SU1681251A1 - Method for diagnosing pancreatitis in patients with hepatocirrhosis - Google Patents

Abstract

The invention relates to medicine, namely to surgery, and can be used in the differential diagnosis of cirrhosis of the liver, complicated and not complicated by diseases of the pancreas. The aim of the invention is to improve the accuracy of the method. This is achieved due to the fact that the suspension of erythrocytes is placed in a hypotonic solution and the hemolysis rate at a temperature of 10, 20, 30, 40 ° C is recorded colorimetrically. Then the hemolysis rate v is calculated, the process of temperature dependence of the hemolysis rate is calculated by the equation v a aTk, where T is the temperature, a and k are the calculated coefficients, the values of a and k are determined with a equal to and less than 0.2, and k equal to and large 1.0, diagnosed with pancreatitis in the background of cirrhosis of the liver. The method allows to significantly improve the accuracy of diagnosis of pancreatitis on the background of cirrhosis compared with such methods as determining the level of blood amylase and ultrasound examination. 1 tab. Yo

Description

The invention relates to medicine, namely to surgery, and can be used in the differential diagnosis of cirrhosis of the liver, complicated and not complicated by diseases of the pancreas.

The purpose of the invention is to improve the accuracy of the method by determining the rate of hemolysis of erythrocytes in a hypotonic solution at 10-40 ° C and calculating the coefficients a and k of the equation v aT expressing the dependence of the speed v hemolysis of erythrocytes on temperature T.

The method is carried out as follows.

The principle of the method is based on the colorimetric registration of the process of hemolysis of erythrocytes placed in a hypotonic environment. Blood for analysis can be obtained from the cubital vein or from the finger.

Reagents: isotonic solution of 2.4 mM veronal buffer prepared with 145 mM NaCI solution, pH 7.4; hypotonic solution of 2.4 mM veronal buffer prepared in 47.6 mM NaCI solution. pH 7.4.

The course of the analysis.

The hemolysis process is recorded at 690 nm by introducing a spectrophotometer into the cuvette containing 3 ml of hypotonic solution, 0.1 ml of erythrocyte suspension in isotonic solution. The hemolysis rate is recorded at 10,20,30 and 40 ° C by analyzing the kinetic curves of the change in the transmission of the solution as a function of time.

Calculation of the rate of hemolysis.

ON 00

GO

ate

The initial optical density of the erythrocyte suspension is determined, the change in transmission over time T is and the change in transmission versus time is referred to. The process of temperature dependence of the hemolysis rate is most fully described by an equation of the type v a Tk - where v is the rate of hemolysis, s and k are the coefficients characterizing the temperature dependence of the process corresponding to a particular membrane structure.

Having determined the rate of hemolysis of erythrocytes in a fairly representative group of healthy donors at various temperatures, we obtained the following values: Vio ° c 2.43 ± 0.12; V2o ° c 3.51 ±

0.21; V30 ° c - 4.36 ± 0.30; Vad ° with -5,10 ± 0,27; a 1.23 ± 0.25; k - 0.39 ± 0.05.

During the examination of 34 patients with liver cirrhosis, the following values were obtained:

Vio ° c 1.32 ± 0.16: V20 ° c 1.8 ±

0.26L / zo ° with 2.26 ± 0.34; V40 ° C 2.65 ± 0.42; a 0.466 ± 0.048; k 0,504 ± 0,039. When examining patients with cirrhosis of the liver with a concomitant lesion of the pancreas, the following values were obtained: yy ° with 0.64 ± 0.15; V a ° with 1.36 ± O.Q3; V3o ° c - 1.74 ± 0.5; V 4 ° C 3.11 ± 0.08; a 0.035 ± 0.01; k 1,358 ± 0,08. Obviously, by the value of the coefficients a and k of the equation v a Tk, which describes the temperature dependence of the hemolysis rate, is possible on | differentiate the presence of pancreatitis in patients with cirrhosis of the liver.

EXAMPLE 1. Sick J., 34 years old, was admitted in a planned order for the surgical correction of the intrahepatic form of portal hypertension on 01/24/87 to the emergency medical center. assistance of Alma-Ata. Admission diagnosis: cirrhosis of the liver, portal hypertension, intrahepatic form,

 varicose veins of the esophagus, splenomegaly. She was not treated in another institution where the diagnosis was verified using FGS, gastric fluoroscopy, and liver scintigraphy. Upon receipt of a complaint of recurrent epigastric pain, without irradiation, nausea, anorexia, the last 12 months. The general condition is of average weight. The skin is a normal color, the pulse is 70 beats / min, the stomach is symmetrical, soft, palpation pain in the epigastrium. In addition to the general clinical laboratory examination, the parameters of the temperature dependence of the hemolysis rate were studied. The coefficient a was 0.057, k - 1.01. This patient was diagnosed with exacerbation of chronic pancreatitis, for which infusioma therapy was performed with the inclusion of protease inhibitors, perirenal novocainic blockade, and subcutaneous administration of anticholinergics. The operation was undertaken after the elimination of the clinical manifestations of pancreatitis. Splicectomy, gastrorenopexy, biopsy and electrocoagulation of the liver liver were performed. Treatment with protease inhibitors continued in the postoperative period, which proceeded smoothly. Thus, there was a coincidence of clinical and laboratory data with indicators of the temperature dependence of the hemolysis rate.

PRI mme R 2. Bolna S., 56 years old, was admitted to the department of portal hypertension

0 26.03.85 g, for prompt correction of portal hypertension on the basis of atrophic liver cirrhosis. 6 anamnesis - repeated bleeding from varicose veins of the esophagus. The diagnosis was confirmed by clinical observation over the past two years, data scintigraphy, fluoroscopy of the stomach, F. HS-studies.

Upon admission, in addition to general biochemical studies, the rates of temperature dependence of the erythrocyte hemolysis rate were studied.

In this case, a 0.008, k 1.84. Proceeding from these data, in parallel with the preoperative preparation, an ultrasound study of the pancreas was performed. In this case, it was possible to visualize the pancreas. Taking into account the absence of characteristic symptoms of the pancreas and negative

0, re-examination of blood and urine nas diastasis, the patient was operated on in a planned manner. Omentohepatopexy, gastrorenopexy, and splenectomy were performed. Splenectomy was

5 is performed in connection with a spleen wound during the operation, at the same time, due to adhesions, the tail part of the pancreas is removed. The presence of chronic pancreatitis was histologically determined. Intraoperative: the tail of the pancreas is enlarged relative to the body, dense. In the lesser omentum and on the adjacent peritoneum there are single stearin plaques. Conclusion

5 on the presence of edematous pancreatitis with localization in the tail of the pancreas. After the operation, protease inhibitors are included in the complex of drugs. Obviously. that the only signs of pancreatic pathology were indicators

temperature dependence of the rate of hemolysis,

EXAMPLE 3. Sick S., 60 years old, was admitted in an emergency order on 2.02.87 to the emergency medical center. assistance of Alma-Ata. Diagnosis at admission: cirrhosis of the liver, portal hypertension, acute esophagogic bleeding from varicose veins of the esophagus and cardia, splenomegaly, ascites. In addition to general clinical laboratory examination, hemolysis rate temperature dependencies were studied. The coefficient a is 0.200; k - 1.46. Other methods of instrumental investigation, except FGS, have not been applied due to the severity of the patient's condition. During 2 days it is intensive and hemostatic therapy did not stop the bleeding completely. 4.02.87. emergency laparotomy was performed, sub-cardiac gastrotomy with flashing of the veins of the cardia of the stomach and the lower third of the esophagus. Intraoperatively detected compaction and enlargement of the pancreatic head, diagnosed

indurative chronic pancreatitis. An intraoperative diagnosis was confirmed six days later at autopsy.

The table shows a comparative analysis of the capabilities of the known and proposed diagnostic methods.

The proposed method allows to significantly improve the accuracy of diagnosis of pancreatitis on the background of cirrhosis compared with such methods as determining the level of blood amylase and ultrasound examination.

Claims (1)

Invention Formula A method for diagnosing pancreatitis in patients with liver cirrhosis by biochemical blood analysis, characterized in that, in order to improve the accuracy of the method, the hemolysis rate of erythrocytes in the hypotonic solution in the range of 10-40 ° C is expressed, depending on the rate of hemolysis v of temperature T by the equation va Tk, where a and k are the calculated coefficients, and at a 0.2 and k 1.0, pancreatitis is diagnosed against the background of cirrhosis of the liver. FULL NAME. Ill S. 0.008 1.84 Pancreatitis Pancreatitis Unspecified. diagnosed Diagnosis Diagnosis by amylase test results according to the results UT-research