RU2640187C1 - Method for endogenous intoxication diagnostics in case of reperfusion syndrome after arterial circulation restoration - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: while diagnosing endogenous intoxication in case of reperfusion syndrome before and after arterial circulation restoration, coefficient K, reflecting the proportion of nitrogen-containing compounds (ACC) in residual nitrogen (RN) is calculated, according to the formula, where RN is residual nitrogen, U is urea, Cr is creatinine, UA is uric acid. If the specific gravity of nitrogen-containing compounds increases with respect to the residual nitrogen after arterial blood flow restoration in comparison with the parameters before restoration, development of endogenous intoxication is diagnosed.EFFECT: method allows to diagnose endogenous intoxication in case of reperfusion syndrome after arterial blood circulation restoration.1 tbl

Description

The invention relates to medicine, to the field of laboratory diagnostics, and directly to the diagnosis of endogenous intoxication with reperfusion syndrome after restoration of arterial circulation.

Assessing endogenous intoxication, it should first be noted that endotoxins are the so-called medium-weight molecules.

The section Biochemical methods for the diagnosis of endogenous intoxication (V.M. Aksenova) provides data (http://www.gastroportal.ru/php/content.php?id=111393&pr=print), which is a class of medium molecular proteolysis products (i.e., catabolism products proteins) are referred to as medium weight molecules (MSM). The chemical composition of MSM is very heterogeneous and unites a heterogeneous group of substances. It includes peptides, glycopeptides, nucleopeptides, endorphins, amino sugars, polyamines, polyhydric alcohols, some humoral regulators - insulin, glucagon, some vitamins, nucleotides, oligosaccharides, derivatives of glucuronic acids and others.

In the works of V.N. Titova (2004) suggests that in aseptic inflammation, endogenous pathogens are protein molecules that escape from the cytosol into the intercellular medium, lymphatic flow and blood when the integrity of the membranes of cells of different organs is compromised, in particular with myocardial infarction, systemic lupus erythematosus and rheumatoid arthritis - these are creatine kinase, LDH, myoglobin and troponins; as well as autoimmune complexes formed in the intravascular pool, and protein macromolecules, physiological components of blood serum that have an aphisiological conformation (spatial, steric form of the molecule). According to V.N. Titova (2004), the endogenous pathogens that initiate inflammation in atherosclerosis are apparently lipid-transporting macromolecules — lipoproteins — modified during oxidative stress (physiologically denatured). Section: Biochemical methods for the diagnosis of endogenous intoxication (V.M. Aksenova) - http://www.gastroportal.ru/php/content.php?id=l11393&pr=print.

Thus, the catabolism of macromolecules in which there are protein fragments, or completely consisting of it, is a substrate for the formation of endotoxins - MSM.

From the data of the sites below it follows (http://diabet-gipertonia.ru/analiz/19_azotistye_komponenty_krovi.html; http://biohimik.net/ostatochnyj-azot) that the excess intake of nitrogen-containing substances into the blood due to the increased breakdown of tissue proteins is called production azotemia. In this case, kidney function is not impaired. The table below shows the normative indicators of the main nitrogen-containing components of the residual nitrogen:

(http://biohimik.net/ostatochnyj-azot).

(http://diabet-gipertonia.ru/analiz/19_azotistye_komponenty_krovi.html).

It should be noted that creatinine, urea and uric acid are the final products of catabolism, while nitrogen-containing compounds are intermediate metabolites formed when it is incomplete, which may be due to a lack of oxygen. In this case, the maximum allowable, total normal indicators of amino acids and other nitrogen-containing compounds are 33-38% or 0.33-0.38 with respect to the indicators of residual nitrogen.

Reperfusion syndrome develops in the restoration of arterial circulation after acute or chronic transient tissue ischemia. Against the background of impaired arterial circulation, tissue ischemia develops, as a result of which there is a decrease in oxygen transport in the tissue and due to this, the transition of life support to anaerobic catabolism. Anaerobic catabolism is characterized by the breakdown of macromolecular compounds into intermediate toxic metabolites. In case of arterial circulatory disturbance, there is a decrease in the intake of not only oxygen to organs and tissues, but also universal, easily digestible energy carriers - carbohydrates. Under such conditions, protein catabolism is activated, the intermediate products of which are nitrogen-containing compounds, the specific gravity of which in residual nitrogen increases. At the same time, the indicators of urea, creatinine and uric acid, which are the final products of catabolism, do not significantly change. Due to the lack of amino acid intake in cases of arterial circulation, an increase in residual nitrogen will occur due to the formation of intermediate nitrogen-containing metabolites.

After the restoration of arterial blood flow, an increase in the specific gravity of nitrogen-containing compounds in the composition of residual nitrogen will indicate the development of endogenous intoxication against the background of reperfusion syndrome.

The task of the invention is the diagnosis of endogenous intoxication with reperfusion syndrome after restoration of arterial circulation.

This is achieved by using a method for diagnosing endogenous intoxication in reperfusion syndrome after restoration of arterial circulation, characterized in that before and after restoration of arterial circulation in reperfusion syndrome, the coefficient K _{ACC / OA is} calculated, which reflects the specific gravity of nitrogen-containing compounds (ACC) in the composition of residual nitrogen (OA) according to the formula:

where OA is the residual nitrogen (mmol / l),

M - urea (mmol / l),

Cr - creatinine (mmol / l),

MK - uric acid (mmol / l),

and with an increase in the specific gravity of nitrogen-containing compounds with respect to residual nitrogen after restoration of arterial blood flow compared with indicators before recovery, the development of endogenous intoxication is diagnosed.

The method is as follows: before and after restoration of arterial blood circulation and determination of residual nitrogen, urea, creatinine and uric acid in the blood, the coefficient K _{ACC / OA} reflecting the specific gravity of nitrogen-containing compounds (ACC) is calculated by the formula:

where OA is the residual nitrogen (mmol / l),

M - urea (mmol / l),

Cr - creatinine (mmol / l),

MK - uric acid (mmol / l),

and with an increase in the specific gravity of nitrogen-containing compounds with respect to residual nitrogen after restoration of arterial blood flow compared with indicators before its restoration, the development of endogenous intoxication is diagnosed.

Example: Patient K., 32 years old, with Ds: Symptomatic uterine fibroids of large sizes (15-16 weeks). Immediately before the operation, the indices of residual nitrogen were determined - 10.8 mmol / l; urea - 6.4 mmol / l; creatinine - 0.11 mmol / l; uric acid - 0.47 mmol / l; respectively, azo containing compounds amounted to 3.82 mmol / L. Moreover, the coefficient K _{ACC / OA} = 0.35, that is, corresponds to normal indicators (0.33-0.38). The operation was performed: laparoscopic conservative myomectomy. In order to reduce the risk of intraoperative blood loss during surgery, the internal iliac arteries were cleared, which facilitated the conditions for conservative myomectomy. After the main stage of the operation, the terminals were removed, arterial blood flow restored in the internal iliac arteries. At the end of the operation, a blood sampling was performed and the content of residual nitrogen (38.8 mmol / L), urea (8.6 mmol / L), creatinine (0.13 mmol / L), uric acid (0.57 mmol) was determined in it / l), respectively, nitrogen-containing compounds amounted to 29.5 mmol / l, and the coefficient K _{ACC / OA} = 0.76, which significantly exceeded normal values and indicators before the development of reperfusion syndrome. Infusion detoxification therapy was performed. 1 day after the operation, the residual nitrogen content is 20.1 mmol / l, urea is 8.7 mmol / l), creatinine (0.14 mmol / l), uric acid (0.56 mmol / l), respectively, are nitrogen-containing compounds amounted to 10.7 mmol / l, and the coefficient K _{ACC / OA} = 0.53, indicating a decrease in endogenous intoxication. Subsequently, detoxification therapy was carried out. The postoperative period without complications. Recovery.

A method for diagnosing endogenous intoxication in reperfusion syndrome after restoration of arterial circulation with a positive result was used in more than 180 patients with operations with temporary occlusion of the internal iliac arteries during conservative myomectomy and in 14 patients with acute femoral thrombosis, after thrombectomy and restoration of arterial blood flow along the femoral artery.

Thus, the method for diagnosing endogenous intoxication in reperfusion syndrome after restoration of arterial circulation by detecting an increase in the specific gravity of nitrogen-containing compounds in the residual nitrogen after restoration of arterial circulation allows diagnosing the development of endogenous intoxication and its severity, thereby solving the problem.

Claims (8)

A method for the diagnosis of endogenous intoxication in reperfusion syndrome after restoration of arterial circulation, including determination of residual nitrogen (OA), urea (M), creatinine (Cr) and uric acid (MK) in the blood, characterized in that before and after restoration of arterial circulation during reperfusion the syndrome calculate the coefficient K _{ACC / OA} , reflecting the specific gravity of nitrogen-containing compounds (ACC) in the composition of residual nitrogen (OA), according to the formula

Where OA - residual nitrogen (mmol / l), M - urea (mmol / l), Cr - creatinine (mmol / l), MK - uric acid (mmol / l), and, with an increase in the specific gravity of nitrogen-containing compounds with respect to residual nitrogen after restoration of arterial blood flow compared with indicators before recovery, the development of endogenous intoxication is diagnosed.