SU1287000A1 - Method of setting differential diagnosis between virus hepatitis and icterus - Google Patents

Abstract

This invention relates to the field of medicine. The purpose of the invention is to improve the accuracy of the method. Blood is taken from a patient before treatment begins with prednisone and 5-7 days after treatment with this drug. A solution of conglome and a saturated solution of sodium chloride are introduced into a test tube with blood serum. The mixture was kept for 24 hours at 37 ° C, filtered, diluted with distilled water and photocolorimetrichesk. With an increase in the binding ability of serum albumin 1.6 times or more, the diagnosis of viral hepatitis is established. 1 tab. about $ (L

Description

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The invention relates to medicine and can be used for the differential diagnosis of viral hepatitis and obstructive jaundice.

The aim of the invention is to improve the accuracy of the method due to the fact that the ability of the serum albumin of the goths to the patient before the administration of prednisolone and 5-7 days from the start of treatment is determined.

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The method is carried out as follows.

In a patient with jaundice of uneasy etiology (hepatocellular or mechanical), blood is drawn before treatment begins with prednisolone and 5-7 days after its daily prescription in the mean therapeutic dose (40-60 mg per day). To do this, 5 ml of 0.1% congote solution and a saturated solution of sodium chloride are successively introduced into a tube with 0.1 ml of serum. The mixture is aged 24 hours at, filtered, diluted 1: 5 in distilled water and photocolorimeted. The result of the study is expressed in units of extinction.

In the case of an increase in the binding capacity of serum albumin 1.6 times (see table) and more, under the influence of prednisone therapy, the diagnosis of viral hepatitis is established, and in the absence of a positive effect, mechanical jaundice is diagnosed.

Example. Sick M., 69 years old, was admitted to the clinic of infectious diseases with a diagnosis of viral hepatitis. She complained of the presence of jaundice, the same in the right hypochondrium, poor appetite, dry mouth. The intensity of jaundice is average. The liver was enlarged by 3-4 cm. Blood bilirubin 163.56 µmol / L with a predominance of the direct fraction (141.0 µmol / L). Blood alanine aminotransferase activity 4.65 mmol / (tsp).

Complex therapy with conventional detoxification, anti-inflammatory and tonic agents was unsuccessful: jaundice began to increase, skin itching

Appointed prednisone 40 mg per day inside. Before the start of the course of prednisone therapy

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albumin function was 0.21 units. extinction. A repeated blood test after 7 days showed a decrease in the bilirubin content to 138.18 µmol / L (direct 121, 26 µmol / L of alanine aminotransferase activity to 2.26 mmol / (hp) and the binding function of serum albumin to 0.14 extinction units.

The absence of an increase in the binding capacity of blood albumin in the process of prednisone therapy, despite a partial reduction in hyperbilinemia and hypertransferasemia, made it possible to express the mechanical nature of jaundice. The patient was transferred to a surgical clinic where, during a laparotomy, cancer of the pancreatic head, complicated by obstructive jaundice, was detected.

PRI mme R 2. Sick V., 42 years old. Gutters for marked yellowness of the sclera and skin, severe general weakness, nausea, vomiting, abdominal pain. Objectively: the condition of the average body weight, the liver at the costal arch, the feces are acholicy, the blood bilirubin is 78.96 µmol / L (direct 62.04 µmol / L), the alanine aminotransferase is 1.83 mmol / (h. .) These amidamnesis without features.

Complex therapy remained unsuccessful, jaundice increased, the concentration of bilirubin increased to 124.06 µmol / l, the activity of ananin aminotransferase - up to 4.23 mmol / (tsp). Therefore, a differential course of prednisone was prescribed for differential diagnostic and treatment purposes (initial daily dose of 60 mg).

Prior to the administration of prednisolone, the binding capacity of serum albumin was 0.16 units. extinction, 5 days after the start of treatment - 0.302 units. extinction.

As can be seen from the above data, there was a rapid and pronounced increase in the binding function of albumin. Therefore, in view of the cited clinical data, the diagnosis of viral hepatitis was made.

PRI me R 3. Patient B ,, 70 years old, was admitted to the clinic of infectious diseases with a diagnosis of viral hepatitis.

Complaints of cutaneous tooth, jaundice, weakness, loss of appetite. The path of possible infection is not identified. The overall state of average gravity. The edge of the liver is 5 cm below the costal arch.

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dense constancy. The spleen is not enlarged. Blood test: leukocytes iOjOxlO / n; red blood cells 13%; sugary rod 2%; segmentary 66%; lymphocytes 18%; monocytes 1%; ESR 17 mm / h; 174.84 µmol bilirubin (direct 135.36 µmol / L); alanine aminotransferase 2.63 mmol / (tsp)

Basic and disinfection therapy was prescribed. However, the patient's condition worsened, skin itching increased, jaundice increased.

No obstructive jaundice has been identified. An indicator of albumin binding (0.1 1 units of extinction) was determined and a course of prednisolone was prescribed with an initial daily dose of 60 mg.

During the first week, prednisone therapy improved appetite, jaundice and itching of the skin decreased, the level of bilirubinemia decreased from 276.36 to 248.16 μmol / l. However, the ability of serum albumin to bind congorot was 0.11 units. extinction.

Further observation has shown that clinical improvement due to

prednisone therapy was short-lived. The diagnosis of liver cancer was confirmed at the consultation, confirmed in the pathoanatomical section.

Thus, in comparison with the known method, the diagnostic accuracy is increased by 15-20%.

Claims (1)

Invention Formula The method of differential diagnosis of viral hepatitis and obstructive jaundice by biochemical examination of blood serum followed by photocolorimetric measurement, characterized in that, in order to improve the accuracy of the method, the patient is given prednisone therapy, the serum is tested the serum is added and the Congo red indicator and at the extinction level, which exceeds the initial one, viral hepatitis is diagnosed, and if the extinction is equal or decreased in comparison with the outcome oh - mechanical jaundice. Viral hepatitis 0.147 ± 0.01 Mechanical jaundice 0.155 ± 0.02 0.242 ± 0.01 0.131 ± 0.01 in 1, 6 times 0.001 0.05