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DERMATOVENEREOLOGY
INVENTION
Patent of the Russian Federation RU2196331

METHOD OF CYTOLOGICAL CONTROL OVER TREATMENT OF PSORIASIS

METHOD OF CYTOLOGICAL CONTROL OVER TREATMENT OF PSORIASIS

The name of the inventor: Teryoshin K.Ya.
The name of the patent holder: Far Eastern State Medical University
Address for correspondence: 680000, Khabarovsk, ul. M-Amursky, 35, FECU, OIS
Date of commencement of the patent: 2000.11.17

The method can be used in medicine, namely - in dermatology. Examination of smears-prints from lesions, stained with 50% silver nitrate (lapis) - AgNO 3 , followed by counting (in an ordinary microscope) of Ag + granule cells fixed in the nucleus. With the number of granules 3.86 ± 0.58% determine the stage of progression, at 3.79 ± 0.69% - the progressively-stationary stage and at 3.66 ± 0.10% - the stationary stage. The method can be used in a conventional general clinical laboratory, in outpatient and inpatient settings, repeatedly to dynamically control the effectiveness of treatment of patients with psoriasis.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, in particular to dermatology.

There is a diagnostic method for autoradiographic determination of mitotic activity (multiplication, division) of skin cells to control the effectiveness of psoriasis treatment. The method is laborious, as it requires a biopsy (cutting a piece of skin from the lesion by surgical means with a scalpel). In addition, this method is very painful, requires sterile conditions, accompanied by bleeding, healing in the biopsy site occurs with the formation of a scar. This excludes research with limited lesions in the face or genitals, and in young children with psoriasis. The possibility of an autoradiographic study to monitor the effectiveness of treatment is limited: first, the need to have a radioactive isotope - thymidine H 3 ; Secondly, the presence of conditions for its storage (special lead tanks and premises for them); Thirdly, long terms of obtaining the result - at least 4 weeks (Dedenkov AN, Pelevina II, Sayenko AS Predicting the reaction of tumors to radiation and drug therapy., Medicine, M., 1987. , 160 s.); Fourth, the impossibility of repeated biopsies on the same site of damage in the dynamics of treatment.

The foregoing makes it difficult to widely use this method in dermatology.

Methods for monitoring the effectiveness of treatment of patients with dermatoses, in particular psoriasis, based on the determination of T- and B-lymphocytes and immunoglobulins (immunograms), as well as on the cytochemical parameters of PUVA therapy, based on changes in the antibody-dependent cytoxicity of lymphocytes after treatment of psoriasis Kauhova O.Ya., Kaplan BS Symposium on Psoriasis of Dermatovenerologists of the Socialist Countries, 3rd, Abstracts of Reports, M., 1987, p.58-59; Rubins A.Ya., Graudina Zh.P., Mashkilleyson AL, Veksler Kh.M. Method of predicting the course of psoriasis: AS 1263250 USSR).

Attempts are made to predict the course of psoriasis and evaluate the effectiveness of therapy in the early stages, long before the end of the normalization of clinical and laboratory indicators (Dovzhansky SI, Narcissov RP, Rumyantseva EV, Utts SR Forecasting the course of psoriasis. Dermatology and Venerology, 1990, 2, p.28-31) using prognostic tables. However, these control methods are nonspecific for psoriasis, since similar changes in indices (immunograms, cytotoxicity of lymphocytes) are observed in other dermatoses.

The method of diagnosis of psoriasis, proposed by NG. Short, K.N. Grimberg, G.Ya. Sharapova, S.M. Terekhova, N.A. Antonova (stated on May 31, 1985, 3951550 / 28-14 (077889)), is based on the evaluation of cell growth stimulating activity of serum of psoriasis patients. To do this, it is necessary to obtain a culture of diploid fibroblasts of human skin in a special laboratory on special media and to evaluate its cytotoxicizing effect on the incorporation of radioactive H 3 - thymidine. This method of diagnostics is possible only for scientific purposes, since special conditions and terms for growing the fibroblast culture are necessary, and the conditions for working with radioactive H 3 -thymidine (see above).

The basis of skin rashes in psoriasis is the increased proliferative (mitotic) activity of skin cells, characterized by an increase in the rate of cell division in the lesions in 8 times, compared with the norm (in the progressing stage of psoriasis, the whole cycle of epidermal formation takes place 4-5 days instead of 28- 30 days in normal - this explains the increased peeling in psoriasis, so another name for the disease is scaly lichen). General clinical and immunological tests do not fully reflect the processes occurring in the skin itself, but characterize the general condition of psoriasis patients, which is not disturbed even with very common skin lesions.

The object of the invention is to improve the method of cytological determination of the proliferative activity of skin cells in patients with psoriasis and the possibility to conduct these studies to monitor the effectiveness of treatment in general clinical laboratories.

The aim of the invention is to simplify the diagnostic process.

The goal is achieved because after scraping the scales with the edge of the slide and removing them from the surface of the lesion focus, a smear-imprint is made with a slide of the epidermal cells. Then the "imprint" on the glass is stained with silver solution - 50% AgNO 3 for several minutes. After drying, the silver Ag + pellets counted by dividing cells in an ordinary microscope are counted at a magnification of 90 times. In this way, it is possible to determine the stage of psoriasis progression (progressive, stationary, regressive), but also the "intermediate" stages (progressively-stationary, stationary-regressive) not only visually, but also laboratory, to monitor the effectiveness of treatment on the basis of a multiple study of the changes in proliferative activity . Studies are carried out in the calculation of Ag + granules in the nucleus of skin cells. The whole process of taking a smear-print and obtaining a laboratory result takes no more than 1.5-2 hours. The need to determine the dynamics of treatment of the stages of psoriasis and especially the "intermediate" stages is that active treatment (physiotherapy, ointments with a high concentration of tar, sulfur, ichthyol, etc.) can not be assigned to the progressive stage, and as in the progressively-stationary "Intermediate") stage. Inadequate treatment leads to severe complications in the form of lesions of the entire skin (erythroderma).

For an objective evaluation of the effectiveness of medicinal preparations on psoriasis, the criteria characterizing the proliferative activity, given in the table, were used.

A consistent decrease in the values ​​of these indicators was regarded as a positive dynamics of the course of psoriasis on the background of the treatment. The advantage of the proposed method is:

1. Specificity of the method for the diagnosis of psoriasis.

2. The ability to repeatedly take a smear-print in the dynamics of treatment from the same site of damage.

3. The speed of obtaining the result (1.5-2 hours).

4. Painless and bloodless manner.

5. The ability to determine the "intermediate" stages of psoriasis, not visually diagnosed.

6. The possibility of a comparative evaluation of the effectiveness of treatment methods.

7. Simplify the diagnostic process.

8. Improvement of the method of cytological investigation of the proliferative activity of skin cells.

Example 1 . Patient A., 35 years old, was diagnosed with: common psoriasis, drop-shaped form, progressive stage, indeterminate type. Has been sick for several years, relapses last years arise 2 times a year - in the spring and autumn seasons.

When entering the inpatient, the patient had a uniform ("drop-shaped") form of dermatosis, when new elements of the rash did not differ from those that had arisen earlier. It was prescribed on an outpatient basis, in the skin dispensary, active treatment: T-activin in injections, vitamins of group B, external-sulfur-tar 5-10% ointment, UFD in erythematous doses. On the 4th day after the beginning of therapy, the patient increased erythema in the elements of the rash, more actively began to appear new psoriatic papules, in connection with which the treatment was canceled and started therapy with indifferent means. The performed analysis of the nuclear index in the smears-prints from the "old" elements of the eruption showed that the patient had a progressive stage of the disease when admitted for inpatient treatment, which was not visually diagnosed, due to the absence of differences in the dimensions of the psoriatic elements. This led to the activation of the skin process and the occurrence of complications in the form of erythroderma (with the appointment of inadequate treatment). To remove the acute phenomena had to appoint hormone therapy.

Example 2 . Patient V., 28 years old, entered the skin hospital with a diagnosis: widespread psoriasis with a tendency to transformation (transition) into erythroderma. The patient received active ointment and physiotherapy treatment on an outpatient basis with a diagnosis: plaque-like psoriasis, stationary stage, winter type. In the study of the smear-print on the first day of admission to hospital, a progressively stationary stage was determined: the average number of Ag + granules in the nucleus was 3.78.

Thus, visually the doctor-dermatologist of the dispensary mistakenly established a stationary stage, while the patient still had progression of the skin process, but with a less pronounced intensity. In the inpatient department, the patient was prescribed treatment corresponding to the laboratory-identified stage.

Example 3 . Patient M., 14 years old, entered the hospital with a diagnosis: a common plaque-nummular ("coin-like") psoriasis, a stationary stage. Given the uncertainty of the clinical picture of the rashes, difficulties in visual evaluation of the stage of dermatosis, the state of the nuclear cellular index was examined in the patient before treatment, which corresponded to the "intermediate" - progressively-stationary stage: the average number of granules in the nucleus was 3.70.

In connection with the "intermediate" state of this indicator, a progressively-stationary stage of psoriasis was established and an indifferent method of therapy was prescribed. Complications for the entire period of treatment was not observed.

The use of the present invention provides rapid diagnosis of various stages of psoriasis and allows monitoring of the effectiveness of treatment of patients in dynamics, repeatedly. The method is bloodless, easily feasible in a general laboratory, highly informative and specific for psoriasis.

CLAIM

A method for determining the stages of psoriasis, including a cytological examination, characterized in that a smear-imprint of skin cells is taken from the lesion focus on the slide after preliminary removal of flakes from the skin surface, staining the preparation with 50% silver nitrate (AgNO 3 ), after fixing the smear, count in the core The number of Ag + granules fixed by dividing skin cells at a granule number of 3.86 ± 0.58% determines the stage of progression, at 3.79 ± 0.69% - the progressively-stationary stage and at 3.66 ± 0.10% Stationary stage.

print version
Date of publication 01.04.2007гг