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INVENTION
Patent of the Russian Federation RU2150705
METHOD FOR PREDICTING THE GRAIN OF GASTRODUODENAL PATHOLOGY
The name of the inventor: Vasileva L.I. Suchkov I.Yu .; Chernitskaya ML; Lyudmirskiy V.G.
The name of the patent holder: Vasilyeva Larisa Ivanovna; Suchkov Igor Yuryevich; Chernitskaya Marina Leonidovna; Lyudmirsky Vladimir Grigorievich
Address for correspondence: 344022, Rostov-on-Don, per. Nakhichevan, 29, Russian State Medical University, Patent Department
Date of commencement of the patent: 1999.07.07
The invention relates to medicine, namely gastroenterology and microbiology, and can find application in medical work both in hospitals and in polyclinic conditions. The method provides for increasing the efficiency and sensitivity of the method. For this, in patients with chronic gastritis, peptic ulcer of the stomach and duodenum, two biopsies of standard size (2 x 2 mm 2 ) are taken from the affected area of the mucous and slightly altered areas of the antrum of the stomach with the help of the fibrogastroduodenoscope XQ-30 and the biotome of the company "Olympus". In the biopsies studied, the presence of DNA of herpes simplex viruses, cytomegalovirus, human papillomaviruses and Helicobacter pylori is determined using a standard polymerase chain reaction.
DESCRIPTION OF THE INVENTION
The invention relates to the field of medicine, namely gastroenterology and microbiology, and can find application in medical work both in hospitals and in polyclinic conditions.
Chronic gastritis and peptic ulcer of the stomach and duodenum occupy one of the leading places in the pathology of the gastrointestinal tract. Great importance in the pathogenesis and severity of the course of these diseases is given to microorganisms colonizing the mucous membrane of the corresponding organs. The exact prognosis of the unfavorable recurrent course of chronic gastritis and peptic ulcer of the stomach and duodenum is very relevant, based on the data of the microbiological study. Determines the choice of adequate antimicrobial therapy in this pathology.
At present, a number of methods for diagnosis and prognosis of gastroduodenal pathology have been developed, based on the discovery in the gastric and duodenal mucosa of spiraling bacteria - Helicobacter pylori. Thus, in the article by E.M. Starodub, M.E. Gavrilyuk et al "Determination of the degree of dissemination of H. pylori gastric mucosa" (Lab - 1991. - N 7. - pp. 66-68) indicates the relationship between the contamination of the mucosa of the stomach of H. pylori and the severity of inflammatory- Erosive changes, and the likelihood of recurrences of chronic gastritis and peptic ulcer of the stomach and duodenum. In LLina's article "Peptic ulcer: new facts - new issues" (Archives of Pathology - Vol. 60. 1998 - N 3. - pp. 63-67), it is reported that the presence of antral gastritis caused by H . Pylori, tenfold increases the risk of developing neoplasms. After successful antibacterial therapy and destruction of H. pylori, recurrences of peptic ulcer of the duodenum appeared only in 5% of patients.
From the patent sources AC SU 1659850 A1, IPC G 01 N 33/48, BI N 24, 1991, a method for determining the infection of the stomach of Campylobacter pyloridis by measuring the urea concentration in the basal and histamine or pentagastrin-stimulated fractions of gastric juice before and after administration of antibacterial therapy .
This method is the closest to the claimed and taken as a prototype. Its essential disadvantage is that the study does not take into account the presence in the studied material of herpetic viruses and papilloma viruses, often colonizing the human body and causing a mixed viral-bacterial infection with a more severe clinical course, which reduces the accuracy of diagnosis and the ability to predict the severity of this pathology.
The aim of the present invention is to predict the severity of the course of the disease. This goal is achieved as follows. In patients with chronic gastritis and gastric ulcer and duodenal ulcer before and after treatment in the fibroadastoduodenoscopy study (FGDS) with the help of the fibrogastroduodenoscope XQ30 and the biochrome of the firm "Olympus" (Japan) 2 biopsies (2x2 Mm 2 ) both from the affected area of the mucosa, and from the slightly modified areas of the antrum of the stomach, This locus is the place of permanent presence of H. pylori. In the biopsies tested, the presence of DNA of herpes simplex virus (HSV), cytomegalovirus (CMV), human papillomavirus (HPV) virus, a and H. pylori by standard polymerase chain reaction (PCR) (Mullis KV Faloona FA - Methods Enzymol - 1987. - V. 155. - P. 335-350), using commercial PCR diagnostic kits manufactured by JSC "DNA-technology", "Dialat", "Litech" (Moscow). DNA isolation and PCR setting are carried out according to the recommendations of the manufacturers of diagnostic kits. If these viruses are detected, the possibility of recurrence and severe course of the disease is predicted.
The invention is illustrated by two clinical examples.
Example 1 . Patient Sh., 50 years old, within 10 years suffering from HG and JBW. Every year there are exacerbations in autumn and spring. In the period of the next exacerbation, the FGDs were performed and biopsy samples of the gastric mucosa were taken, in which viruses (HSV) and bacteria (H. pylori) were detected by PCR, which allowed predicting the occurrence of relapses. In the hospital was 4 weeks, where complex antiulcer therapy was carried out, including antibacterial and antiviral treatment. Control FGDS before discharge: complete cicatrization of the ulcer, residual inflammatory changes in the antrum mucosa. In the biopsy specimens of the gastric mucosa HSV and H. pylori were not found, which allowed to establish the effectiveness of treatment and predict the absence of a recurrent course of the disease.
Example 2 . Patient S., 26 years old with a diagnosis of HG, JBD. At admission to the hospital: in biopsy specimens taken at FGDS, were found in the lesions of HSV, HPV and H. pylori, which indicated the possibility of severe disease. Based on the results of the study, the patient received antimicrobial and antiviral therapy for three weeks in hospital. Before discharge from the hospital, conducted control studies of biopsies showed the absence of H. pylori, but HSV continued to be detected in the mucosa of the duodenum, which indicated the ineffective antiviral treatment and predicted the high probability of the recurrence of CG and JBD in the near future. After 6.5 months after discharge from the hospital, a relapse of the disease actually developed.
Similar studies were performed in 67 patients with HB, JAJ and JBD. In Table. 1 presents data on the frequency of detection of the investigated viruses and H. pylori in gastroduodenal pathology in comparison with the control group of healthy people. As you can see from Table. 1, to accurately predict the severity of gastroduodenal pathology, it is necessary to take into account the presence in the biopsy specimens of the stomach and duodenal mucosa not only of bacteria (H. pylori), but also of cytomegalovirus, herpes simplex and human papillomavirus, the frequency of which is much higher than the frequency of H .pylori.
In Table. 2 presents the data obtained by a comparative analysis of the effectiveness of the proposed method and the prototype method, which we used for predictive purposes in two groups of subjects. The first group (n = 38) consisted of patients who had a relapse after treatment. The second group (n = 29) consisted of patients who subsequently had no recurrences of the disease for 3.5 years.
In comparison with the prototype, the claimed method provides a more complete determination of gastric infectivity by microorganisms characteristic of this pathology, which contributes not only to improving the accuracy of the prognosis, but also to a more correct choice of antimicrobial therapy for the treatment of gastroduodenal pathology.
CLAIM
A method for predicting the severity of gastroduodenal pathology by detecting microorganisms (Helicobacter pylori) in the affected areas of the gastric and duodenal mucosa (Helicobacter pylori), wherein in the mucosal biopsies, the presence of DNA of herpes simplex virus, cytomegalovirus and human papillomavirus viruses is determined by polymerase chain reaction, Which predict a serious course of the disease with the occurrence of relapses.
print version
Date of publication 30.03.2007gg
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