RU2432898C1 - Method of laboratory diagnostics of early disorders of liver functional state - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to field of medicine. For laboratory diagnostics of early disorders of liver functional state activity of ALT, AST, LDH, GGT, ALP, total bilirubin are measured. Additionally carried out is 3-minute long occlusion of shoulder vessels - "cuff test" (CT) to create short-timer hypoxia. Indices of liver functional activity are determined by the following formulas: ALT index=((ALT after CT - ALT before CT)/ALT before CT)*100%; AST index=((AST after CT - AST before CT/AST before CT)*100%; LDH tot = ((LDH after CT - LDH before CT)/LDH before CT)*100%; ALP index=((ALP after CT - ALP before CT)/ALP before CT)*100%; GGT index=((GGT after CT - GGT before CT)GGT before CT)*100%; Bilirubin index=((Bilirubin after CT - Bilirubin before CT)/Bilirubin before CT)*100%. If said indices increase by more than 10%, early disorder of liver functional state is diagnosed. ^ EFFECT: method increases diagnostics efficiency due to early detection of liver functional state disorders, preceding registered by laboratory methods changes in its functioning. ^ 2 ex, 4 tbl

Description

The invention relates to medicine, namely to methods for determining violations of the functional state of the liver.

There is a method of using a "cuff" test (MP) to assess the atrombogenic function of the endothelium and hematovasal interactions (Baluda M.V. Method), based on short-term occlusion of the vessels of the shoulder by applying a cuff of the sphingomanometer. In the body, information about the "response" of cells of various organs and tissues to any changes in living conditions is transmitted through various blood components and through the cells of the vascular wall. At the same time, tissue cells “respond” with the release of certain biochemical substances, depending on their functional state. The direction of these changes is determined by a short-term change in the conditions of life (which is short-term ischemia or hypoxia - in this case, MP).

It is known that under the influence of short-term hypoxia a metabolic response occurs, which consists not only in physiological reactions of the body, but also in a certain change in blood biochemical parameters (Tkachuk E.N., Lyapkov B.G., Tsvetkova AM “Metabolic response to short-term hypoxia in young, practically healthy volunteers "// Hyp. Med. J. 1994. T.2. N 4. C). Closest to the invention is the "Method for assessing the functional state of the liver in patients with chronic hepatitis and cirrhosis" (D2: RU 2194280 C2 dated 10.12.2002), which considers hypoxia as a "test stimulus of the hemostasis system", to confirm the degree of decompensation processes in the liver, when clinical and laboratory disorders of its functioning (cirrhosis and hepatitis) are already known.

On the other hand, the closest to the invention is the generally accepted method of laboratory diagnosis of impaired functional state of the liver by measuring the activity of ALT, ACT, LDH, GGT, alkaline phosphatase enzymes, as well as total bilirubin (A.Ya. Tsyganenko, V.I. Zhukov, V. V.Leonov, V.V. Myasoedov, I.V. Zavgorodniy. Textbook "Clinical Biochemistry", publishing house "Fact" 2005 and other textbooks on the wedge. Biochemistry).

However, this method establishes the fact of a violation of the functional state of the liver only when a significant increase in these indicators in the blood is already determined.

The authors of the invention revealed the use of MP for the early diagnosis of impaired liver function. For the first time, MP was used not only as a functional test for studying endothelial function and as a “test stimulus of the hemostatic system”, but also for creating short-term hypoxia, under the influence of which a metabolic response occurs, i.e. a change in a number of biochemical blood parameters (ALT, ACT, LDH, GGT, ALP, total bilirubin, reflecting / characterizing (in this case) the functional state of the liver.

The technical result of the invention is to increase the efficiency of diagnosis due to the early detection of violations of the functional state of the liver, preceding laboratory-recorded changes in its functioning (i.e., an increase in the listed indicators), as well as the clinical manifestations of its violation. This allows you to start timely adequate therapeutic prophylaxis aimed at restoring the normal functioning of the liver.

The method is as follows.

A quantitative assessment of the activity of liver enzymes ALT, ACT, LDH total., Alkaline phosphatase, GGT, as well as bilirubin before and after MP. MP - a three-minute occlusion of the vessels of the shoulder, caused by the imposition of the cuff of the sphingomanometer on the shoulder of the subject. Indices of functional activity are determined, which show the ratio of these indicators before and after the MP. Indices are calculated using the following formulas:

Index ALT = ((ALT after MP - ALT to MP) / ALT to MP) · 100%.

Index ACT = ((ACT after MP - ACT to MP) / AST to MP) · 100%.

LDH index total = ((LDH after MP - LDH to MP) / LDH to MP) · 100%.

Index of alkaline phosphatase = ((alkaline phosphatase after MP - alkaline phosphatine to MP) / alkaline phosphate to MP)

GGT index = ((GGT after MP - GGT to MP) / GGT to MP) · 100%.

Bilirub Index. = ((Bilirubin after MP - Bilirubin to MP) / Bilirubin to MP) · 100%.

T.O. conduct a quantitative assessment of the degree of increase of the defined indicators. Normally (in healthy individuals), the indices do not exceed 5%. The indices of the six parameters are compared with the indices of the same name in healthy individuals. If an increase of more than 10% is detected, a violation of the functional state of the liver is diagnosed.

Normally, a change in indicators does not occur or does not exceed 5%. This was investigated and evaluated in 44 healthy individuals.

The proposed method examined 154 people, of which 110 patients with various pathologies and 44 healthy individuals. In 72 people, the claimed diagnostic method revealed a violation of the functional state of the liver.

Example 1

Patient L., 79 years old. He entered the NCH RAMS with acute cerebrovascular accident in the left middle cerebral artery with the formation of a heart attack. A study of the proposed method on the day of admission.

Table 1 presents data and the percentage of change before and after MP.

Table 1 ALT % ACT % Alkaline phosphatase % LDH % GGT % Bilirubin % 19 23 151.94 267 48 28.97 25 31.58 28 21.74 176.42 11/16 307 14.9 52 8.3 07/33 06/14

A comparative analysis of the obtained values with the same names in healthy individuals showed that in a patient L. there is a violation of the functional state of the liver.

Along with the main course of treatment, additional therapeutic correction with hepatoprotectors within 1 month was recommended. After 1 month, a second study was conducted in this way. Table 2 presents the data and percent change before and after MP.

table 2 ALT % ACT % Alkaline phosphatase % LDH % GGT % Bilirubin % fifteen 19 170.15 378 40 12.7 16 6.6 19 0.00 175.64 3.2 401 6.0 41 2.5 13.4 5.5

A comparative analysis of the obtained values with those of healthy individuals showed that almost all the values were within the normal range, and when comparing the data with the values of the previous analysis, an improvement in the functional state of the liver was revealed, which confirmed the effectiveness of the therapeutic correction.

Example 2

Patient K., 49 years old. He entered the NCH RAMS with acute cerebrovascular accident with the development of a heart attack in the deep parts of the right hemisphere of the brain. A study of the proposed method on the day of admission. Table 3 presents the data and the percentage change before and after MP.

Table 3 ALT % ACT % Alkaline phosphatase % LDH % GGT % Bilirubin % 35 25 206.18 360 31 15.1 42 20.0 31 24.0 248.73 20.6 434 20.5 36 16.1 17.4 15.2

A comparative analysis of the obtained values with the same names in healthy individuals showed that patient K. has a violation of the functional state of the liver.

Along with the main course of treatment, additional therapeutic correction with hepatoprotectors was not carried out.

After 1 month, a second study was conducted in this way. Table 4 presents the data and percent change before and after MP.

Table 4 ALT % ACT % Alkaline phosphatase % LDH % GGT % Bilirubin % 48 37 257.15 352 44 17.8 60 25 45 21.6 304.64 18.5 477 35.5 52 18.1 22.4 25.8

Comparison of the obtained results with those in healthy individuals showed that patient K. showed a violation of the functional state of the liver. At the same time, there is a deterioration in its functional state in comparison with the initial examination of the proposed method, manifested not only by increased indices of the studied parameters during the cuff test, but also by an increase in their initial level (before the cuff test) above normal, which is a direct sign of a violation of the functional state of the liver .

Based on the two examples above, the medical and clinical effectiveness of the proposed method is identified, which consists in the possibility of conducting early diagnosis of violations of the functional state of the liver, preceding the development of clinical manifestations of violations of its functioning. Early diagnosis of liver dysfunction in this way allows you to assign and conduct an adequate therapeutic correction with hepatoprotectors and, possibly, prevent further deterioration of its functioning (as in example 1).

Claims (1)

A method for laboratory diagnosis of early violations of the functional state of the liver by measuring the activity of the enzymes ALT, ACT, LDH, GGT, AL, total bilirubin, characterized in that they additionally carry out a three-minute occlusion of the vessels of the shoulder - “cuff test” (MP) to create short-term hypoxia, under the influence which the metabolic response occurs, and determine the indices of the functional activity of the liver, which show the ratio of these indicators before and after the MP according to the following formulas:
Index ALT = ((ALT after MP - ALT to MP) / ALT to MP) · 100%
AST index = ((AST after MP - ACT to MP) / AST to MP) · 100%
LDH index total = ((LDH after MP - LDH to MP) / LDH to MP) · 100%
Index of alkaline phosphatase = ((alkaline phosphatase after MP - alkaline phosphate to MP) / alkaline phosphate to MP) · 100%
GGT index = ((GGT after MP - GGT to MP) / GGT to MP) · 100%
Bilirub Index. = ((Bilirubin after MP - Bilirubin to MP) / Bilirubin to MP) · 100%,
when detecting an increase in these indices by more than 10%, an early violation of the functional state of the liver can be diagnosed.