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INVENTION
Russian Federation Patent RU2195152

Method for predicting the course of peptic ulcer, erosive lesions of gastroduodenal zone combined with arterial hypertension

Method for predicting the course of peptic ulcer, erosive lesions of gastroduodenal zone combined with arterial hypertension

Name of the inventor: Smirnova LY .; Shpak LV .; Homullo GV .; Vinogradov VF
The name of the patentee: State University Tver State Medical Academy
Address for correspondence: 170642, Tver, ul. Sovetskaya, 4, Tver State Medical Academy
Starting date of the patent: 2001.05.15

The method can be used in medicine, namely in gastroenterology. In patients with arterial hypertension (AH) is determined intravascular, perivascular, vascular microcirculatory indexes. Then, after calculating the total summation of microcirculatory index (OMI) and its values ​​from 1 to 5 points in hypertension 1 degree relatively favorable forecast for ulcerative erosive lesions, and at 6 - 11 points with AH 2-3 degree - a dubious prognosis, with 12 points and up to 2-3 degrees of hypertension - a poor prognosis. The method is more accurate and takes into account the severity of the disease.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, namely to gastroenterology.

One of the main features of modern clinical medicine is the fact that various diseases increasingly lose their character mononozologichesky, acquiring the status of comorbidity, which provides co-expression of two or more diseases.

Ulcerative erosive lesions of gastroduodenal zone (YAEPGDZ) are among the most common diseases (5-15% of the population) do not have a tendency to decrease. As for arterial hypertension (AH), it is not only the most common disorders of the cardiovascular system, but is most common (30-40% of the population), non-communicable diseases in the world.

Already because of its prevalence and YAEPGDZ AG have often "meet" together, especially in the older age groups, where AG is registered in more than 50% of patients. According to our data, 30% of patients with hypertension YAEPGDZ there. Both diseases - hypertension and YAEPGDZ now acquire the status of social diseases, occupying one of the first places on the number of complaints, disability and disability of patients. This situation encourages the search for different flow YAEPGDZ forecast models. However, information on the prediction YAEPGDZ flow combined with hypertension, depending on the severity of the latter, in spite of the undoubted practical importance, is not detected by the authors.

The authors propose a method for predicting the flow YAEPGDZ, combined with hypertension, depending on the degree correlating with endoscopic and morphological criteria.

As an analogue applicants refer to the work of the combined course of peptic ulcer (BU) and hypertension, ON Minushkina et al (OM Minushkin, IV Zverkov, GA Elizavetino, LV Maslowski Peptic ulcer -.. M, 1995. - S.51-52), according to which the clinical picture of ulcer against the background of hypertension becomes more pronounced, and the pain and symptoms of gastric dyspepsia often do not correspond to the morphological substrate. It is associated with a significant deterioration of blood supply to the gastric mucosa (GM) and the combination of BU AG.

The disadvantage of the proposed analogue is that in this work are not considered especially microcirculatory changes in coolant and communication of clinical and endoscopic manifestations of BU to the degree of hypertension, and not take into account the specifics and severity of disorders of the microcirculation as a prognostic factor.

The prototype, according to the authors, is a way to determine the functional and structural changes in secondary coolant gastric lesions associated with cardiovascular disease (J. S. Zimmerman chronic gastritis and peptic ulcer disease - Perm.. Perm State Medical Academy, 2000... , S.26-27) that cause morphological and functional changes in the form of intravascular microcirculatory changes (venous stasis) and tissue hypoxia. Occurring at the same dystrophic and atrophic processes in the coolant associated with its extremely high sensitivity to hypoxia.

A disadvantage of the proposed prototype consists in the fact that structural and morphological changes in the coolant are described only in general terms and with respect to the whole group of chronic cardiovascular disease, combined heart failure, excluding the severity of cardiac disease, and without isolation of specific clinical entities, in particular AG.

The authors propose a method of predicting flow in conjunction with YAEPGDZ AG depending on the extent (severity) AG.

The study involved 472 patients with comorbid hypertension and over YAEPGDZ: men - 278, women - 194; age - from 16 to 77 years. The degree of hypertension was assessed according to the WHO classification / ISH (1999): 1-I was at 245, 2nd - at 137, 3rd - in 90 patients. The structure includes YAEPGDZ gastric ulcer (GU) and duodenal ulcer (DU) - 355 patients, and chronic erosive gastro - 117. During the endoscopy of the upper digestive tract was carried out aiming biopsy mucosa antrum.

The distribution of patients by YAEGTGDZ flow characteristics of diseases based on data endoscopy revealed certain patterns depending on the degree of hypertension. Thus, the simultaneous combination of GU and DU with 1st and 2nd degree of hypertension was observed in 53 (18%) patients, whereas a third degree - in 19 (29%; p <0.05). The large (or huge) and / or multiple ulcers occurred in 109 (38%) cases of hypertension of 1-2 degrees and in 35 (54%; p <0.025) - in AH 3rd degree. Regarding morbidity YAEGTGDZ depending on the degree of hypertension, in relation to the GU and DU significant differences were obtained for such complications as gastrointestinal bleeding. In particular, when AH 1 -2 degree the number of patients with bleeding was 54 (14%), and in hypertension grade 3 - 20 (31%; p <0.05). Thus, according to endoscopy at YAEPGDZ AH 3rd degree, compared with AH 1-2 degree, we can predict an unfavorable course of the disease: development of more frequent combination of GU and DU, the presence of large (giant) and multiple ulcers, but also a greater incidence of gastro-intestinal bleeding. Hence, it has been suggested that structural and morphological change of the mucosa and microvasculature, particularly in YAEPGDZ comorbidity and hypertension, have not only different for each of these conditions alone, but also depending on the degree of hypertension. Furthermore, if the whole morphological changes consistent with the nature erosive-ulcerous lesions, the structure changes in vascular coolant may depend on the degree of hypertension.

Morphological state of coolant evaluated in 72 patients with hypertension and YAEPGDZ (main group) with the help of light-optical microscopy on sections 6-7 microns thick, stained with hematoxylin with eosin. The control group consisted of 18 patients with YAEPGDZ without hypertension. These groups were matched by sex, age and character of somatic pathology.

Violations of the microcirculation in the coolant is determined by parameters such as the extravascular, endovascular and vascular changes (VA Tkachev, Matyas BL Miller DA qualitative-quantitative assessment of morphological status of the gastric mucosa -. Proc .: The Chernin .In Solovyov VA, VA Tkachev, Matyas BL Miller DA Gastritis -.. Tver, Tver State Medical Academy RIO, 1999. - S.72-77) that were scored, depending on the severity of violations. Among the extravascular microcirculatory changes were determined: the perivascular tissue edema, hemorrhage in the number and depth of the location, which is summarized as assessed by perivascular microcirculatory index (PMI). Vascular microcirculatory changes included: expansion of venules and capillaries, the state of the vascular wall, the aneurysm microvascular and vascular microcirculation index (media). Intravascular microcirculatory changes included: intravascular stasis in venules and capillaries, the presence of thrombi in venules and capillaries, intravascular microcirculatory index (VMI). Points indices amounted to total microcirculatory index (OMI), the normal value is 0,45 ± 0,21.

It turned out that people in the control group microcirculatory disorders in the coolant absent in 3 (16.7%) patients were not significant - in 13 (72.2%) and moderate - in 2 (11.1%). In the study group, on the other hand, microcirculation disturbances in GM were observed in all patients: only 11 (15.3%) cases were minor, others 18 (25.0%) - moderate and in 43 (59.7%) - pronounced. Thus, when YAEPGDZ AG without disturbance of microcirculation in most patients coolant slight or absent, whereas when combined with YAEPGDZ AH small percentage of patients (p <0.001).

Compared with YAEPGDZ normotensive (control group), while YAEPGDZ combined with hypertension (study group) is more pronounced were extravascular microcirculatory changes (at MIT), cardiovascular disorders (media), intravascular microcirculatory disorders (in IUI), and and OMI .

Because OMI reflects the severity of the studied microcirculatory changes, it is on this index can be most accurately judge the degree of microcirculatory disorders in the coolant. The applicants consider the value of the SMI as an indicator of prognosis of YAEPGDZ, combined with hypertension, according to the results of research degree of microcirculatory disturbances in the coolant not only reflects the peculiarities of YAEPGDZ, but also is the earliest predictor of an unfavorable development of these diseases. OMI are 4 categories:

0th category: OMI = 0 points (0.00) - microcirculatory changes are absent, reflecting the favorable prognosis of YAEPGDZ;

1st category: OMI = 1-5 points (3,06 ± 0,20) - minor (light) microcirculatory disorders, the prognosis YAEPGDZ relatively favorable;

2nd category: OMI = 6-11 points (6,86 ± 0,18) - moderate (moderate severity) microcirculatory disturbances, determine the questionable forecast, pointing to the likelihood of more severe, including complications YAEPGDZ flow;

3rd category: OMI = 12 points or higher (16,75 ± 0,31) - marked (heavy) microcirculatory disorders, the prognosis YAEPGDZ unfavorable.

From OMI category at YAEPGDZ without hypertension disorders of microcirculation in the coolant, mostly minor or non-existent (88.9% forecast of favorable or favorable) and only 11.1% - moderate (doubtful prognosis). In contrast, in patients with hypertension YAEPGDZ in most cases (59.7%) in violation of the microcirculation in the coolant expressed (forecast neblagopryatny), and the rest - moderate (25.0% forecast a doubtful) or minor (15.3%; forecast relatively favorable).

As can be seen from Table 2, microcirculatory indexes characterizing the qualitative and quantitative changes in the morphological state of the coolant YAEPGDZ patients with hypertension significantly increase at weighting AG.

Microcirculatory disorders at SMI in patients with hypertension YAEPGDZ depending on the degree (severity) of the last showed that in hypertensive patients, 1 st degree (26 patients) in 11 (42.3%) cases of microcirculation disturbances were minor (relatively favorable prognosis) and 15 (57.7%) - moderate (doubtful prognosis). In Stage 2 nd and 3 rd degree (46 patients), moderate microcirculatory disorders in the coolant (a doubtful prognosis) were found in only 3 (6.5%) patients and in 43 (93.5%) they were expressed (forecast adverse).

Thus, the amplification degree of hypertension (from 1 st to 2 nd, and 3) there is a significant deterioration in microcirculatory processes in the coolant, which leads to a poor prognosis YAEPGDZ flow.

Structural and morphological changes in the coolant resulting microcirculatory disturbances (hyperemia, venous stasis, thrombosis, hemorrhage, and others.) Contribute to the development of tissue hypoxia and lead not only to the atrophy of glandular elements coolant, but based on the results of endoscopic studies, and more severe course YAEPGDZ. This is expressed in the more frequent formation of large and giant ulcers, their multiplicity, combined course of GU and DU, and more frequent and gastrointestinal bleeding.

Morphological changes of coolant in hypertension patients with YAEPGDZ ahead of the development of more pronounced, endoscopically detected violations, as they significantly increase at strengthening AG from 1st degree to the 2nd and 3rd, while the endoscopic parameters are significant differences observed only between 1 2 and grade 3 hypertension. Consequently, not only the fact YAEPGDZ combination with hypertension, but also the latest manifestation of influence on the course of YAEPGDZ, including the degree of morphological changes in the coolant. At the same time violations of the microcirculation in the coolant can be considered as the earliest predictor of an unfavorable course of YAEPGDZ, combined with hypertension. The results obtained by the SMI, allow us to conclude that the YAEPGDZ with hypertension is not only the third, but the 2nd degree, the prognosis of gastroduodenal pathology generally unfavorable due to more severe, including complications YAEPGDZ flow.

Thus, the claimed method YAEPGDZ flow forecasting in conjunction with hypertension for the first time takes into account the impact on the degree of hypertension severity of microcirculatory disturbances in the coolant detected at endoscopy and morphological studies.

The ability to predict the course YAEPGDZ, combined with hypertension, allow more reasonably determine tactics of treatment of these patients, the need for and timing of repeat endoscopic studies, but also to evaluate the effectiveness of treatment and full recovery from YAEPGDZ in the presence of high blood pressure. From a pathogenetic point of view found an important mechanism for the mutual weights at which systemic circulatory disorders, hypertension inherent exacerbate inflammatory and destructive processes of the mucous membrane of the gastroduodenal zone.

CLAIM

A method of predicting flow ulcerative erosive lesions gastroduodenal combined with hypertension (AG), comprising determining the intravascular microcirculatory index, characterized in that it further define perivascular microcirculatory index vascular microcirculation index, in their sum is calculated total microcirculatory index (OMI) and its value from 1 to 5 points, with 1 degree of hypertension predicted relatively favorable for ulcerative erosive lesions of gastroduodenal zone, while values ​​of from 6 to 11 points at 2-3 degrees of hypertension - a questionable prognosis and at 12 points and above at 2-3 degrees AG - a poor prognosis.

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Publication date 29.03.2007gg