RU2522202C1 - Method for prediction of developing bacterial complications with underlying acute respiratory viral infection - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and can be used for the prediction of developing bacterial infections in the patients suffering acute respiratory viral infection prior to clinical presentations. Substance of the method: NAPD-dependent glutamate dehydrogenase activity in peripheral blood lymphocytes of the patient suffering acute viral infection is measured. If the value is more than 2.89 mcU/10000 cells, the bacterial complications are predicted to develop within 3-5 days after admission to hospital.

EFFECT: method implying measuring the one value enables predicting the developing bacterial infections prior to their clinical presentations in the patients suffering an acute respiratory viral disease with 92,31% confidence, conducting the early treatment with antiviral preparations and metabolic immune protectors to prevent the developing bacterial complications.

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Description

The invention relates to medicine and can be used for early prediction of complications of acute viral infections in the clinic of internal and infectious diseases.

An analogue of the proposed method can be considered a method for predicting the course of psoriatic arthritis (RF Patent No. 2032379 A61B 10/00, 04/10/1995), in which a favorable course of psoriatic arthritis is predicted by the ratio of the levels of isoforms of bone fractions of alkaline and acid phosphatases. There are also known methods for predicting the course of the postoperative period in patients with purulent surgical infection, which uses the activity indicator in the lymphocytes of the G6PDH enzyme and NADP-malate dehydrogenase (RF Patent No. 2153674 G01N 33/573, 07.27.2000, RF patent No. 217759 G01N 33 / 573, 11/27/2003). However, these methods are not applicable in predicting bacterial complications of influenza and SARS.

The well-known "Method for predicting bacterial complications of influenza and acute respiratory viral infections on the 1-5 day of illness" (RF Patent No. 20063039; G01N 33/48, G01N 33/483, 06/27/1996). Its essence is that a blood test is carried out, and luminol-dependent chemiluminescence indicators are determined in combination with other clinical and laboratory parameters, and with a total diagnostic coefficient of less than 13, the development of bacterial complications of influenza and SARS is predicted. With a total diagnostic coefficient of more than 13 - a favorable course of the disease. The disadvantages of this method are the need to determine a large number of physiological parameters of the patient using expensive equipment, as well as the subsequent rather complicated statistical processing of the results.

The objective of the proposed method is to predict the development of bacterial complications in acute respiratory viral infection.

The task is achieved due to the fact that the activity of the enzyme NADP-dependent glutamate dehydrogenase (NADPHDG) is determined in the lymphocytes of the peripheral blood of a patient with acute viral infection, and if the activity of NADPHDG is exceeded by more than 2.89 μE / 10000 cells, the development of bacterial complications is predicted in 3-5 days after admission to the hospital.

The choice of this indicator is due to the fact that the activity of NADPHDG reflects the intense consumption of amino acid metabolites in the tricarboxylic acid (CTK) cycle, which limits the use of amino acids by lymphocytes in the synthesis and proliferation processes that provide an adequate immune response (Bulygin G.V., Kamzalakova N.I. , Andreychikov A.V. Metabolic basis for the regulation of the immune response. - Novosibirsk: SB RAMS, 1999. - 346 s). The decrease in the ability of lymphocytes to proliferate and synthesize immunoglobulins and cytokines limits the formation of an antiviral and antibacterial immune response, which contributes to the attachment of infectious complications.

The proposed method is implemented as follows:

3-5 ml of peripheral blood is taken from a patient from a vein, a suspension of lymphocytes is isolated from it on a density gradient of ficollverographin (1.077 g / ml) according to the method of A. Bouym (Boyurn A. Separation of blood leukocytes, granulocytes and lymphocytes // Tissue Antigens . - 1974. - Vol.4. - P.250-260). The activity of NADPHDG is determined in 100-120 thousand cells by the method of bioluminescence with bacterial luciferase (Savchenko A.A., Suntsova L.N. - Lab. Delo. - 1989. - No. 11. - P.23-25.). Given the increase in NADPHDH activity above 2.89 μE / 10000 cells, a conclusion is drawn about the possible development of bacterial complications in a patient with acute viral infection.

Table 1 presents the results of a survey of 52 patients admitted to the infectious ward of GBSMP them. N.S. Karpovich with acute respiratory viral infection. On the 3-5th day of hospitalization, 21 of them developed bacterial complications of the disease (No. 32-No. 52), and 31 patients (No. 1-No. 31) had no complications. According to the results of determining the activity of NADPHDH in four patients (in the table No. 3, 4, 8, 13), the development of bacterial complications was predicted, since the enzyme activity index exceeded the critical value (2.89 μE / 10000 cells), but this did not happen. Thus, the reliability of the proposed method for predicting the development of bacterial complications in acute respiratory viral infection is 92.31%.

Example 1. Patient M., 21 years old (in the table, data No. 44) was admitted to the infectious ward of GBSMP them. N.S. Karpovich on October 14, 2009 with complaints of: weakness, chills, “aching in the whole body”, fever up to 40 ° C, a headache of a pressing nature, nasal congestion, profuse mucous discharge from the nose, sore throat. It hurts the second day. Epidemiological history: on the eve of the disease, a hypothermia factor is noted, it is not vaccinated against flu.

Objectively: The general condition is severe, the consciousness is clear, inhibited. Body temperature - 39.5 ° C. The skin is of normal moisture and color. The mucosa of the oropharynx is moderately hyperemic, the granularity of the posterior pharyngeal wall. Peripheral lymph nodes are not palpable. Difficulty breathing through the nose. The lungs have hard breathing, no wheezing, NPV - 24 per minute. Heart sounds are clear, rhythmic, heart rate - 110 per minute, blood pressure - 120/70 mm Hg. Pathology from the gastrointestinal tract and kidneys was not detected.

On admission, the activity of NADPHDH was 8.31 μE / 10000 cells (above the critical value of 2.89 μE / 10000 cells). In accordance with the value of this indicator, the possible development of bacterial complications is predicted.

The patient received the generally accepted treatment complex, but on the 3rd day of hospitalization, despite a decrease in temperature to 38.5 ° C, an increase in cough and the appearance of mucopurulent sputum, shortness of breath, and chest pain were noted. Objectively: in the lungs against the background of hard breathing, dry rales in the lower lobe on the right along the scapular line.

R-graph of the chest from 15.10. - there is no data for pneumonia; from 20.10. - right segmental (S6) pneumonia, 28.10. - Infiltration in the lung tissue resolved. R-graph of the sinuses from 15.10. - pneumatization of the paranasal sinuses is preserved.

PCR smear from the nasopharynx from 16.10. - influenza A, influenza A (H1N1) swin.

Thus, the prognosis of the development of bacterial complications, determined by the activity of the NADPHDH enzyme as positive, coincided with the course of the disease: Flu A (H1N1) swin, a severe course complicated by right-sided segmental (S6) pneumonia. The patient was discharged from the hospital after 18 days in the stage of clinical recovery.

The advantages of the proposed method are that it allows the determination of one indicator to predict the development of bacterial complications before the appearance of their clinical picture in patients with acute respiratory viral infection with a reliability of 92.31%, to conduct timely treatment with antiviral drugs and metabolic immunocorrectors to prevent the development of bacterial complications .

Claims (1)

A method for predicting the development of bacterial complications in the presence of an acute respiratory viral infection, which consists in determining the activity of the NADP-dependent glutamate dehydrogenase enzyme in the lymphocytes of the peripheral blood of a patient with acute viral infection, and when its index exceeds 2.89 μE / 10000 cells, the development of bacterial complications is predicted in 3 -5 days after admission to the hospital.