SU1471133A1 - Method for diagnosing active rheumatic process - Google Patents

Abstract

This invention relates to the field of medicine, in particular, to rheumatology. The aim of the invention is to improve the accuracy of the method. For this, the concentration of oxidized and reduced pyridine nucleotides is determined in the erythrocytes by obtaining acidic and alkaline extracts, which are then processed according to the method of A.G. Halmuradov for fluorimetric measurement. At the same time, hematocrit is determined and recalculated for 1 ml of erythrocytes. By reducing the level of the first indicator and simultaneously increasing the second indicator relative to the norm, an active rheumatic process is diagnosed. The method is simple to perform and allows diagnostics with an accuracy of up to 98%. 1 tab.

Description

one

The invention relates to medicine, namely to rheumatology, and dp diagnosis of an active rheumatic process can be used.

The purpose of the invention is to demonstrate the accuracy of the method.

The method is carried out as follows.

Upon admission of a patient with suspected active rheumatism to the hospital, his clinical examination is carried out, including electro- and phonocardiographic, X-ray studies and determination of clinical and biochemical tests: complete blood count, diphenylamine sample, sialic acids, glycoproteins, a inografy test, antistreptococcal antibody titers. Additionally, diagnostics of the activity of the rheumatic process is conducted, the content of oxidized and reduced nicotin-amide coenzymes in erythrocytes is determined.

To determine the oxidized pyridine nucleotides in the erythrocytes, 2 ml of blood is drawn from the cubital vein into a volumetric centrifuge tube containing 2.0 ml of a 25% trichloroacetic acid solution and 6.0 ml of double-distilled water, shaken and centrifuged at 1500 rpm 20 min. The content of reduced nicotinamide coenzymes in erythrocytes is determined in parallel. 2 ml of blood is taken from the ulnar vein into a centrifuge tube containing 7 ml of a 0.3 M solution of sodium bicarbonate prepared in 25% ethanol and cysteine is immediately added to the final

WITH

with

concentrations of 1 mM. The contents of the tubes are also centrifuged for 20 minutes at 1500 rpm, and aliquots of the obtained acidic and alkaline extracts of the preparations are prepared for fluorimetric measurement in full accordance with the description of the known technique. At the same time, the hematocrit is determined and recalculated for 1 ml of erythrocytes using the formula: X A x 0.1: x

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X and-S where A is the calibration curve, µg / ml 0.1 is the amount of blood taken for the test; 0.4 recalculation factor, taking into account that the degree of fluorescence of nicotinamide coenzymes is 2.5 times greater than that of N-methyl nicotine; N. - hematocrit.

129 patients with rheumatism were examined, out of 1 SH 1 2 people in the inactive period of the disease and 117 with signs of the process activity divided by the degree of activity into two groups: 60 patients with minimal and 57 with pronounced activity of the process. As a control, 7.5 healthy individuals and 6 patients without a rheumatic process (with neurotifutory dystonia) were examined,

It has been established that in the inactive period of rheumatism the content of oxidized and reduced nicotinamide coenzymes in erythrocytes does not differ from that in healthy people. Similar., The data were obtained during examinations of Atshi patients without rheumatism. The data are given in the table.

With minimal activity of the rheumatic process, the concentration of oxidized pyridine halide in erythrocytes decreases, and the number of their reduced forms increases.

Example 1, Patient G., 22 years old, entered the cardio-rheumatology department with complaints of pain in the area of the upper heart of the heart, moderately during exercise, which recently appeared, of the volatile nature of pain in large joints without signs of inflammation. W, periodic increase in temperature, fatigue and general weakness. Sick with rheumatism for 8 years, History of 3 rheumatic attacks; chronic decompensated tonsillitis.

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Objectively: the joints are not changed, the shift of the borders of the relative dullness of the heart to the left and up. During auscultation and on the uCG, a three-membered rhythm, systolic and presystolic noise at the apex, accent II tone above the pulmonary trunk is determined. Pulse rhythmic 96 n G, HELL 130/80 mm Hg On ECG, there are signs of left atrial and both ventricular hypertrophies, a decrease in the amplitude of the T wave in the X-ray examination of the mitral configuration of the heart, the results of laboratory data: leukocytes 6.8-10 / l; ESR 6 mm / h; sialic acid 2.42 mm / l; S-RB neg. total protein 64 g / l; albumin 53.6%, globulins oi, 4.4%; cx 8.8%; p 15.5%; in 17.7%; antistrepto-lysino titer 0-1: 250.

Thus, when examining a patient with an obs; the division of rheumatism activity was not revealed. The patient additionally carried out the determination of the activity of the rheumatic process by the proposed method. A decrease in the level of oxidative pyridine nucleotides was found to 58.37 μM / l of erythrocytes, i.e. “1.5 times comp. with normal (89,14 ±, 55) and at the same time an increase in the restored forms to 61.96 μM / l of erythrocytes, i.e. I; 1.3 times compared with the norm (47,774: 2,42) 5 which, together with the data of the clinical picture, made it possible to diagnose the minimal activity of rheumatism in this patient. Examination of the patient in the dynamics, after the course of antirheumatic therapy, showed the normalization of oxidized and reduced nucleotides in erythrocytes. (NADP + NADPH 91.33 μM / L of red blood cells; NADN.2 + NADPH 47.87 μM / L of erythrocytes).

PRI me R 2 Patient G., 36 years old, entered the cardio-rheumatology department with complaints of palpitations, interruptions in the work of the heart, shortness of breath, weakness, sweating. Sick rheumatism with P-age. Sharpen 1 time in 2-3 years. During the last three years, paroxysms of atrial fibrillation have occurred during colds and colds with little exertion. When examining a spilled apical

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push, shift of borders of relative dullness of the heart to the left and. upwards and slightly to the right. Auscultatory and phonocardiographic clapping tone I, accent II tone above the pulmonary artery, systolic and presystolic noise above the apex and at the Botkin point, atrial fibrillation from ches 115 in 1. BP 120/70. On ECG: paroxysm of atrial fibrillation, signs of hypertrophy of both ventricles, disturbance of re-polarization processes. Radiographically detected mitral configuration of the heart. Data from laboratory studies: leukocytes 4, ESR 13 mm / h; sialovy test of 1,60 mm / l; C-RB ref .; total protein 72 g / l; albumin 54.4%; globulins ai, 3.7%; (K.Z 5.7%; / 3 15.7%; J 18.5%; antistreptolysin titer 0-1: 125.

From the above data it is clear that the measured 5 by the standard laboratory tests in this patient are not detected, and therefore he was carried out to determine the activity of rheumatism by the proposed method. At the same time, a decrease in oxidized nicotinamide coenzymes in erythrocytes to 61.07 μM / l of erythrocytes, i.e. : 1.5 times compared

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with the norm and a simultaneous increase in the recovered nucleotides to 59.93 μM / l of red blood cells, i.e. ci; 1.3 times compared to normal. Teach these data and the results of the clinical examination of the patient, he was diagnosed with minimal rheumatism activity.

The use of the proposed method in medical practice allows to increase the accuracy of diagnosis of the active phase of rheumatism in 96.7% (activity I degree) and in 98.2% (activity II-III degree).

In addition, the method is simple to perform, available for implementation in any clinical laboratory.

Claims (1)

Invention Formula A method for diagnosing an active-rheumatic process by examining blood, characterized in that, in order to increase the accuracy of the method, the concentration of oxidized and reduced pyridine nucleotides in erythrocytes is determined and when the first indicator decreases and the second indicator is increased relative to the norm, the active rheumatic syndrome is diagnosed - Cess.