SU1527586A1 - Method of differential diagnosis of hypertension disease and arterial hypertension caused by chronic pyelonephritis - Google Patents

Abstract

The invention relates to the field of medicine and can be used in the clinic of internal diseases as a simple and reliable method for differential diagnosis of hypertension in the period of exacerbation and arterial hypertension caused by chronic pyelonephritis, according to the level of the diagnostic factor (the ratio of total lipid erythrocyte membranes to the level of membrane lipid peroxidation) which is highly reliable for patients with hypertension and chronic pyelonephritis. The proposed method makes it possible to exclude in the process of diagnosis of hypertensive disease a number of complex and expensive research methods, and, with widespread adoption, to provide significant cost savings.

Description

The invention relates to medicine, in particular to internal diseases, the predominant area of its use is the differential diagnosis of hypertension (GB) and arterial hypertension caused by chronic pyelonephritis (CP) „

The purpose of the invention is to simplify the method by eliminating the need to use sophisticated equipment.

The method is carried out as follows.

From the patient's cubital vein, 3 ml of blood is withdrawn into a tube with a solution of citrate, centrifuged for 10 minutes (4000 rpm), and then the erythromass is removed from the plasma. The erythromass is washed twice with physiological saline (by stirring and centrifuging for 5 min at 2000 rpm). After the second centrifugation, the supernatant is drained and 1.0 ml of the washed erythromas is transferred to an empty tube, to which distilled water is added for hemolysis of erythrocytes (up to 10 ml) ), after stirring, the mixture is centrifuged at 4000 rpm for 10 minutes, the supernatant (8.5 ml) is removed. A physiological solution (up to 10 ml) is added to the remaining mixture, the contents are mixed and centrifuged again in the same mode. The distilled water and saline are added to the tube successively, followed by centrifugation three times, resulting in 1 ml of standard solution.

00 od

a thief of erythrocyte membranes, which is transferred to a test tube with a ground in stopper, to which 8 ml of an extracting heptane – isopropanol mixture (in a 1: 1 ratio) are then added. In the first 30 minutes, the tube containing the membranes and extracting mixture is shaken every 5 minutes, and then 1.2 ml of 0.02 N is added to the tube. HC1 solution and gently stirred (tilting) 3 times. The mixture was held at 16-20 ° C for 60 minutes. The mixture is divided into two layers. In the upper (heptane) layer containing extracted lipids (3.5 - 3.7 ml is taken), the spectrophotometer in the UV spectrum / is determined in units of extinction the absorption level at waves 232 and 273 nm. At the same time, the extinction value corresponds to the quantitative level of lipid peroxidation products (sex) - diene conjugates and diene ketones, respectively. For the final calculation and standardization of indicators, the extinction is calculated for 1 mg of extracted lipids, for which the amount of lipids in the test sample is determined by a known method using a sulfophosphonyl reagent.

Calculate the diagnostic coefficient (DK) - the ratio of membrane lipids (L) to the POL level of the membranes (floor):

DK since

L,

 floor „POL

m

Em

Ldl

the sum of the extinction units of the absorption of lipid peroxides of UV-irradiated membranes at 232 and 273 nm, then

DK

one

l "Z3

On average, for GB DK 27.82 ± 0.68, for CP DK 51.23 ± 1.31, the calculation of this indicator in each of the studied patients and analysis of the data showed that DC from 33 and below is typical for 90% of patients with GB and from

0

five

0

five

0

five

0

five

40 and above - for 90% of patients with arterial hypertension due to CP, With a DC value between 35 and 40, the differential diagnosis is questionable.

Example 1, Patient H, 38 years old, was admitted to the therapeutic department with a preliminary diagnosis: hypertensive illness of the II degree.

In the study of the parameters of lipid peroxidation and lipids of the patient’s membranes, the following were found: the lipid peroxidation of the erythrocyte membranes was 0.053 uul, u / mg of lipids, the total membrane lipids were 2.94 mg / l; DK 55,41, It was made an indication of the presence of a large chronic pyelonephritis,

Subsequently, on the basis of clinical data and laboratory and instrumental research methods, the diagnosis of chronic pyelonephritis (hypertensive stage) was confirmed.

Example 2, Patient E, 42 years old, was admitted to the therapeutic department with a diagnosis of grade II hypertensive disease, crisis.

In the study of parameters of lipid peroxidation and lipid membranes, the patient was found: the level of lipid peroxidation of membranes was 0.047 uul, u / mg, lipids, total membrane lipids - 3.02 mg / ml; DK 64,23, It was concluded that the patient had chronic pyelonephritis,

Subsequently, on the basis of a comprehensive assessment of clinical data, laboratory and instrumental methods of investigation, the diagnosis of chronic pyelonephritis (hypertensive stage) was confirmed

Pr 3, Ill L ,, 40 years old, was first hospitalized for significant blood pressure (215 - max, 115 - rain mm Hg, St). Diagnosis at admission: hypertensive disease is secondary (renal) and hypertension

In the study of parameters of lipid peroxidation and lipid membranes, the patient was found: the level of lipid peroxidation of membranes was 0.074 uul, u / mg of lipids, total membrane lipids - 2.03 mg / ml; , 46, On the basis of these data, an opinion was expressed about the presence of hypertensive disease in the patient.

In the course of further carrying out the complex, lexical laboratory and instrumental examination of the patient, the diagnosis of hypertension of TI degree (crisis) was confirmed

Example 4. Ill F, 43 years old was referred for hospitalization (taking into account these complaints, analysis, clinic) with a preliminary diagnosis: chronic pyelonephritis.

In the study of parameters of lipid peroxidation and lipid membranes of the patient, the level of lipid peroxidation of erythrocyte membranes was found to be 0.067 uul, u / mg of lipids, total membrane lipids - 2.38 mg / ml, DK 35.54. Based on these data, it was concluded that the patient had hypertensive diseases,

Subsequently, a set of laboratory-instrumental methods and dynamic observation of the patient made it possible to make a diagnosis of chronic pyelonephritis. The final clinical diagnosis: hypertensive disease of the II degree, the state after the crisis,

Example 5, Sick B ,, 39 years old, entered the therapeutic department with a diagnosis of I-II degree hypertension, crisis.

In the study of the levels of lipid peroxidation and total lipids of erythrocyte membranes, the patient was found: the lipid permeability of the membranes was 0.067 uel, u / mg of lipids, the total membrane lipids were 2.68 mg / ml, DK 40.0. in a patient with hypertensive stage of chronic pyelonephritis. The patient's manifestation of unexpressed pathological changes from the side of urine caused her to be transferred to the uronephrology department, where later a complex of special laboratory and instrumental studies allowed to set the final diagnosis: chronic pyelonephritis, hypertension stage, exacerbation phase.

Thus, the developed method of differential diagnostics of hypertension and CP is simple, technically affordable for a conventional clinical and biochemical laboratory, eliminates the use of complex and expensive equipment, scarce materials and reagents and is therefore economical, does not require a long time. special training of patients. At the same time, the diagnostic accuracy in comparison with the known method is not removed.

Claims (1)

Invention Formula The method of differential diagnosis of hypertension and arterial hypertension due to chronic pyelonephritis by taking blood, isolating erythrocyte membranes and then examining them, in order to simplify the process by eliminating the need for complex equipment, lipids are extracted from erythrocyte membranes. their total amount and optical density of lipid extracts at 232 and 273 nm, then calculate the ratio of the square of the total amount of lipid in mg / ml and the sum of optical densities at 232 nm and at a ratio of 35 and below are diagnosed hypertension, and with a value of 40 and above - chronic pyelonephritis.