RU2051387C1 - Method for diagnosing chronic relapsing pancreatitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves taking blood sample to obtain plasma poor in blood platelets, diluting the plasma with physiologic salt solution in 1:3 proportion, adding 0.1 ml of 1% protamine sulfate solution to the diluted plasma, thermostating the mixture at room temperature for 5-10 min with following photometric examination at 490 nm wavelength. The optical density being higher than 0.47 units and blood sample blood platelets number being in norm, chronic relapsing pancreatitis is diagnosed. EFFECT: enhanced reliability of diagnosis.

Description

 The invention relates to medicine, namely to gastroenterology, and can be used in the differential diagnosis of pancreatitis.

Diagnosis of chronic recurrent pancreatitis is difficult due to the fact that the methods used in the clinic are not accurate. The only accurate method for diagnosing chronic recurrent pancreatitis is recognized worldwide as a method for determining radioimmune trypsin in human serum [1]
However, this method is expensive, requiring a special radio-immune laboratory, which is not available in a regular hospital.

 There is also a method for the diagnosis of chronic recurrent pancreatitis by indirect determination of trypsin by determining the level of fibrinogen degradation products in blood plasma (Lab. Delo, 1987, N 8, p. 576-578).

 However, this method is not accurate enough, it requires scarce reagents (soybean trypsin inhibitor), and blood serum of cattle.

 When implementing the proposed method increases the accuracy of diagnosis. In addition, the inventive method is simple and cheap.

 It is known that exacerbation of chronic recurrent pancreatitis is accompanied by an increase in the level of trypsin in the blood. An increase in the level of trypsin in the blood leads to the activation of the fibrinolysis process, which results in the formation of fibrinogen degradation products, which form complex compounds with early complexes of fibrinmonomers (RKFM) and prevent their polymerization. In this connection, RKFM accumulate in the blood. On the other hand, trypsin directly interferes with the binding of fibrin monomer molecules, i.e., its polymerization. By the amount of RKFM in the blood, one can indirectly judge the level of trypsin in human blood. The principle is based on the photometric determination of RKFM upon their release from their complexes with fibrinogen, with the products of fibrinogen degradation and among themselves. The magnitude of the optical density is used to diagnose exacerbation of chronic recurrent pancreatitis, provided there are no signs of damage to the blood coagulation system.

 The method is as follows.

 Upon admission to the clinic, the patient is comprehensively examined (general clinical methods, radiological, laboratory, etc.) and if a patient is suspected of having an exacerbation of chronic recurrent pancreatitis, a diagnostic examination is performed.

Take platelet-poor plasma and dilute it in a 1: 3 ratio with physiological saline (0.6 ml of plasma + 1.8 ml of physiological saline). 0.1 ml of a 1% solution of protamine sulfate is added there. The solutions are thoroughly mixed. In parallel, prepare a control experiment without serum. The prepared samples are placed in cuvettes with a working distance of 3 ml. The incubation time is 5 minutes, but not more than 10 minutes at room temperature. The cuvettes are placed in a colorimeter brand FEC or KFK-2. At a wavelength of 490 nm, the optical density is determined. When the optical density is higher than 0.47 units, an exacerbation of chronic recurrent pancreatitis is diagnosed. In parallel, the number of platelets in the blood is determined in order to exclude the pathology of the coagulation system (norm: 180-320 thousand in 1 million blood). FEC and KFK-2 photo-calorimeters used in the method are produced by domestic industry. The method uses reagents:
protamine sulfate
saline solution produced by the domestic pharmacological industry.

 A platelet-poor plasma is prepared as follows: 2 ml of blood is taken from a patient’s vein, placed in a test tube into which 0.2 ml of a 3.8% aqueous solution of sodium citrate is previously introduced. The tube is centrifuged for 20 min at a speed of 3000 rpm.

 PRI me R 1. Patient K., 42 years old, complains of sharp girdle pain in the left hypochondrium, aggravating 20-30 minutes after eating, especially after eating sharp, fatty, sweet, baked. Nausea, vomiting, a mushy stool 3-4 times a day with the remains of undigested food are disturbing.

 Sick for 2 years. The course of the disease is chronic relapsing. The last exacerbation began 5 days ago.

 An objective study of moderate severity. Pale skin and mucous membranes are noted. The tongue is densely lined with white coating. The stomach is evenly swollen. On palpation, a sharp whiteness in the area of the head and body of the pancreas, the pancreas is palpated in the form of a dense painful cord. Peripheral blood platelets 300 thousand in 1 μl of blood, serum amylase 80 g / l-h (normal up to 32 g / l-h), serum trypsin (radio-immune) 214 ng / ml (normal 10-57 ng / ml) . Ultrasound examination of the pancreas: enlarged, heterogeneous structure, fuzzy contours.

 RKFM 0.68 units of optical density.

 Diagnosed with chronic recurrent pancreatitis in the acute stage.

 After counter-treatment, pain decreased significantly. At discharge: platelets 320 thousand in 1 μl of blood, amylase 28 g / l-h, trypsin 38 ng / ml, RKFM 0.42 optical density units.

 PRI me R 2. Patient S., 46 years old, notes complaints of frequent mushy stools with undigested food 8-10 times a day, a sharp loss in weight (18 kg over the past 3 months), pronounced general weakness.

 She was ill for 10 years with chronic recurrent pancreatitis with frequent exacerbation. Over the past year, abdominal pain does not bother, but progressively loses weight, it constantly notes a mushy stool with undigested food. The condition is satisfactory. Dramatically reduced nutrition. Pale and dry skin is noted. The tongue is clean, dry. The abdomen is soft, moderate spilled soreness around the navel.

 Platelets 280 thousand in 1 μl of blood, serum amylase 8 g / l-h, trypsin 12 ng / ml, RKFM 0.34 units of optical density.

 Ultrasound examination of the pancreas: sharply uniformly densified.

 The patient was diagnosed with chronic pancreatitis with severe exocrine pancreatic insufficiency without exacerbation.

 The treatment with enzyme preparations (pancreatin, festal). Stopped losing weight, stool 2-3 times a day.

 When discharge, platelets of 300 thousand in 1 μl of blood, amylase 10 g / l-hour, trypsin 14 ng / ml, RKFM 0.36 units of optical density.

 This method was tested on 110 patients. Of this number, 10 patients did not suffer from chronic recurrent pancreatitis. The method allowed to correctly determine the diagnosis in 95% of cases.

 Thus, the proposed method for the diagnosis of chronic recurrent pancreatitis allows you to simply and accurately determine the diagnosis and, accordingly, subsequently prescribe the correct treatment.

Claims (1)

 A METHOD FOR DIAGNOSIS OF CHRONIC RECIDIATING PANCREATITIS, including determining the parameters of the blood coagulation system, characterized in that the blood is platelet-poor plasma, diluted with saline in a ratio of 1 to 3, 0.1 ml of a 1% solution of protamine sulfate is added to diluted plasma, the mixture is for 5 to 10 minutes at room temperature, followed by photometry at 490 nm and when the optical density is higher than 0.47 units. and a normal platelet count in a blood sample is diagnosed with chronic recurrent pancreatitis.