SU1617376A1 - Method of differential diagnosis of liver pathology - Google Patents

Abstract

The method relates to biochemical methods for monitoring the evaluation of the functional state of the liver and can be used in practical medicine, biology, and pharmacology. The purpose of the invention is to accelerate and reduce the morbidity of the diagnostic method. The essence of the proposed method is that potentiometrically measures the reducing capacity of whole blood, serum, plasma and erythrocyte mass by oxidation of its reversible redox system, such as alkaline solution of potassium ferrofericyanide, and with an increase in these indicators relative to the norm, chronic persistent hepatitis is diagnosed with increasing the third and the reduction of the first, second and fourth relatively normal - chronic cholestatic hepatitis, with a decrease in the first and the second and the third and fourth increase relative to the norm - cirrhosis in the initial stage, and with the second and third increase and the decrease in the first and fourth indicators relative to the norm - liver cirrhosis in the dystrophic stage. The method is less traumatic compared to the known one, since instead of the biopsy material, the patient's blood, taken from the vein by a conventional method, is examined. The method makes it possible to diagnose diseases in as little as 5 to 15 minutes, while the known biochemical methods require 2 to 48 hours. The method is simple to perform and can be used in any poorly equipped laboratory.

Description

J The invention relates to medicine, in particular to biochemical methods for studying the functional state of the liver, and can also be used in practical medicine for the differential diagnosis of the pathology of AieHH.

The purpose of the invention is to accelerate the method and reduce its trauma.

The goal is achieved by measuring the recovery capacity of whole blood, serum, plasma, and erythrocyte mass in a patient, and with an increase in these indicators

relatively normal, chronic chronic cholestatic hepatitis is diagnosed with chronic and persistent hepatitis, while cholesteric hepatitis decreases with the first, second, and fourth normal, and the initial stage of the first and second decreases and the third increases, with an increase in the second and third and a decrease in the first and fourth indicators relative to the norm — cirrhosis of the liver in the disrophic stage.

 The method is carried out as follows.

In a fasting patient, blood is taken from a vein in a volume of 10 ml. The obtained blood is prepared by generally accepted methods of shortening, plasma and red blood cell mass. As an oxidizing agent: an alkaline solution of potassium ferro-ferricyanide is used.

First, 20 ml of the redox mixture is placed in the electric cell of the potentiometer and its potential E. is measured, then 0.2 ml of the test material is introduced into the sample. And after 5 min, the potential value of the system EJ is measured. Changes (potential difference) are not calculated by the formula:

Af.

EO-Eg.

Donors served as controls. Values of 4fg are normal for whole blood, pharynx, plasma, and spectrocyte mass, respectively; 69.0-71.0; 44.0- 46, 0 ;; 39.5-41.5; 80.5-82.5. Specific changes in these parameters in different patients corresponded to various forms of liver disease.

Example 1. Patient R., 37 years old, was admitted to the hospital with complaints of brules in the right hypochondrium, abdominal distension, bitterness in the mouth, and before entering he noted an increase in abdominal pain, weakness. Upon admission to the clinic, the state is satisfactory, the skin is clean, the pulse is 76 beats / min, rhythmic, BP 120/80 mm Hg, muffled heart sounds, vesicular breathing, soft stomach, painless on palpation, liver at the edge of the costal arch, the spleen is not defined.

 Blood test; er 4 ,, hemo .globin 150 g / l, leukocytes 5.9 10 ° / l,

. d

five

0

5 Q

0

0

five

n 4l, 3 1% ,, with 53%, l 26%, m 16%, ESR 6 mm / h.

Biochemical studies: total protein 86 g / l, albumin 60%, globulins: alpha-1 4%, alpha-2 6%, beta 11%, gamma 19%, thymol sample 19 units. sublimate titer 1.8 units, AsAT 0.18 mmol / l, AlAT 0.9 mmol / l, bilirubin 24.7, μmol / l, cholesterol 5.6 mmol / l, prothrombin index 88%.

The patient was examined by the proposed method using a potentiometer: whole blood 73.3; tifj serum 48,0; fg plasma 48,0; UFJ red cell mass of 83.6.

Diagnosis: Chronic persistent hepatitis. Subsequently, the diagnosis was confirmed by examining biopsy material.

Liver biopsy: the architectonics of the liver is not broken; portal tracts expanded, infiltrated with lymphocytes, neutrophils; boundary plate is not broken; hydropic dystrophy of hepatocytes; dual nuclear hepatocytes are found.

Conclusion: The histological picture is characteristic of persistent hepatitis.

PRI mme R 2. Sick V., 57 years old, was admitted to the clinic with complaints of persistent skin itching, weakness, pain in the right hypochondrium, nausea. Repeatedly treated by a neuropathologist, an endocrinologist, an allergist, a psychiatrist with a visible effect; the year before it was received, a liver puncture was performed, at which data j were obtained indicating that chronic cholestatic hepatitis was present. In the history of life - an indication of long-term contact with the microwave, fiberglass. Objectively: the state is satisfactory, the integuments are pigmented, scratches, xanthomas, xanthaslams, heart rate 76 beats / min, rhythmic, BP 150/80 mm Hg, muffled heart sounds, vesicular breathing ,. the abdomen is soft, the enlarged liver comes out from under the costal arch 9 cm, the spleen is not palpable.

Blood test: er 4.9-10 / l, hemoglobin 140 g / l, leukocytes 6.1 x b / l, e 2%, n 2%, with 66%, l 26%, m 5%, ESR 55 mm / h, platelets 411000,

Biochemical studies: total protein 81 g / l, albumin 43%, globulins: alpha-1 7%, alpha-2 10%, be 14%, gamma 26%, thymol test 115 units, sublimate TNTP 1.6 units ., cholesterol. 8.1 mmol / l, beta-lipoprotein 85 units, alkaline phosphatase

210 U / l, prothrombin index 75%, AlAT 3.0 mmol / l, AsAT 1.0 mmol / l.

The patient's blood was examined on a potentiometer according to Example 1. The results of the study: D f with whole blood 64.0; Af blood serum 40.0; plasma 8,; D red cell mass 77.0.

Diagnosis: chronic cholestatic hepatitis.

Froze Ill P., 57 years old, was admitted to the hospital with complaints of pain in the right hypochondrium, itching of the skin, skin pigmentation. Pain in the right hypochondrium concerns about 7 years. Repeatedly treated in the hospital. In the last year, there was pigmentation and itching of the skin. In the history of life - prolonged contact with chemicals. Objectively, the state is satisfactory, the skin is pigmented, T2 pulse, beats min, rhythmic, HELL 130/80 mm Hg, muffled heart sounds, vesicular breathing, tongue lined with white bloom, the stomach is swollen, palpated enlarged liver, the lower edge of which 4 cm out of the costal margin, spleen not palpated.

Blood test: er A, 63 10 l, hemoglobin 160 g / l, leukocyte b, 2-10 / l, e 2%, n 5% - with 66%, l- 24%, m 3%, SOe 25 mm / h, platelets 111200.

Biochemical studies: total protein 80 t / l, albumin 48%, globulins: alpha-1 6%, alpha-2 7%, beta 11%, gamma 28%, thymol sample 25 units, sublimate titer 1.64 units, AsAT 1.66 mmol / l, ApAT 3.76 mmol / l, alkaline phosphatase 153 U / l, bilirubin 8.2 μm µmol / l, cholesterol 7.5 mmol / l, prothrombin index 70%.

The blood of a research patient; w on a potentiometer: uf whole blood 60, ufy shorter blood 40, fj plasma 49.0, ufp red blood cell 83.

Diagnosis: cirrhosis of the liver, initial stage.

 The diagnosis was confirmed by a liver biopsy study.

but

1617376

but

PRIMER 4. Sick D., 61 year. I came to the clinic with complaints of weakness, jaundice, an increase in obesity, weight loss, nausea. About two years ago, there was pain in the right hypochondrium, bloating, and weight loss. Not treated. Year. before jaundice. Hospital 10 is lysed to the clinic. -; Life history - indications of alcohol abuse about 10 years ago.

The state is satisfactory, 5 yellowness of the skin and sclera, pulse 80 beats / min, rhythmic. HELL 130/90 mm Hg, muffled heart sounds, vesicular breathing, abdomen swollen, an enlarged liver is detected, which goes out from under the costal arch by 7-8 cm, the spleen is not palpated.

Blood analysis: er 4.33-10%, hemoglobin 150 g / l, leukocytes 5.7.10 / l e 3%, n 5%, with 80%, l 19%, m 3%, platelets 148680, ESR 45 / h

Biochemical studies; total protein 67 g / l, albumin 29%, globulins: alpha-1 6%, alpha-2 8%, beta JO 18Z, gamma 39%, lAT 0.54 mmol / l, AcAT 0.60 mmol / l, sh. alkaline phosphatase 193 U / l, thymol test 82 units. sublimate titer 1.1 units, cholesterol 4.6 mmol / l, bilirubin 124.2 m.kmop / l, 35 prothrombin index 62%.

The patient's blood was studied on a potentiometer: ufj of whole blood 70, .0, & f 5 - serum 54, 1, Af plasma 56.0, Л с с - erythrocyte mass 40,0 80.0.

Diagnosis: cirrhosis of the liver, active, dystrophic stage, decompensated with portal hypertension (ascites).

45 Diaptosis was confirmed by diagnostic laparotomy and liver biopsy.

Thus, the proposed method makes it possible to detect functional disorders of the liver in patients suffering from chronic persistent hepatitis, while all other biochemical methods do not detect any impairment. The existing disorders 5 are revealed only by clinical manifestations and morphological examination. The method provides a more accurate determination of the nature and stage of the disease, does not injure

the patient, since instead of a liver biopsy, blood was sampled by a usual method from a peripheral vein. In addition, the method lasts 5–15 minutes, in contrast to the known biochemical methods (2–48 hours), is simpler to perform, does not require the use of scarce and expensive reagents and equipment.

Formula a and 3 turns Eni.,

The method of differential diagnostics of liver yatology by examining biological material, about t - 5 is personalized by the fact that, in order to speed up and reduce the trauma of the method, blood is taken from the patient.

0

| 5

the recovery capacity of whole blood, serum, plasma and erythrocyte mass is measured, and with an increase in these indicators relative to the norm, chronic persistent hepatitis is diagnosed, with an increase in the third and a decrease in the first, second and fourth relative to the norm - chronic cholestatic hepatitis, with a decrease in the first and second and . an increase in the third and fourth relative to the norm - cirrhosis in the initial stage, and with an increase in the second and third and a decrease in per-. first and fourth indicators relative to the norm - cirrhosis in the dystrophic stage.

Claims (1)

The method of differential diagnosis of liver pathology by examining biological material, characterized in that, in order to accelerate and reduce the traumatic method, the patient is taken blood, the recovery capacity of whole blood, serum, plasma is measured and erythrocyte mass and with an increase in these indicators relative to the norm, chronic persistent hepatitis is diagnosed, with an increase in the third and a decrease in the first, second and fourth relative to the norm, chronic cholestatic hepatitis patitis, with a decrease in the first and second and an increase in the third and fourth relative to the norm - cirrhosis in the initial stage, and with an increase in the second and third and a decrease in the first and fourth indicators relative to the norm - cirrhosis in the dystrophic stage.