RU2363386C2 - Method of predicting occurrence of venous dishemia in children with attention-deficit/hyperactivity disorder - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: microcirculation and vegetal responsiveness in 5-6 year old children is analysed on the following parametres: fluxmotion index (FMI) and percentage cerebral-ergotropic effects on regulation of vegetal functions (% VLF). Prognostic coefficient values are then found. If the fluxmotion index value is less than 2.27, prognostic coefficient equals 4.8, if fluxmotion index equals or greater than 2.27, prognostic coefficient equals 0.78; if % VLF is less than 10.32 fluxmotion index equals 0.72, if % VLF equals 10.32-20.4 fluxmotion index equals 1.1, if % VLF equals 20.4 fluxmotion index equals 4.02. The sum of prognostic coefficients is found and divided by 11.5 and if values between 0.51 and 0.77, occurrence of venous dishemia is predicted.

EFFECT: wider arsenal of means of predicting occurrence of venous dishemia in children with attention-deficit/hyperactivity disorder.

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Description

The invention relates to medicine, namely to neurology.

In the available literature, we did not find data regarding the prediction of cerebral hemodynamic disturbances, namely venous dysgemia, in children 5-6 years old with attention deficit hyperactivity disorder (ADHD) (Andreyev A.V. Vascular headaches in children: Diss. ... doctors of medical sciences. - St. Petersburg, 2000; Mikhaylichenko N.V. Attention deficit hyperactivity disorder in children of primary school age: (Aspects of diagnosis and treatment): Diss. ... candidate of medical sciences. - Irkutsk, 2001; Chinenova N.S. Features of the physical, neuropsychic development, morbidity of children 4-7 years old with ADHD, their adaptation to schooling: Diss ... Candidate of medical sciences. - Ivanovo, 2001). Normally, the direct sinus discharge in children is 28-32 cm / s. The imperfection of the regulatory function of the central nervous system in children with ADHD often contributes to the development of functional inferiority of cerebral hemodynamics, having a negative effect on the course of this disorder. The disclosure of the picture of cerebrovascular disorders in children with ADHD and a description of their features at different age periods is of high practical importance both for a comprehensive diagnosis and optimization of therapeutic measures. Particularly relevant is the allocation of children with cerebral hemodynamic impairment before they transition to new social conditions (school), when increased demands are made on the body.

The technical result of the proposed method for predicting the occurrence of venous dysgemia in children with attention deficit hyperactivity disorder is that in children 5-6 years old, microcirculation and autonomic reactivity are examined according to the following indicators: index of phaxmotia (IFM) and the percentage of cerebral-ergotropic effects in the regulation of autonomic functions (% VLF), find the value of the prognostic coefficient (PC): when the obtained value of IFM below 2.27 PC is taken equal to 4.8, when the value of IPM is 2.27 and above PC = 0.78; when the% VLF is below 10.32 PK-0.72, when the value of 10.32-20.4 PC = 1.1, when% VLF = 20.4 PC = 4.02; then calculate the sum of prognostic factors, divide it by 11.5, and with the obtained values in the range from 0.51 to 0.77, the occurrence of venous dyshemia is predicted.

The development of prognostic tables was carried out on the basis of methodological recommendations on the topic: “Forecasting methods in socio-hygienic research”, part 3. Prediction of the risk of pathology using the method of normalized intensive indicators. Ivanovo, 1993. O.V. Kuligin, T.P. Vasilyeva. Statistical processing of clinical material was carried out to identify reliable signs distinguishing children with ADHD who had or did not have cerebral hemodynamic disturbances at the age of 5-6. We conducted a study of the autonomic regulation and microcirculation in these children and identified indicators that reliably correlate with cerebral hemodynamic disturbances: 1) IPM (index of fluxmotion) is an integrative microcirculation index that reflects the ratio of active modulations of skin blood flow due to myogenic and neurogenic mechanisms, and additional parasympathetic influences on him; 2)% VLF - an indicator reflecting the degree of involvement of cerebral-ergotropic structures in the modulation of vegetative functions. For each indicator, a prognostic coefficient (PC) was calculated.

For this:

1) the intensive incidence rate was calculated for the group as a whole, as well as for each studied factor (per 1000 examined);

2) the calculation of the weight index (K), which is the ratio of the maximum intensity indicator (Nmax) to the minimum (Nmin): K = Nmax / Nmin. If the factor has no effect, then this ratio is equal to unity. The larger it is, the higher the significance of the factor for the occurrence of this type of pathology;

3) calculation of normalized intensive indicators (NPC). To do this, intensive indicators calculated for each gradation of factors (Ni) must be divided by a normalizing indicator (N). As the latter, an intensive indicator of the level of this type of disease is used according to the entire study. NPC = Ni / N;

4) PC calculation. The need for this stage of work is determined by the fact that NPCs assume the equality of significance of the “weight” selected for predicting factors. But factors have different strengths of influence on the development of morbidity. Therefore, we must take into account the value of the relative risk indicator for each factor. PC = NPC · K;

5) compilation of a forecast table:

6) the calculation of the ranges and sub-ranges of risk values for a set of factors taken. A) The initial risk value of the identified pathology = ΣPCmin / ΣK. Maximum risk value = ΣPCmax / ΣK. B) Calculation of subranges: the entire range is taken as 100%. The first sub-range - the least risk probability - includes all risk values ranging from 0 to 30% of the entire range, the second 30-60%, the third from 60 to 100%. To make a decision in the search table, it is necessary to determine the prognostic coefficient for each characteristic, to obtain their sum, which then will be divided by ΣK. Thus, we get a value that falls into the range that determines the forecast.

In our study, the ranges are as follows:

1) favorable prognosis: 0.13-0.31;

2) risk group: 0.32-0.5;

3) unfavorable prognosis: 0.51-0.77.

Example 1

Veronika M., 6 years old, was observed from birth with the consequences of mild perinatal lesion At the time of the examination, there was an ADHD clinic in the form of impulsivity and attention deficit. As a result of the studies,% VLF = 23% (PC = 4.02); IFM = 2.24 (PC = 4.8). ΣPC = 8.82. ΣPC / ΣK = 0.76.

Conclusion: a child is expected to have cerebral hemodynamic disturbances in the form of venous dysgemia.

Objectively: when a child had an ultrasound scan of the brain vessels 6 months after prediction, a direct sinus discharge of 40 cm / s was detected, which corresponds to venous dyshemia.

The forecast came true.

Example 2

Nikita K., 5 years old was observed from birth with the consequences of mild perinatal lesion At the time of the examination, there was an ADHD clinic in the form of hyperactivity. As a result of the studies,% VLF = 3% (PC = 0.72); IFM = 1.6 (PC = 4.8). ΣPC = 5.52. ΣPC / ΣK = 0.48.

Conclusion: it is assumed that the child is at risk for venous dyshemia.

Objectively: when a child had ultrasound of the brain vessels 6 months after forecasting, a direct sinus discharge of 35 cm / s was detected, which can be attributed to the borderline state, i.e. risk group, as direct sine discharge rate 28-32 cm / s.

The forecast came true.

Example 3

Julia F., 6 years old, was observed from birth with the consequences of mild perinatal lesion At the time of the examination, there was an ADHD clinic in the form of hyperactivity. As a result of the studies,% VLF = 14% (PK = 1.1); IFM = 2.55 (PC = 0.78). ΣPC = 1.88. ΣPC / ΣK = 0.16.

Conclusion: it is assumed that the child will not experience cerebral hemodynamic disturbances.

Objectively: when conducting ultrasound scan of cerebral vessels 6 months after forecasting, a direct sinus discharge of 30 cm / s was detected, which is a normal variant.

The forecast came true.

Table Prediction of venous dysgemia in children 5-6 years old with attention deficit hyperactivity disorder Factor Graduation Ni TO NPC PC factor a IFM lower than 2.27 750 0.8 4.8 -2.27-2.83 125 6 0.13 0.78 over 2.83 125 0.13 0.78 % VLF below 10.32 125 0.13 0.72 -10.32-20.4 187.5 5.5 0.2 1,1 -over 20.4 687.5 0.73 4.02 N = 937.5 ΣK = 11.5

Claims (1)

A method for predicting the occurrence of venous dysgemia in children with attention deficit hyperactivity disorder, which consists in the fact that in children 5-6 years old microcirculation and autonomic reactivity are examined in terms of: index of phaxmotia (IPM) and the percentage of cerebral-ergotropic effects in the regulation of autonomic functions (% VLF), find the value of the prognostic coefficient (PC): with the obtained value of the IFM below 2.27 PCs are taken equal to 4.8, with the value of the IPM 2.27 and above PC = 0.78; with a% VLF value below 10.32 PC = 0.72, with a value of 10.32-20.4 PC = 1.1, with a% VLF = 20.4 PC = 4.02; then calculate the sum of prognostic factors, divide it by 11.5, and with the values obtained from 0.51 to 0.77, the occurrence of venous dyshemia is predicted.