RU2407014C1 - Method of diagnosing volume of lung tissue affection in case of out-of-hospital pneumonia in adults by determination of serum alveomucin level - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: in blood serum on the first day of treatment level of serum alveomucin is determined. If its value is from 44 un/ml to 52 un/ml, volume of lungs tissue affection is estimated as nidal, if value is over 52 un/ml - as lobe.

EFFECT: application of invention allows with high accuracy estimate volume of lung tissue affection in case of out-of hospital pneumonia.

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Description

The invention relates to medicine, namely to therapy, pulmonology, and can be used to assess the volume of lung tissue lesion in community-acquired pneumonia in adults by determining the level of serum alveomucin.

Community-acquired pneumonia is one of the most common acute infectious diseases [Chuchalin A.G., Sinopalnikov A.I., Strachunsky L.S., Kozlov R.S., Rachina S.A., Yakovlev S.V. Community-acquired pneumonia in adults: practical recommendations for diagnosis, treatment and prevention. - M., LLC "Publishing house" M-Vesti ", 2006]. Pneumonia as a nosological form is an inflammatory disease caused by a nonspecific pathogenic and conditionally pathogenic flora with a violation of the body's natural defense mechanisms. The inflammatory process in this disease covers the distal part of terminal bronchioles, respiratory bronchioles, alveolar passages, alveolar sacs and alveoli [Karmanova TT, Lychev V.G. The basics of outpatient pulmonology. - Rostov-on-Don: Phoenix, 2007]. There is order No. 263 of November 23, 2004 of the Ministry of Health and Social Development of the Russian Federation “On approval of the standard of care for pneumonia patients”. The standard includes measures for the diagnosis of pneumonia: a general clinical examination, a general analysis of blood and urine, a Gram stain smear sputum smear, sputum culture with a determination of flora and its sensitivity to antibiotics, chest x-ray in two projections. The volume of damage to the lung tissue revealed in this case to a certain extent determines the intensity of etiotropic and pathogenetic therapy.

A known method for assessing the volume of damage to lung tissue by conducting a general clinical examination of the patient [Vasilenko V.Kh., Grebenev A.L. Propaedeutics of internal diseases. - M., Medicine, 1982]. The disadvantage of this method is subjectivity, the dependence of the evaluation results on the competence of the doctor and the characterological characteristics of the patient.

The prototype of the invention is a method for assessing the volume of damage to lung tissue by chest x-ray. The absence or inaccessibility of x-ray confirmation of focal lung infiltration makes the diagnosis of community-acquired pneumonia inaccurate / uncertain (category of evidence A) [Chuchalin A.G., Sinopalnikov A.I., Strachunsky L.S., Kozlov R.S., Rachina S.A. ., Yakovlev S.V. Community-acquired pneumonia in adults: practical recommendations for diagnosis, treatment and prevention. -M., LLC "Publishing House" M-Vesti ", 2006]. The disadvantage of this method is the dependence of the procedure on the technical equipment of the place / institution in which medical care is provided to the patient, the proven negative effect of ionizing radiation on the human body, the dependence of the results of the assessment of the extent of the lesion on the competence of the doctor.

The technical result when using the invention is to increase the accuracy of the method, preventing side effects.

The proposed method is as follows. In patients with a suspected diagnosis of community-acquired pneumonia, venous blood is taken from the ulnar vein on the first day of hospitalization in compliance with the relevant rules. Determination of the level of alveomucin in the serum extracted from the patient’s venous blood is carried out according to the principle of two-site enzyme-linked immunosorbent assay using standard kits of the company "Hema" (Russia). With its value from 44 u / ml to 52 u / ml, the volume of lung tissue lesion is estimated as focal, with a value of more than 52 u / ml - as lobar.

The level of serum alveomucin was determined in 45 patients with community-acquired pneumonia of varying severity, aged 18 to 80 years; the average age of the subjects was 51.38 ± 1.3 years; among them 21 men (47%) and 24 women (53%). The control group was formed of 20 practically healthy individuals, comparable in age and sex with the group of subjects. Based on the clinical and radiological data, two groups are distinguished, depending on the volume of lung tissue lesion: patients with lobar (54%) and focal (46%) lesions. On the first day of hospitalization, the value of the studied protein in all cases of lobar lung lesions was higher than the level of 52 units / ml, with focal lesions it was in the range of 44-52 units / ml, in the control group it did not exceed 44 units / ml.

Thus, the content of the studied protein in the blood serum of a patient with community-acquired pneumonia at the onset of the disease above the level of 44 units / ml allows us to consider lung damage as focal, above the level of 52 units / ml lobar. Determination of the level of alveomucin in the patient’s blood serum on the 10th day of hospitalization allows you to evaluate the changes in the volume of lung tissue damage in dynamics, to judge the effectiveness of the treatment of this patient.

In the available scientific, medical and patent literature, the authors did not find information about the popularity of the method for assessing the volume of lung tissue lesion in community-acquired pneumonia in adults by the level of serum alveomucin. Thus, the claimed invention meets the criterion of "novelty."

The studies of the authors for the first time proved that the indicators of the content of serum alveomucin in the blood of patients with community-acquired pneumonia can reliably estimate the volume of lung tissue damage. Thus, the claimed invention meets the criterion of "inventive step".

The proposed method is illustrated by the following clinical examples.

Example 1

Patient M., 47 years old (medical history No. 4615), was admitted to the Moscow City Children's Clinical Hospital No. 5 on November 3, 2006 with a diagnosis of community-acquired bacterial upper lobe right-sided pneumonia of moderate severity, DN-1. Concomitant diagnosis: Chronic calculous cholecystitis without exacerbation. From the anamnesis: considers himself ill for about 3-4 days, became ill acutely, after suffering hypothermia. Upon receipt of a complaint of a fever up to 38.5 ° C, a wet cough with a small amount of sputum mucus, chills, weakness, fatigue, headache. Objectively: moderate state, body temperature - 38.2 ° C, respiratory rate - 27 per minute, blood pressure - 125/80 mm Hg, pulse - 94 per minute. Shortening of percussion sound over the region of the upper lobe of the right lung is noted, there are auscultatory listening to small bubbling rales against the background of bronchial breathing. Auscultatory heart sounds are rhythmic, clear, clear, heart rate - 94 per minute. A general blood test revealed leukocytosis (10.7 * 10 ⁹ / ml), an increase in ESR up to 30 mm per hour, in the leukocyte formula a shift to the left. On the chest radiograph: darkening of the upper lobe of the right lung, slight expansion of the roots of the lungs, the x-ray picture corresponds to upper lobar right-sided pneumonia. The level of serum alveomucin on the day of hospitalization is 75.3 units / ml. The patient was hospitalized in the therapeutic department, treatment was prescribed according to medical and economic standards: ceftriaxone at 1.0 v / m 2 times a day, macropen 0.4 at 1 table. 4 times a day, glucose solution 5% - 200.0 + ascorbic acid 4.0 iv drip and saline intravenously, bromhexine 8 mg three times a day, inhalation with lazolvan, symptomatic. During treatment, there was a positive dynamics of clinical and radiological data. The level of serum alveomucin on the 10th day of hospitalization is 48.4 units / ml. Clinical and radiological data with positive dynamics. The patient with recovery was discharged in standard terms.

Example 2

Patient I., 48 years old (medical history No. 5250), was admitted to the Moscow City Children's Clinical Hospital No. 5 on December 7, 2006 with a diagnosis of community-acquired bacterial focal pneumonia in the lower lobe of the left lung of mild severity, DN-0. Concomitant diagnosis: stage 1 hypertension, degree 2, risk 2. From the anamnesis: works as a storekeeper, the workplace is in the basement (damp, drafts), considers herself sick for about six days, felt growing weakness, fatigue, then a dry cough appeared. Upon receipt of a complaint of a fever up to 38 ° C, dry cough, sweating, weakness, fatigue. Objectively: moderate condition, body temperature - 38.1 ° C, respiratory rate - 24 per minute, blood pressure - 135/90 mm Hg, pulse - 86 per minute. Auscultatory weakened vesicular breathing in the lower lobe of the left lung, no wheezing. Percussion - dullness of pulmonary sound in a small area above the lower lobe of the left lung. Auscultatory heart sounds are rhythmic, clear, heart rate - 86 per minute. A general blood test revealed leukocytosis (10.4 * 10 ⁹ / ml), an increase in ESR to 22 mm per hour, in the leukocyte formula a shift to the left. On the chest radiograph: focal dimming without clear boundaries in the lower lobe of the left lung, the x-ray picture corresponds to focal pneumonia in the lower lobe of the left lung.

The level of serum alveomucin on the day of hospitalization is 46.1 units / ml. The patient was hospitalized in the therapeutic department. Appropriate treatment was prescribed: cefotaxime 0.5 i / m 2 times a day, glucose solution 5% - 200.0 + ascorbic acid 4.0 i.v. drip, bromhexine 8 mg three times a day, diroton 5 mg in the evening, inhalation with lazolvan. The level of serum alveomucin on the 10th day of hospitalization is 40.4 units / ml. Clinical and radiological data with positive dynamics. The patient with recovery was discharged in standard terms.

Example 3

Patient P., 49 years old (medical history No. 225), was admitted to the Moscow City Children's Clinical Hospital No. 5 on July 16, 2007 with a diagnosis of community-acquired bacterial lower lobe right-sided pneumonia of moderate severity, DN -1. Concomitant diagnosis: hypertension 2 stages, 2 degrees, risk 3; post-traumatic epilepsy, remission. From the anamnesis: considers herself ill for about 4-5 days, felt growing weakness, fatigue, severe headaches, cough with sputum, spasms, chills, fever up to 38.7 ° C. Upon receipt of a complaint of a fever up to 38.7 ° C, chills, cough with a small amount of sputum mucus, sweating, weakness, fatigue, headache. Objectively: a moderate state, body temperature - 38.6 ° C, respiratory rate - 28 per minute, blood pressure - 140/90 mm Hg, pulse - 96 per minute. Percussion shortening of the sound over the region of the lower lobe of the right lung, crepitation on the background of bronchial breathing is also auscultated. Auscultatory heart sounds are rhythmic, clear, heart rate - 96 per minute. In a general blood test, an increase in ESR up to 20 mm per hour. On the chest radiograph: darkening of the lower lobe of the right lung, expansion of the roots of the lungs, the x-ray picture corresponds to lower lobe right-sided pneumonia.

The level of serum alveomucin on the day of hospitalization is 82.5 u / ml. The patient was hospitalized in the therapeutic department. The treatment was prescribed: ceftriaxone 1.0 v / m 2 times a day, macropen 0.4 - 4 times a day orally, glucose solution 5% - 200.0 + ascorbic acid 6.0 w / drop, NaCl solution 0 , 9% - 200.0 intravenous drip, bromhexine 8 mg three times a day, inhalation with lazolvan, antihypertensive drugs. The level of serum alveomucin on the 10th day of hospitalization is 48.9 units / ml. During treatment, a positive clinical and radiological dynamics was noted. The patient with recovery was discharged in standard terms.

The proposed method is easily reproducible in a polyclinic or hospital. Thus, the claimed invention meets the criterion of "industrial applicability".

Claims (1)

A method for assessing the volume of lung tissue lesion in community-acquired pneumonia in adults, characterized in that the level of serum alveomucin is determined in the blood serum on the 1st day of treatment and, with its value from 44 u / ml to 52 u / ml, the volume of lung tissue lesion is estimated as focal , with a value of over 52 u / ml - as a fraction.