RU2674770C1 - Method for predicting risk of development of ventricular premature beats in athletes - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to the field of medicine, namely to pediatric cardiology, and relates to a method for predicting the risk of developing ventricular premature beats in children who have been engaged in sports activities for 2–3 years. Essence of the method: in children who have been engaged in sports activities for 2–3 years, a study of blood serum is performed and the concentration of immunochemical parameters is determined: tumor necrosis factor-α, interleukin-10 and anti-cardiac antibodies -COS-05. Further, a high risk of ventricular premature beats is predicted at a concentration of tumor necrosis factor-α from 13.2 to 15.1 pg/ml, at a concentration of interleukin-10 from 18.1 to 21.3 pg/ml and at a concentration of anti-cardiac antibodies -COS-05 from 10.1 to 15.8 standard units; a low risk of ventricular premature beats is predicted. When the concentration of tumor necrosis factor-α is from 9.8 to 10.6 pg/ml, with the concentration of interleukin-10 from 14.3 to 17.3 pg/ml and with the concentration of anti-cardiac antibodies -COS-05 from 7.1 to 9.8 standard units.EFFECT: proposed invention is aimed at improving the accuracy of predicting the risk of developing ventricular premature beats in children engaged in sports.1 cl, 1 tbl, 4 ex

Description

The invention relates to medicine, namely to pediatric cardiology, and can be used to predict the risk of ventricular extrasystole in children involved in sports.

Prediction of the development of cardiac arrhythmias is an urgent medical problem due to the complexity of early diagnosis and a significant negative impact on the quality of life of patients.

With the introduction of the TRP standards and presidential programs for the development of children's sports, its importance in achieving high sports results is based on the state of processes of adaptation to physical activity. Long and intense training in children can adversely affect the work of the cardiovascular system and manifest itself in the form of a decrease in tolerance to physical activity, which is also characterized by a change in immunological parameters.

From the practice of medicine, methods for assessing the functional activity of the heart muscle, as well as the state of cardiomyocytes, are known.

So, there is a method for predicting adaptation disorders in children in the early neonatal period (Sinchikhin S.P. et al. Patent for invention No. 227990, published March 10, 2005, Bull. Inventions No. 7).

In this work, in order to predict adaptation in newborns, we use the determination of the levels of tumor necrosis factor - alpha and immunoglobulin subclass G ₂ , and with the value of tumor necrosis factor-α - 22.5-52.0 pg / ml, immunoglobulin G ₂ - 1, 49-2.03 mg / ml predict pronounced adaptation dysfunctions; with a tumor necrosis factor-α value of 16.0-20.5 pg / ml, an immunoglobulin G _{2 of} 2.30-2.70 mg / ml moderate adaptation dysfunctions are predicted, and with a tumor necrosis factor-α value of 14.3 -15.9 pg / ml, immunoglobulin G ₂ - 2.86-3.18 mg / ml predict a favorable course of adaptation.

The disadvantages of this method are:

- the level of tumor necrosis factor - α reflects the activity of only pro-inflammatory processes, at the same time, the state of anti-inflammatory processes is not given due attention;

- a change in the levels of immunoglobulin G ₂ depends on antigenic stimulation and reflects immune disorders in the body, but cannot be used to characterize the state of the myocardium and detect dysfunction of the cardiac conduction system;

- the state of the levels of tumor necrosis factor-α and immunoglobulin G ₂ is determined in children of the neonatal period.

Thus, the simultaneous determination of the levels of tumor necrosis factor-α and the immunoglobulin G ₂ subclass does not allow predicting the risk of ventricular extrasystoles in children involved in sports.

In addition, there is a quantitative method for using the polymerase chain reaction to detect the expression of interleukin-4 genes in peripheral blood in the physiological state in adults (Abstract CN 1629316 (A) - 20050622 (Fluorogenic quantitative PCR method for detecting interleukin 4 gene expression in peripheralblood under physiological state , inventor (s): Chen Peijie; Dong Qianggang; Wang ru [cn] Applicant (s): shanghai physical education in (Shanghai Physical education institute)). The authors propose a quantitative method for determining the immunochemical marker cytokine-4 in peripheral blood, and the method can also be used for specific expression of the cytokine gene, interleukin-4, to determine the early stage of fatigue and prevent a decrease in immunological reactivity caused by excessive physical exertion.

The disadvantages of this method are:

- to predict the risk of ventricular extrasystole in children who have been involved in sports for a long time, it is not enough to use one indicator;

-concentration of interleukin-4 reflects the activity of anti-inflammatory processes in the body, at the same time, the state of pro-inflammatory processes is not evaluated;

- an increase in the concentration of interleukin-4 does not reflect the state of the heart muscle, so using it to predict ventricular extrasystole in children is not advisable.

The present invention is aimed at improving the accuracy of predicting the risk of ventricular extrasystole in children involved in sports for 2-3 years.

The specified technical result of the method is achieved by determining the concentration of tumor necrosis factor-α, interleukin-10 and anti-cardiac antibodies -COS-05 in the blood serum of children involved in sports for 2-3 years, while predicting a high risk of ventricular development extrasystoles at a concentration of tumor necrosis factor-α from 13.2 to 15.1 pg / ml, at a concentration of interleukin-10 from 18.1 to 21.3 pg / ml and at a concentration of anticardial antibodies -COS-05 from 10.1 to 15.8 srvc units; they predict a low risk of developing ventricular extrasystole with a tumor necrosis factor-α concentration of 9.8 to 10.6 pg / ml, an interleukin-10 concentration of 14.3 to 17.3 pg / ml and a concentration of anti-cardial antibodies -COS-05 from 7.1 to 9.8 srvc units

Existing clinical and laboratory research methods do not allow to objectively predict the risk of ventricular extrasystole in this category of patients.

As a result of this, it is important to use comprehensively the determination of concentrations of immunochemical parameters, including pro- and anti-inflammatory cytokines, as well as anti-cardiac antibodies that have not found sufficient use in predicting the risk of ventricular extrasystole in young athletes.

The advantage of our proposed method is the use for determining the risk of ventricular extrasystole determination in children involved in sports for 2-3 years, the concentrations of tumor necrosis factor-α, interleukin-10 and anti-cardial antibodies -COS-05.

This allows not only to predict the risk of developing further ventricular extrasystole in them, but also to more differentially approach the preparation of children for serious sports, as well as develop individual physical training programs for them.

Exercising is a powerful stress for the whole body and the immune system in particular. The imbalance in the child’s immune system that exists before this can be significantly exacerbated.

It is known that the tumor necrosis factor alpha (TNF-α) refers to pro-inflammatory cytokines. It dramatically increases the formation of hydrogen peroxide by macrophages and neutrophils, activates catabolic processes, has a negative inotropic effect on the myocardium, and also causes its metabolic depletion. It modulates the activity of other cytokines, contributing to the development of inflammation. High levels of TNF-α are known to be associated with sinus node dysfunction.

Interleukin-10 (IL-10) refers to anti-inflammatory cytokines. It has negative regulatory activity against inflammatory processes. Its products perform purely inhibitory functions, that is, it is capable of inhibiting the synthesis of all inflammatory cytokines. IL-10 can inhibit the cellular immune response, while stimulating the proliferation of B-lymphocytes and the humoral immune response.

Thus, the imbalance in the levels of pro- and anti-inflammatory cytokines largely determines the development of the inflammatory reaction.

It is known that with infectious toxic cardiopathy, an increase in the production of antibodies to the conduction system and cardiomyocytes was detected. Changes in the levels of anticardial antibodies can be observed both in inflammatory and non-inflammatory myocardial diseases, and they can act as witnesses of the pathological process and be aggressors. Increased levels of COS-05 anticardial antibodies (AT COS-05) accompany the development of stress-induced myocardial remodeling in young athletes.

Long and intense training in young athletes is accompanied by changes in the metabolism of cardiomyocytes and even lead to its remodeling.

Determination of the concentration of TNF-α, IL-10 and AT COS-05 in children involved in sports for 2-3 years will allow an objective assessment of the myocardium and predict the risk of ventricular extrasystole.

The proposed method was successfully tested during 2015-2017. in the GBUZ JSC "Regional Physical Dispensary" for 129 children who have been involved in sports for 2-3 years and underwent regular examination on the basis of this medical institution.

The data obtained were processed by the method of variation statistics and are presented in table 1.

Below are the results of testing.

Example No. 1.

Child T., a boy, 11 years old. Since 8 years old he has been engaged in freestyle wrestling. No complaints at the time of inspection. Physical exercise tolerates well. The condition is satisfactory. Height 138 cm, weight - 31 kg. The skin is pale pink. Subcutaneous fat is developed moderately, distributed evenly. The musculoskeletal system is developed satisfactorily, muscle strength is sufficient. Vesicular respiration in the lungs, respiratory rate 20 per minute.

The apical impulse is palpated in the 5th intercostal space on the left. Borders of the heart: the right one is in the middle between the right parasternal and right sternal lines, the upper one is located at the level of the third rib, the left one is 0.5 cm outward from the left mid-clavicular line. Heart rate is 85 beats per minute. Heart sounds are clear, loud, rhythmic. HELL = 105/70 mm Hg The liver is palpated along the edge of the costal arch.

On the ECG - respiratory arrhythmia, normal position of the electrical axis. Incomplete blockade of the right bundle branch block.

Based on clinical data and the results of instrumental studies, it is difficult to assess the risk of developing ventricular extrasystole.

To more accurately assess the risk of developing ventricular extrasystole, the child was additionally immunochemically tested for blood serum by enzyme-linked immunosorbent assay, in order to determine the concentration, the concentrations of cytokines were determined: tumor necrosis factor α, interleukin-10, as well as the concentration of anticardial antibodies-COS-05. The procedure for enzyme immunoassay was carried out in accordance with the attached instructions. As a result, it was found that the concentration of TNF-α in the boy is 9.8 pg / ml, IL-10 - 14.3 pg / ml, and AT COS-05 - 7.1 conv. units

The data obtained were compared with the values given in table No. 1.

Our concentration analysis showed that the results of the study fall into the range that allows us to predict a low risk of ventricular extrasystole in this child.

Example No. 2.

Baby E. girl, 9 years old. He has been swimming since 7 years. There are no complaints. Physical exercise tolerates well. The condition is satisfactory. Height 130 cm, weight 28 kg. The skin is pale pink. Vesicular breathing, respiratory rate 22 per minute.

The apical impulse is not changed. Borders of the heart: the right one is in the middle between the right parasternal and right sternal lines, the upper one is located at the level of the 3rd rib, the left one is 0.5 cm outward from the left mid-clavicular line. The heart rate is 87 beats per minute. Heart sounds are loud, rhythmic. HELL = 100/65 mm Hg The liver is along the edge of the costal arch.

On the ECG - sinus rhythm, the normal position of the electrical axis of the heart.

The child was determined by determining the concentration of TNF-α, IL-10, AT COS-05 in serum according to the method described in example 1.

It was found that the level of TNF-α was 10.6 pg / ml, IL-10 - 17.3 pg / ml, AT COS-05 - 9.8 srvc. units Similar values, as can be seen from table No. 1, allow us to predict a low risk of ventricular extrasystole in this child.

Example No. 3.

Child V. girl, 8 years old. He has been cheerleading since 6 years. There are no complaints. Physical exercise tolerates well. He regularly takes part in competitions. The condition is satisfactory. Height 125 cm, weight - 25 kg.

The skin is tan. Vesicular breathing, respiratory rate 20 per minute.

The apical impulse is not changed. Borders of the heart: the right one is in the middle between the right parasternal and right sternal lines, the upper one is located at the level of the 3rd rib, the left one is 0.5 cm outward from the left mid-clavicular line. Heart rate 86 beats per minute. Heart sounds are loud, rhythmic. HELL = 100/70 mm Hg The liver is along the edge of the costal arch.

On the ECG - sinus rhythm, the normal position of the electrical axis of the heart.

On ECHO-KG: ectopically located chord of the left ventricle. Based on clinical data and the results of instrumental studies, it is difficult to assess the risk of developing ventricular extrasystole.

Therefore, the child was determined the concentration of TNF-α, IL-10, AT COS-05 and it was found that the concentration of TNF-α was 13.2 pg / ml, IL-10 - 18.1 pg / ml, AT COS-05 - 10.1 conv. units Similar values, as can be seen from table No. 1, allow us to predict a high risk of ventricular extrasystole.

This example shows the advantage of the proposed forecast method, which is expressed in the fact that it allows you to predict the presence of a high risk of ventricular extrasystole in a child, in the complete absence of its clinical and instrumental manifestations.

Example No. 4.

Child W., a boy, 12 years old. Since 10 years, has been involved in handball. No complaints at the time of inspection. Physical exercise tolerates well. The condition is satisfactory. Height is 149 cm, weight - 40 kg. The skin is of normal color. The respiration in the lungs is vesicular, percussion above the lungs, clear pulmonary sound, respiratory rate 18 per minute.

Visually, the region of the heart is not changed. The apical impulse is palpated in the 5th intercostal space on the left. Borders of the heart: the right one is in the middle between the right parasternal and right sternal lines, the upper one is located at the level of the third rib, the left one is 0.5 cm outward from the left mid-clavicular line. Heart rate 79 beats per minute. Heart sounds are clear, loud, respiratory arrhythmia. HELL = 110/70 mm Hg The liver is palpated along the edge of the costal arch.

On the ECG - respiratory arrhythmia, normal position of the electrical axis.

The child was determined by the concentration of TNF-α, IL-10, AT COS-05 in serum.

It was found that the concentration of TNF-α was 15.1 pg / ml, IL-10 - 21.3 pg / ml, AT COS-05 - 15.8 conv. units Similar values of immunological parameters, as can be seen from table No. 1, allow us to predict a high risk of ventricular extrasystole in this child.

The presented clinical examples clearly demonstrate the practical implementation of the proposed method for predicting the risk of ventricular extrasystole in children involved in sports for 2-3 years. The specified technical result is achieved due to the combination of all the components of the proposed method, their sequence and modes of its implementation.

The positive effect of the proposed method is achieved by increasing the accuracy of predicting the risk of ventricular extrasystole in children who have been involved in sports for a long time, by assessing the state of immunological parameters. Predicting the risk of developing ventricular extrasystole is the basis for determining a specific amount of physical activity and developing individual physical training programs for children who are seriously involved in sports.

This will allow with high accuracy to predict the risk of ventricular extrasystole in young athletes, since the accuracy of the method is 95%.

This method is at the same time technically simple, reliable and available for wide practical application, since it does not require the use of expensive reagents and equipment.

Note:

TNF-α - tumor necrosis factor-α;

IL-10 - interleukin-10;

AT COS-05 - anticardial antibodies;

n is the number of observations;

* - M ± m, where M is the arithmetic mean value, and m is the standard error of the arithmetic mean;

** - scatter of values of indicators (minimum and maximum values);

p is the reliability criterion of values when comparing indicators in children with a high and low risk of developing ventricular extrasystole.

Claims (1)

A method for predicting the risk of ventricular extrasystole in athletes, including determining in the blood serum of children involved in sports for 2-3 years, the concentration of tumor necrosis factor-α, interleukin-10 and anti-cardiac antibodies -COS-05, while predicting high the risk of developing ventricular extrasystole with a concentration of tumor necrosis factor-α from 13.2 to 15.1 pg / ml, with an interleukin-10 concentration of 18.1 to 21.3 pg / ml and with a concentration of anti-cardial antibodies -COS-05 of 10 , 1 to 15.8 conv. units; they predict a low risk of developing ventricular extrasystole with a tumor necrosis factor-α concentration of 9.8 to 10.6 pg / ml, an interleukin-10 concentration of 14.3 to 17.3 pg / ml and a concentration of anti-cardial antibodies -COS-05 from 7.1 to 9.8 srvc units