SU1273059A1 - Method of diagnosis of immunocomplex injures of the lungs - Google Patents

Abstract

The invention relates to radiology, immunology, and can be used to diagnose immunocomplex lesions of the lungs. The purpose of the invention - improving the accuracy of diagnosis. The patient is prescribed glucocarticulars, such as prednisone, orally for 7-10 days, 30-50 mg per day, depending on the age and severity of the disease. After the end of the glucocortic coid administration, x-ray examination of the lungs is repeated. Make one front overview shot of the lungs. If the dynamics on the anterior radiograph of the lungs is positive, then I have reduced the size and size of the infiltration and foci sites, there is a tendency to restore the normal structure of the lungs, diagnose immunocomplex lung injury.

Description

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The invention relates to medicine, namely, radiology and immunology, and can be used to diagnose immunocomplex lesions of the lungs. The purpose of the invention is to improve the accuracy of diagnosis. This goal is achieved by the fact that after X-ray diffraction, prednisone is administered for a week, then the X-ray is repeated and, when the pulmonary pattern is changed towards normalization, an immune complex lung lesion is diagnosed. The method is carried out as follows. The patient is prescribed glucocorticoids, such as prednisone, from 30 to 50 kg per day, depending on the duration of the disease and the severity of the pathological process in the lungs. Glucocorticoids are prescribed orally for 7-10 days. The duration of glucocorticoid use and their daily dose depends on the duration of the disease and the severity of the pathological process in the lungs. Other glucocorticoids (urbazone, triampsinolone, dexamethasone) are prescribed in amounts equivalent to the dose of prednisolone. The use of glucocorticoids in a daily dose below 30 mg (prednisolone) for the purposes of radiological diagnosis is ineffective. The range of the daily dose of prednisolone is 30-50 mg for this purpose is optimal. At the end of glucocorticoid intake, a repeated X-ray examination of the lungs is performed, which includes only one anterior observational image of the lungs. The positive dynamics in the anterior observational radiograph of the lungs, expressed in a decrease in the number and size of infiltration sites and foci, as well as a tendency to restore the normal structure of the lungs, diagnose immune complex lung injury. Example. Sick H., 32 years old, was admitted to the therapeutic department with a diagnosis of bilateral focal drain and inferior pneumonia; She complained of a cough with a small amount of sputum difficult to separate, shortness of breath, general weakness, fever up to 37.4 ° C, headache. Ill for a month. A month before the disease, there was an urgent delivery without complications. In the past, did not hurt. Objective: condition of average weight. Pale skin with cyanotic edema. Peripheral lymph nodes are not enlarged. Visible mucous clear, pale. Pulse 92 per minute, rhythmic, satisfactory filling. Blood pressure is 100/60 mm Hg. Borders of the heart in the normal range. The tones are muffled. The number of breaths is 32 per minute. Perkutorno siy pulmonary sound. The breathing is harsh, weak, in the lower parts of the lungs an abundance of finely bubbly loud crepitus. Abdomen, soft, painless. The liver and spleen are not enlarged. Blood test: erythrocytes 4,4x10 l; hemoglobin 144 g / l; color indicator 1.0; leukocytes 5, eosinophils 2%; sugary rod 5%; segment segment 65%; lymphocytes 20%, monocytes 8%, ESR 10 mm per hour. Urinalysis: density 1020, traces of protein, leukocytes 2-3 in the visual field. ECG: sinus rhythm. Left ventricular hypertrophy. Signs of severe myocardial hypoxia. X-ray examination of the organs of the thoracic cavity, in all the lungs, except for the apexes, revealed multiple polymorphic foci of formation in the lower regions with a tendency to merge. The roots on their background are not differentiated. The diaphragm is traced on both sides. Heart and large vessels without pathological changes. It was concluded that the patient is more likely to have bilateral focal pneumonia. Clinical diagnosis in this period: bilateral focal pneumonia plum. Myocardiostrophy. Pulmonary insufficiency II degree. Despite intensive therapy with antibiotics (penicillin, tseporin, chloramphenicol succinate, sulfonamides (Biseptolum), antiinflammatories, cardiovascular drugs and oxygen therapy, the state of the patient continued to deteriorate progressive signs of pulmonary serdech DEFICIENCY. Cyanosis, dyspnea, tachycardia, usilils kaschel with the separation of a small amount of gray viscous sputum, the number of crepitating wheezes in the lungs increased. The patient herself could not get out of bed. sterile. There was no significant change in the blood analysis. At the next x-ray examination of the lungs, a further increase in the number of foci tending to merge and extending almost to the tops of both lungs was noted. The lung pattern due to the abundance of foci is not clearly defined. The ineffectiveness of antibacterial and anti-inflammatory therapy was abolished and a progressive process in the lungs was established, the etiology of which is not sleep. At the consultation, it was decided to exclude immunocomplex lesion of the lung, a glucocorticoid test followed by repeated direct x-ray examination of the lung. To this end, the patient was prescribed prednzolone at a dose of 30 mg per day orally three times a day in equal amounts for a period of 7 days.

With repeated reviewing anterior radiography of the lungs after treatment with prednisolone, the dynamics of the pathological process in the lungs were established: a significant decrease in the number of lesions in the lower and middle sections of the lungs and the number of confluent foci. There is an increase in the airiness of the lungs, especially in their upper sections, and multiple areas of bullous swelling in the central sections of the lungs. The pulmonary pattern became more differentiated, basically it was rebuilt according to fine cellular network. You find the unstructured roots of the lungs.

Based on the clear positive dynamics found on the repeated anterior radiograph of the lungs after the test with glucocorticoids, a diagnosis of a multi-complex pulmonary lesion, namely Hammenich syndrome (idiopathic fibrosing alveolitis, desquamative form) was made. The patient was prescribed pathogenetic therapy, and her condition began to improve: the phenomena of pulmonary heart disease gradually decreased, coughing and sputum production ceased, weakness disappeared, and body temperature returned to normal.

The patient was in a satisfactory condition and was discharged for outpatient treatment. In a control radiological study of the patient, it was found that focal and infiltrative changes in the lungs are absent, the roots of the lungs are structural, pulmonary pattern with moderate fibrous transformation in a finely cellular type in the lower sections of the lungs.

The invention provides a reduction in the time of diagnosis by two times and improves the accuracy of diagnosis, which makes it possible to prescribe pathogenetic immunosuppressive therapy in a timely manner until serious complications of the disease appear and, consequently, prolong the life of patients.

Claims (1)

Invention Formula A method for diagnosing immunocomplex lesions by radiography of the lungs, characterized in that, in order to improve the accuracy of diagnostics, prednisolone is administered after radiography for a week, then x-rays are repeated and, when the pulmonary pattern is changed towards normalization, an immunocomplex lesion is diagnosed.