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INVENTION
Russian Federation Patent RU2007728

Method for predicting the course of gastric ulcer and 12 duodenal ulcer in patients with pyloric Campylobacter

Method for predicting the course of gastric ulcer and 12 duodenal ulcer in patients with pyloric Campylobacter

Name of the inventor: Rubtsov MA .; Rubtsov NI .; Perkin EM
The name of the patentee: Mikhail Rubtsov
Address for correspondence:
Starting date of the patent: 1991.06.17

Usage: In the medical field, namely surgery. The inventive preparation is determined in one degree of bacterial contamination of the content of cationic proteins in epithelium and stroma granulocytes mucosa and when the content of cationic proteins in epithelium within 1.5 - 1.8, cationic proteins in granulocytes 0 - 0.8, the degree of bacterial dissemination to 20 microns in sight (+) are judged on normal mucosal barrier function and no acute illness, when the content of cationic proteins in the epithelium of less than 1.0, cationic proteins in granulocytes greater than 1.0, with the average - 50 microns (++) or severe more than 50 microns (+++) The extent of bacterial contamination judge the strength of the local bakteriditsinoy mucosal protection mechanism and an exacerbation of the disease, when the content of cationic proteins in the epithelium of less than 0.8 and cationic proteins in granulocytes less than 1.0 in conjunction with bacterial contamination of more than 50 microns (+++) are judged on the system decompensation bactericidal protection of the mucosa and the threat of complications. The method can improve the accuracy of prediction of the pathological process and the choice of method of treatment.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, specifically to surgery, gastroenterology.

There are known methods for predicting the course of gastric ulcer and duodenal ulcer (12 p. In.) With the use of the test as a prognostic determination of the content of the glycoproteins in the gastric juice (1,2,3), proteolytic activity (4), the ratio of the acid-peptic factor and factors "protection" (5.6).

These methods have a number of drawbacks:

1. Do not always show a clear link between the state of gastric secretion and the clinical course of the disease (the cost of laboratory methods for the quantitative determination of the components of gastric juice).

2. Do not reflect the state of the local non-specific resistance of the gastric mucosa and 12 n. A.

3. Conducted excluding bacterial background of the stomach and 12 p. In. (Presence of pyloric campylobacter).

Known method of evaluating local humoral immunity in patients with peptic ulcer disease 12 p. In. With pyloric Campylobacter. (9) Status local humoral immunity was evaluated by determination of the secretory immunoglobulin -A in gastric juice, saliva, blood serum by radial immunodiffusion according to Mancini domestic using monospecific antisera.

Method has the following disadvantages:

1. It is impossible to evaluate the stage of ulcer process in severe degree of bacterial contamination.

2. The gastric juice is a very aggressive medium destroys proteins and immunoglobulins in particular. The probability of erroneous conclusion great.

The closest to the claimed method is a method of predicting the flow of various diseases of the stomach, and 12 n. K. A cationic protein by determining (LCT) as an indicator of physiological resistance coating mucosal epithelium (7,8).

However, an attempt to characterize the severity of morphological changes by determining the state of the barrier function of the epithelium excluding specific bacterial background of the stomach and 12 p. In. (Presence of pyloric campylobacter) not fully reflect the true nature of the ratio of cationic proteins and the dynamics of the pathological process. Screening for pyloric Campylobacter was conducted. Cationic proteins in granulocytes stroma mucosa have not been determined.

The present invention is to improve the process flow prediction of gastric ulcer and 12 p. A., By increasing the reliability evaluation results of the determination of cationic proteins in epithelium and granulocytes mucosa and comparing the identified parameters with the degree of bacterial contamination and the dynamics of ulcerative process that allows the selection of the method of treatment . The goal is achieved by a method based on the determination of cationic proteins in gastric epithelium and 12 n. A., Further comprising determining the presence in a single preparation pyloric campylobacter, and the ratio of cationic proteins in epithelium and stroma granulocytes mucosa. When the content of cationic proteins in the epithelium in the range 1.5-1.8, cationic proteins in granulocytes 0-0.8 degree of bacterial contamination up to 20 microbes in the field of view (+) are judged on normal mucosal barrier function and the absence of disease exacerbation. When the content of cationic proteins in the epithelium of less than 1.0 cationic proteins in granulocytes with an average of more than 1.0 - 50 microbes in the field of view (++) or severe - more than 50 microbes in the field of view (+++) The extent of bacterial contamination is judged on strength bactericidal mechanisms of local protection of mucosal and exacerbation of disease. When the content of cationic proteins in the epithelium of less than 0.8 and cationic proteins in granulocytes less than 1.0 in conjunction with severe bacterial infection - more than 50 microbes in the field of view (+++) are judged on the system decompensation bactericidal protection of the mucosa and the threat of disease complications.

The method consists in the following:

the object of study are patients with gastric ulcer and 12 p. in. with different disease duration, severity of morphological changes and varying flow dynamics of ulcerative process. Patients performed fibrogastroduodinoskopiya. Fence biopsies performed by two-time targeted biopsy of the mucous of the bulb 12 p. In., Antrum and body of stomach. For determination of cationic proteins in epithelium and granulocytes, pyloric campylobacter presence made smears - imprints on the glass slide and then placed in a biopsy to determine the environment Sachs urease activity. Smear were fixed in methanol for five minutes, and then stained with a lasting green pH 8.1-8.2 for twenty minutes. Without washing dokrashivayut strokes in three portions at 0.02% safranin in every five seconds. Stained swabs and dried with increasing mikroskopirovali 630 (10). Cationic protein content in the surface epithelium and granulocytes was determined semiquantitatively by formula (VE Pigarevsky, 1981 YG):

LZC (cat. B.) = Where LZC (cat b.) - Average cytochemical index of cationic proteins

and - i - the number of surface epithelium cells and granulocytes with a certain degree of staining cytoplasm fast green

3 - 0 - the degree of staining intensity (0 - no coloration, 1 - pale green and 2 - clearly visible light green, 3 - intense green)

n - number of cells counted in the formulation, not less than 100.

The assessment of the local innate immunity voltage is determined by the ratio of the value of cationic proteins in the epithelium and granulocytes.

Having determined the pyloric campylobacter in smears on the same characteristic shape and size. Further confirmation of the presence of pyloric campylobacter served as a positive urease test. The degree of bacterial contamination was determined by the number of bacteria in the field of view (up to 20 microns - weak; 50 microns - moderate; 50 micron - severe) and changing the medium color when the urease test from yellow to crimson over 1 hour 3 hours 24 hours .

According to the results of the survey judged the state of the barrier function of the gastric mucosa and 12 n. A., Determined prognosis and treatment policy.

1. If the content of cationic proteins in epithelium is within 1.5-1.8, cationic proteins in granulocytes 0 - 0.8, and the degree of bacterial contamination of microbes to 20 p / z (+) - can say that the state of mucosal barrier function satisfactorily, the pathological process is outside of exacerbations, no threat to the development of complications of the disease. It is expedient to proceed with a conservative antiulcer therapy treatment inclusion complex of bismuth preparations.

2. The low content of cationic proteins in the epithelium of less than 1.0 and a high content of cationic proteins in granulocytes - more than 1.0, with an average (50 microbes in n / h) or severe (more than 50 microbes in n / h) the degree of bacterial contamination - evidenced the voltage of the local bactericidal mechanisms to protect the mucosa and an exacerbation of the pathological process. In this case, the conservative treatment is shown. If, after a course of conservative therapy (using bismuth preparations), no significant change in the ratio of cationic proteins in the epithelium and granulocytes in the direction of increasing the content of the latter in the epithelium, and the degree of bacterial contamination remains the same - these indicators point to the lack of effect of the therapy and are one of the essential arguments in the formulation of indications for surgical treatment.

3. The low content of cationic proteins in epithelium - less than 0.8 and a low content of cationic proteins in granulocytes less than 1.0 in combination with a high degree of bacterial contamination (more than 50 microbes n / s, +++) indicates a decompensation germicidal protection mucosa and is a poor prognostic sign (the threat of complications - perforation, bleeding). In this case, the patient surgical treatment.

The method allows to comprehensively assess the condition of non-specific resistance and the nature of morphological changes in the gastric mucosa and 12 n. A., Predict the course of ulcerative process in patients with bacterial invasion.

The novelty of the method is as follows:

1. The method significantly expands the possibility previously proposed a method of diagnosis, shows a clear link between the degree of bacterial contamination and the condition of the barrier function of the gastric mucosa and 12 PK on the one hand and the degree of bacterial contamination and the dynamics of ulcer process on the other, thus confirming the true purpose of the cationic bactericidal proteins as a universal system and the participation of the pyloric campylobacter in the pathogenesis of peptic ulcer disease.

2. Allows you to define in one product:

a) the presence of pyloric campylobacter and extent of bacterial contamination,

b) content of cationic proteins in mucosal epithelium and granulocytes and their ratio.

This method can be used with any gastroduodenal disease in combination with campylobacteriosis. Comparison of the claimed studies with the prototype has allowed to establish compliance with the criterion of "novelty". In the study of other well-known technical solutions in the field of medicine, the symptoms that distinguish the claimed invention from the prior art, have not been identified and therefore provide the claimed solution corresponds to the criterion of "substantial differences".

Example 1 (control group)

A. Surveyed. . , 19 years, history of disease N 1001. Diagnosis: a foreign body (needle) of the gastrointestinal tract. Gastric pathology and 12 n. No. To. He went into the control group (see. Table. 1).

Conclusion: This example illustrates the lack of bacterial invasion of the patient and a pathological process in the gastric mucosa and to claim 12, the normal epithelial barrier function...

Example 2. Patient L.. . , 45 years, history of disease N 209.

The diagnosis: peptic ulcer 12 items k in the acute stage... Chronic ulcer 12 items to see 1,2h0,8 located on the front wall of the bulb 12 n to Histology:.... Progressive ulcer with the expressed signs of an exacerbation. Subatrophic duodenitis, gastric metaplasia. Atrophic gastritis. Prescription of ulcer history 15 years. (See. Table. 2).

In this case, there is a progressive ulcer 12 p. In. And there is no bacterial invasion. The content of cationic proteins in epithelium appeared normal granulocytes and cationic proteins are not detected.

Example 3. Patient K.. . , 45 years, history of disease N 2578. Diagnosis: gastric ulcer in the acute stage. Chronic gastric ulcer angle 3h3sm with penetration into the left lobe of the liver, the deformation of the antrum and pylorus. Dekampensirovanny stenosis output of the stomach.

Histology: N 1639-1642. Progressive gastric ulcer, duodenitis subatrophic, atrophic antral gastritis, patchy superficial gastritis. Prescription of ulcer history for 23 years. Closure of perforated ulcer in 1976 (see. Tab. 3).

Conclusion: The above examples N 2-3 demonstrate the lack of communication between the content of cationic proteins in the epithelium and severity of morphological changes in the group of patients without campylobacteriosis. In this case, the cationic proteins do not reflect the dynamics of ulcerative process and as a predictive test can not be used.

Example 4. Patient P.. . , 40 years, history of disease N 1927. Diagnosis:.. Peptic ulcer 12 items to the outside of an exacerbation. Condition after the course of conservative therapy with the drug Denol. Campylobacteriosis mild. Histology N 2369-2371. Subatrophic duodenitis, chronic superficial gastritis, gastric fundus - gastritis not. Prescription of ulcer history of 10 years (see. Table. 4).

In this case, after the course of conservative therapy with Denol drug has a pronounced bactericidal activity against pyloric Campylobacter, succeeded in reducing the degree of bacterial contamination and remission of ulcerative process.

Conclusion:

The content of cationic proteins in the epithelium of the patient somewhat reduced in all departments (mostly in the antrum) and corresponds to an insignificant degree of bacterial contamination with scant morphological picture, demonstrating the remission of ulcerative process. It noted a moderate increase of cationic proteins in granulocytes 12 p. In. And antrum which can be regarded as a compensatory reaction in response to the reduction of cationic proteins in the surface epithelium. In general, the state of mucosal barrier function in this patient can be characterized as satisfactory.

Example 5. S. Ill. . , 33 years, history of disease N 1351. The diagnosis: peptic ulcer 12 items k in the acute stage... Chronic ulcers bulbs 12 p. In. With the localization of the front wall, 0.8 cm in diameter. Campylobacteriosis moderate severity. Histology: N 2058-2061. Chronic progressive ulcer, duodenitis subatrophic, atrophic antral gastritis. The bottom of the stomach - gastritis of the unknown. Prescription of ulcer history of 8 years (see. Table. 5).

Conclusion:

In this case, the content of cationic proteins in the epithelium reduced significantly and corresponds to an average degree of bacterial contamination in the stage of ulcer process (aggravation). It noted a marked granulocytic infiltration with high cationic proteins, which can be regarded as a compensatory phenomenon in response to the reduction of cationic proteins in the epithelium. This picture shows the local intensity of the non-specific defense mechanisms.

Example 6. Patient B.. . , 60 years, history of illness N 2617.

The diagnosis: peptic ulcer in the acute stage.

Chronic ulcer of the antrum of the rear wall of 1 cm in diameter. Campylobacteriosis pronounced degree. Histology: N 1632-1635. Chronic progressive ulcer, duodenitis subatrophic, atrophic antral gastritis. The bottom of the stomach - gastritis of the unknown. Prescription of ulcer history for 3 years (see. Table. 6).

Conclusion:

In this case there is a marked reduction of cationic proteins in the epithelium of the antrum combined with a pronounced degree of bacterial contamination, stage and localization of ulcer process. There is an increase of cationic proteins in granulocytes antrum, which should be regarded as a compensatory phenomenon.

Example 7. Patient B., 47 years old, medical history N 1107.

The diagnosis: a. Perforated ulcer 12 items to Campylobacteriosis pronounced degree.. Histology: N 1855-1852. Progressive ulcer, atrophic duodenitis, atrophic antral gastritis, gastric fundus - no gastritis.

Prescription of ulcer history for 3 years (see. Table. 7).

Conclusion:

Following the results of the survey revealed a very low content of cationic proteins in the epithelium, the absence of compensatory granulocyte infiltration at 12 p. In. And the bottom of the stomach combined with a pronounced degree of bacterial contamination. This situation can be considered as a deep depression of nonspecific mechanisms of local gastric mucosal resistance and 12 n. A., Morphological mapping which is the presence of complicated peptic ulcer (perforation).

The examples show a high degree of correlation between the content of cationic proteins in the epithelium and granulocytes and the degree of bacterial contamination, and the severity of morphological manifestations of disease dynamics in patients with peptic ulcer disease in combination with bacterial invazatsiey pyloric Campylobacter. Since the frequency of detection of pyloric campylobacteriosis in peptic ulcer disease, according to our data and the data of other authors is great (peptic ulcer 12 items to. -. 89%, a stomach ulcer - 70%), the proposed method can be used as a prognostic test and allow a differential approach to the choice method of treatment to prevent complications and relapses. (56) Pigarevsky VE-lysosomal cationic test with gastroduodenal bleeding. // Guidelines. M., 1979, p. 22.

CLAIM

Method for predicting the course of gastric ulcer and 12 duodenal ulcer in patients with pyloric Campylobacter by determining on smears content of cationic proteins in the surface epithelium of the stomach and duodenum 12, characterized in that it additionally determined in the same preparation of cationic proteins in granulocytes and the degree of bacterial contamination and the value of the first index of 1.5 - 1.8, the second - 0 - 0.8, and the third to 20 microns in the field of view (+), respectively, predict a favorable course of the disease, when the first indicator value is less than 1, 0, the second - more than 1.0, and a third - 50 microns in sight (++) forecast for burdened, and if the value of the first index of less than 0.8, the second - less than 1.0, and the third - more than 50 microns in the field of view ( +++) - heavy.

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Publication date 30.03.2007gg