoked potentials, the latency P2 and the amplitude P2N2 of auditory long-latent evoked potentials are determined, the discriminant function (F) is calculated taking into account the calculated discriminatory coefficients, taking into account the constant equal to 365.09. At a value of F, more than a constant, the initial signs of the effect of vibration on the body are diagnosed, if F is less than or equal to a constant, there is no evidence of vibration.

EFFECT: method allows to increase the reliability of diagnostics, which is achieved by determining the indicators of auditory and visual evoked potentials and calculating the discriminative function.

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Description

The invention relates to medicine, namely to neurology and occupational pathology, and can be used to detect early signs of damage to the nervous system when exposed to vibration on the body.

To diagnose limb polyneuropathy under the influence of vibration, generally accepted methods are used: clinical and neurological examination of patients with determination of vibration and pain sensitivity, limb thermometry, electroneuromyography [3, 7, 8, 10, 11].

In addition to damage to the peripheral part of the nervous system under the influence of vibration, the central departments also suffer. With prolonged exposure to an unfavorable factor, foci of stagnant excitation or pathologically enhanced excitation arise with the subsequent formation of pathological determinants and pathological functional systems [9]. Currently, using computer processing of EEG and analysis of evoked brain potentials, it has become possible to establish foci of brain pathological activity under the influence of general and local vibration [2].

A known method for the diagnosis of vibrational disease by determining the latency indices of peaks N9 and N13 using somatosensory evoked potentials, peak P1 using auditory long-latent evoked potentials, peak N1 using visual long-latency evoked potentials, calculating diagnostic coefficients [4]. In the described manner, 1 or 2 degrees of an already developed vibrational disease are diagnosed.

To reduce vibration pathology and reduce cases of disability, early preclinical identification of the harmful effects of vibration on the worker’s body is necessary [1]. To identify the most informative biochemical parameters that change in the preclinical stage of vibrational pathology in the blood, the parameters of oxidative metabolism, lipid and mineral metabolism, and the state of muscle tissue were determined [1].

Also known is a method for pre-nosological diagnosis of health problems from local vibration, the essence of which lies in the fact that those working under conditions of local vibration in the blood determine the level of tumor necrosis factor-α and S-100β protein by enzyme-linked immunosorbent assay, after which prognostic factors are determined, according to which they conclude that there are early manifestations of health disorders from the effects of local vibration or their absence [12].

The objective of the invention is to expand the arsenal of methods of early health disorders when exposed to vibration.

The problem is solved by determining the most informative indicators of the state of the peripheral and central nervous systems with the subsequent calculation of diagnostic coefficients and the conclusion that there are early signs of damage to the nervous system when exposed to vibration on the body.

The method is as follows.

The patient is measured vibrational sensitivity at a frequency of 125 Hz visual and auditory long-latent evoked potentials. The following indicators are determined: vibration sensitivity at a frequency of 125 Hz on the zygomatic bone and first toe, amplitude P2 of visual long-latency evoked potentials and P2N2 auditory long-latency evoked potentials, and latency P2 of auditory long-latency evoked potentials.

Then calculate the discriminant function F according to the formula:

F = 365.09-8.1 × A ₁ + 14.57 × A ₂ -8.52 × A ₃ -0.2 × A ₄ -9.6 × A ₅ ,

where F is the discriminant function;

365.09 is a constant;

-8.1; 14.57; -8.52; -0.2; -9.6 - discrimination factors;

A _{1, 2 ... 5} - numerical values of the indicators of the survey:

And ₁ is an indicator of vibration sensitivity at a frequency of 125 Hz on the zygomatic bone;

And ₂ is an indicator of vibration sensitivity at a frequency of 125 Hz on the first toe;

And ₃ is an indicator of the amplitude of P2 of visual long-latency evoked potentials in μV;

And ₄ is an indicator of latency P2 of auditory long-latency evoked potentials in ms;

And ₅ is an indicator of the amplitude of P2N2 auditory long-latent evoked potentials in μV.

With a value of F greater than a constant, the initial signs of the effect of vibration on the body are diagnosed, with F less or equal to a constant, their absence.

A comparative analysis of the proposed solution with the prototype [11] shows that the proposed method is characterized in that the indicators of vibration sensitivity, visual and auditory long-latent evoked potentials were used as informative signs. Thus, the proposed technical solution meets the criteria of the invention of "novelty."

It is known to use indicators of vibration sensitivity at frequencies of 125 and 250 Hz in various parts of the body, including the zygomatic bone and first toe for differential diagnosis of polyneuropathy of vibrational origin and diabetic polyneuropathy [6].

The amplitude index P2N2 of long-wave auditory evoked potentials in the right temporal lead is used in combination with other indicators for the differential diagnosis of polyneuropathy of vibrational origin and diabetic polyneuropathy [5].

The use of the proposed complex of indicators to identify the initial signs of the effect of vibration on the body in the literature available to us has not been identified. The proposed informative indicators allow you to diagnose the initial signs of the effect of vibration on the body with a high degree of accuracy. Thus, the proposed method meets the criterion of "inventive step".

As a result of our neurophysiological examination of workers exposed to local and general vibration for a long time, the effectiveness of a comprehensive examination of the nervous system in order to identify early signs of its damage was confirmed.

The discriminant analysis of the indicators of the neurophysiological examination allowed us to obtain a combination of 5 indicators, in which the accuracy of the diagnosis was maximum.

The coefficients of linear discriminant functions are presented in the table.

The information content of these indicators was 100% in the group of trained patients with exposure to general and local vibration, and 100% in the group of healthy individuals.

The formula is obtained by subtracting the discriminant functions for the trained workers in contact with general and local vibration, and for healthy patients:

F ₁ = -788.28 + 11.99 × A ₁ + 30.6 × A ₂ -17.59 × A ₃ + 0.05 × A ₄ -21.23 × A ₅ ,

F ₂ = -423.19 + 3.89 × A ₁ + 16.03 × A ₂ + 5.5 × A ₃ + 0.25 × A ₄ -11.83 × A ₅ ,

Where

F ₁ is the coefficient of discriminant function when exposed to local and general vibration among the trained patients,

F ₂ - coefficient of discriminant function for a group of healthy individuals,

11.99; 30.6; 17.59; 0.05; 21.23; 423.19; 3.89; 16.03; 5.5; 0.25; 11.83 - discrimination factors;

A _{1, 2 ... 5} - numerical values of the indicators of the survey:

A ₁ - an indicator of vibration sensitivity at a frequency of 125 Hz on the zygomatic bone,

And ₂ is an indicator of vibration sensitivity at a frequency of 125 Hz on the first toe,

And ₃ is an indicator of the amplitude of P2 of visual long-latency evoked potentials (μV),

And ₄ - an indicator of latency P2 auditory long-latent evoked potentials (ms),

And ₅ is an indicator of the amplitude of P2N2 auditory long-latent evoked potentials (μV)

Evaluation of the effectiveness of the proposed diagnostic method was carried out in the training and control samples. In the training sample (59 people), the correct recognition was 100% for interns and 100% for healthy people. In the control sample (40 patients), the correct recognition was 91% for interns and 89% for healthy people.

The proposed method makes it possible to identify early signs of damage to the nervous system when exposed to local and general vibration using a minimum number of the most informative diagnostic indicators, thereby contributing to a decrease in the volume of paraclinical studies.

Example 1

Patient S., aged 47, work experience as a driver of heavy vehicles for 11 years, complains of numbness of the fingers and toes, paresthesia, coldness of the arms and legs, constant aching pains in the arms and legs, especially during work. A neurological examination revealed sensory disturbances in sensitivity of the distal type, positive symptoms of Palya and white spot, hyperhidrosis, hypothermia of the extremities, and movement in the joints in full. The study was conducted:

And ₁ is an indicator of vibration sensitivity at a frequency of 125 Hz on the zygomatic bone - 10,

And ₂ is an indicator of vibration sensitivity at a frequency of 125 Hz on the first toe - 14,

And ₃ is an indicator of the amplitude of P2 of visual long-latency evoked potentials of 1.5 μV,

And ₄ is an indicator of latency P2 of auditory long-latent evoked potentials - 260 ms,

And ₅ is an indicator of the amplitude of P2N2 auditory long-latent evoked potentials - 2.5 μV.

F = 365.09-8.1 × 10 + 14.57 × 14-8.52 × 1.5-0.2 × 260-9.6 × 2.5 = 399.29

399.29> 365.09. F is more than a constant.

Conclusion: Patient S. has initial signs of the effect of vibration on the body.

Example 2

Patient Z., 49 years old, works as an assistant excavator driver, 10 years experience. Complains of pain and numbness in the hands after work, sweating feet. A neurological examination revealed sensory disturbances in the sensitivity of the distal type on n / a, negative symptoms of Palya and white spot, limb hyperhidrosis. The study was conducted:

A ₁ - an indicator of vibration sensitivity at a frequency of 125 Hz on the zygomatic bone - 4,

And ₂ - an indicator of vibration sensitivity at a frequency of 125 Hz on the first toe - 7,

And ₃ is an indicator of the amplitude of P2 of visual long-latency evoked potentials of 3 μV,

And ₄ is an indicator of latency P2 of auditory long-latent evoked potentials - 170 ms,

And ₅ is an indicator of the amplitude of P2N2 auditory long-latent evoked potentials - 5 μV.

F = 365.09-8.1 × 4 + 14.57 × 7-8.52 × 3-0.2 × 170-9.6 × 5 = 327.12

327.12 <365.09. F is less than a constant.

Conclusion: Patient Z. has no initial signs of the effect of vibration on the body.

Example 3

Patient K., age 37 years old, works as a driver of a timber truck, experience 8 years. Complains of heaviness and swelling of the hands and feet after work, weakness in the hands. A neurological examination revealed mild sensory disturbances in the distal type of legs, negative symptoms of Palya and a white spot. Pain on palpation of the spinous processes in the lumbar spine. The study was conducted:

And ₁ - an indicator of vibration sensitivity at a frequency of 125 Hz on the zygomatic bone - 5,

And ₂ - an indicator of vibration sensitivity at a frequency of 125 Hz on the first toe - 9,

A ₃ - an indicator of the amplitude P2 of visual long-latency evoked potentials - 1.6 μV,

And ₄ is an indicator of latency P2 of auditory long-latent evoked potentials - 240 ms,

And ₅ is an indicator of the amplitude of P2N2 auditory long-latent evoked potentials - 3 μV.

F = 365.09-8.1 × 5 + 14.57 × 9-8.52 × 1.6-0.2 × 240-9.6 × 3 = 365

365 = 365. F is equal to a constant.

Conclusion: Patient K. has no initial signs of the effect of vibration on the body.

This invention can be used in medical institutions, centers of occupational pathology and other specialized medical organizations when conducting medical examinations of workers who have contact with general and local vibration.

Literature:

1. Antoshina L.I., Pavlovskaya N.A. Biochemical markers of the effects of vibration on the body of workers and their criteria-based assessment // Occupational Medicine and Industrial Ecology. No. 12. 2009.S. 22-27.

2. Gnezditsky V.V. Evoked brain potentials in clinical practice. - Taganrog: TRTU, 1997 .-- 252 p.

3. Izmerov N.F. Occupational pathology. National leadership. - M .: GEOTAR-Media, 2011 .-- 784 p.

4. Kartapoltseva N.V., Katamanova E.V., Lakhman O.L., Rukavishnikov B.C. A method for the diagnosis of vibrational disease / RU 2345703 C1, 10.02.2009, Bull. Number 4.

5. Kartapoltseva N.V., Lakhman O.L., Rukavishnikov B.C. The method of differential diagnosis of polyneuropathy of vibrational origin and diabetic polyneuropathy / RU 2367348 C1, 09/20/2009. Bull. No. 26.

6. Kartapoltseva N.V., Lakhman O. L., Rukavishnikov B. C., Mikhalevich I. M. "A method for the differential diagnosis of polyneuropathy of vibrational origin and diabetic polyneuropathy" - RU 2361509 C1, Bull. No. 20 dated 07/20/2009.

7. Kolesov V.G. Pathology of the peripheral nervous system and musculoskeletal system of the upper extremities from the effects of "local" vibration in mining workers of the Northern and Eastern regions of the country (principles of early diagnosis and rehabilitation). Abstract. dis. for a job. scientist step. doctors honey. sciences. - Ivanovo, 1995 .-- 39 p.

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Claims (12)

A method for detecting early signs of damage to the nervous system when exposed to local and general vibration, including instrumental examination, determination of informative indicators, followed by counting discriminant function, characterized in that the patient is measured vibration sensitivity at a frequency of 125 Hz on the zygomatic bone and first toe, determine the amplitude P2 of long-latency visual evoked potentials, the latency of P2 and the amplitude of P2N2 auditory long-latent evoked n potentials, calculate the discriminant function according to the formula: F = 365.09-8.1 × A ₁ + 14.57 × A ₂ -8.52 × A ₃ -0.2 × A ₄ -9.6 × A ₅ , where F is the discriminant function; 365.09 is a constant; -8.1; 14.57; -8.52; -0.2; -9.6 - discrimination factors; And _{1, 2 ... 5} are the numerical values of the indicators of the survey: A ₁ - an indicator of vibration sensitivity at a frequency of 125 Hz on the zygomatic bone; And ₂ is an indicator of vibration sensitivity at a frequency of 125 Hz on the first toe; And ₃ is an indicator of the amplitude of P2 of visual long-latency evoked potentials in μV; And ₄ is an indicator of latency P2 of auditory long-latency evoked potentials in ms; And ₅ is an indicator of the amplitude of P2N2 auditory long-latent evoked potentials in μV, with a value of F greater than a constant, the initial signs of the effect of vibration on the body are diagnosed, with F less or equal to a constant, the absence of signs of vibration is detected.