RU2194995C2 - Method for diagnosing progressive angina pectoris in patient suffering from myocardial ischemia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves separating leukocyte-enriched cellular suspension from venous blood of a patient in 50000 per 1 mcl concentration. The sample is incubated for 62 h at 37 C temperature. Supernatant fluid is collected and general cholesterol length is determined. The value being greater than 0.150 mmole/l, progressive angina pectoris is to be diagnosed in a patient suffering from myocardial ischemia. EFFECT: high accuracy of diagnosis. 1 tbl

Description

 The invention relates to medicine, namely cardiology, and can be used to diagnose progressive angina pectoris - a form of coronary heart disease requiring emergency medical care.

 A known method for the diagnosis of progressive angina (forms of unstable angina) using clinical and ECG signs: an increase in the frequency, intensity and duration of seizures in patients who have previously had attacks of stable angina, confirmed by transient changes in the ECG in the form of changes in the ST segment, most often depression, and / or inversion of the T wave that occurs at the time of an attack of sternal pain (Internal diseases. In 10 books. Book 5: Translated from English / Edited by E. Braunwald, K. J. Isselbacher, R.G. Petersdorf, etc. - M .: M editsina. - 1995 .-- S. 284).

 Disadvantages: this method is not accurate enough, does not have clear quantitative criteria. In addition, transient ECG changes may not be detected outside an angina attack or, in other cases, require differential diagnosis with other conditions.

 The invention is aimed at solving the problem: improving the accuracy of the method.

The solution to this problem is achieved by examining the venous blood of a patient having appropriate clinical symptoms and changes on the ECG. After culturing the cell suspension enriched in leukocytes for 62 hours at 37 ^{° C.} under sterile conditions, the concentration of total cholesterol in the supernatant is determined. With a value of this indicator over 0.150 mmol / l, progressive angina pectoris is diagnosed - a form of coronary heart disease.

 The method is as follows.

After studying the patient’s complaints and medical history, physical examination and ECG assessment in 12 standard leads from a patient with diagnosed coronary heart disease with angina pectoris, blood is taken from the ulnar vein in the amount of 10 ml in a sterile tube containing heparin solution (500 PIECES) . Cell suspension containing leukocytes is isolated by sedimentation in a polyglucin solution. The ratio of whole venous blood and polyglucin solution is 5: 3. The cell suspension is washed twice (once in physiological saline of sodium chloride and once in Eagle’s medium), resuspended in the culture medium, the number of leukocytes and red blood cells in the Goryaev’s chamber is counted, the leukocyte concentration is adjusted to 50,000 in 1 μl (erythrocytes not more than 0.6-0, 8 million in 1 μl) and placed in sterile vials of 0.2 ml. Incubated for 62 hours at 37 ^o C. Determine the amount of total cholesterol in the supernatant by the cholesterol oxidase method. To do this, in order to increase the sensitivity of the method when determining low concentrations of total cholesterol, the ratio of the studied biological fluid (serum, supernatant) and the working solution of the reagents, specified in the description of the method by the manufacturer (LACHEMA) 1: 101, is changed to a ratio of 1:10 and performed calculation of total cholesterol as a ratio of the optical density of the experimental sample and the standard sample multiplied by a factor of 0.517.

 Diagnosis of progressive angina pectoris, a form of coronary heart disease, is carried out in the presence of appropriate clinical manifestations of repeated attacks of angina pectoris and an increase in the lipid-producing ability of leukocytes above the threshold value (separation point) established for patients older than 40 years of age at the level of 0.150 mmol / L.

 Examples of specific performance.

 Example 1

 Patient N., 71 years old, was admitted to the clinic on January 19, 2000 with the aim of surgical treatment for cataracts of the right eye. From the anamnesis it is known that earlier, more than 20 years, periodic attacks of angina pectoris, persistent increase in blood pressure, up to a maximum of 200/120 mm Hg were noted In 1998, an artificial pacemaker was implanted, installed in de-mand mode for syncope episodes associated with atrioventricular block II-III degree.

 01/20/2000 surgical treatment was carried out - basal myrectomy on the right. In the postoperative period, there was an increase in blood pressure to 200/120 mm Hg, pressing, compressing pain behind the sternum, increasing in intensity and duration. 01/31/2000 the patient was transferred to the cardiology department. Long-term compressive pain behind the sternum with irradiation under the left scapula, requiring infusion of nitroglycerin solutions, was noted. On the ECG 02/01/2000 - sinus rhythm; complete blockade of the right bundle branch block and anteroposterior branching of the left bundle branch block; enlargement of the right atrium; myocardial ischemia of the anterior wall of the left ventricle, the posterior wall of the left ventricle. The level of serum myoglobin on 02.02.2000 was 20 ng / ml.

 In the study of the lipid-producing ability of leukocytes on 02/04/2000, the result was 0.209 mmol / l, which corresponds to the diagnosis: coronary heart disease in combination with essential arterial hypertension of 2 tbsp., Progressive angina pectoris. Atherosclerosis of the aorta and cerebral vessels. H2a. Against the background of ongoing antianginal and antihypertensive therapy, positive dynamics were noted with respect to pain and changes in the ECG.

 Example 2

 Patient X., 49 years old, was admitted to the clinic on 06.03.2000 with a diagnosis of coronary heart disease, progressive angina pectoris. Atherosclerosis of the aorta. H1. An anamnesis of the disease can be traced back to 1998; for 2 years, rare compressive pains behind the sternum with radiation to the left arm, arising during physical exertion, stopped at rest alone or after taking nitroglycerin, worried. Deterioration in the form of an increase in the intensity and frequency of pain, the occurrence of pain with minimal load, poor effectiveness of nitroglycerin from 03/01/2000. On the ECG from 03.03.2000 the sinus rhythm, depression of the S-T segment in V4, “coronary” T waves in V4, V5. In the study of the lipid-producing ability of leukocytes on March 10, 2000, the level was 0.220 mmol / l, which corresponds to the established diagnosis.

 Example 3

4 groups of patients were examined:
1. 5 patients with coronary heart disease, progressive angina pectoris over the age of 40;
2. 5 patients with coronary heart disease, angina pectoris I - II functional class over the age of 40 years;
3. 10 patients who do not have clinically obvious manifestations of diseases of the internal organs and risk factors for coronary heart disease or essential arterial hypertension, over the age of 40 years;
4. 10 healthy individuals under the age of 40.

 In the study of the lipid-producing ability of leukocytes, the following values were obtained, mmol / l: group 1 - 0.189 + 0.019; 2 group - 0.105 + 0.009; 3 group - 0,072 + 0,020; Group 4 - 0.171 + 0.028.

 Significant differences in Student's t test were revealed between two groups: a group of practically healthy people under the age of 40 years and patients who did not have clinically obvious manifestations of diseases of the internal organs and risk factors for coronary heart disease and essential hypertension, over the age of 40 years (t = 2.88).

 It was established that the presence of progressive angina pectoris, a form of coronary heart disease requiring urgent therapeutic measures, is accompanied by an increase in the lipid-producing ability of leukocytes relative to the corresponding age control group and the group of patients with coronary heart disease, functional angina I-II.

 The operational characteristics of a new criterion for diagnosing progressive angina pectoris have been determined in comparison with a group of patients with coronary heart disease, functional class I-II angina pectoris: sensitivity and specificity. The separation point was selected taking into account the construction of the curve of the interdependence of the indicated operational characteristics and corresponded to 0.150 mmol / L. The sensitivity of the test was 80%, specificity 100%.

 The proposed method differs from the known following features.

 In the proposed method, an additional new criterion is used - the level of lipid-producing ability of leukocytes.

 This indicator has clear quantitative criteria; it can be used in complex cases of clinical practice requiring differential diagnosis, especially in patients with "mute" angina pectoris. The new indicator reflects the participation of certain pathogenetic factors, which has an advantage in terms of determining treatment tactics.

 The level of leukocyte lipid-producing ability correlates with the severity of the clinical picture of coronary heart disease and is a highly informative diagnostic criterion for progressive angina pectoris.

Claims (1)

A method for diagnosing progressive angina pectoris in patients with coronary heart disease by determining total blood cholesterol, characterized in that a cell suspension enriched in white blood cells at a concentration of 50,000 in 1 μl is isolated from the patient’s venous blood, incubated for 62 hours at 37 ^{° C.} , the supernatant is collected and determine in it the level of total cholesterol and with its value exceeding 0.150 mmol / l, a patient with coronary heart disease is diagnosed with progressive angina pectoris.