RU2377948C2 - Express diagnostic technique for structural changes of liver in chronic viral hepatitis type b - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to gastroenterology, physiology and morbid anatomy. Diagnostics of structural changes of liver in viral hepatitis type B is ensured by application of a biological test system containing a compound of 0.1% aqueous solution of amino acids - asparaginic, glutamic, glycine, tryptophan, valine, leucine, proline, arginine, threonine, serine; 0.5% aqueous solution of neurotransmitter dopamine; aqueous mixture 1 mM of nucleotide DNA bases (guanine, cytosine, thymine, adenine); 25% aqueous solution of magnesia sulphates in the ratio 4:1:1:4. A number of glass plates with applied biological test system are placed within a projection of liver on the skin surface of right hypochondrium, kept for 2-3 minutes, then dried at T=+18-20°C throughout 2-3 minutes. Then they are analysed in polarised light with a quartz compensator. Structural changes of liver in viral hepatitis type B are diagnosed if deformed calculi, including fragmented, mosaic or extended mottled are observed.

EFFECT: method allows recording operatively in dynamics structural failures in liver caused by chronic viral hepatitis type B, differentiating these failures, eliminating completely injuries and reducing cost price of the diagnostic technique.

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Description

The present invention relates to medicine, gastroenterology, pathophysiology and can be used to diagnose structural changes in the liver in chronic hepatitis (CH).

Early diagnosis of chronic hepatitis is a traditionally difficult global problem. The most common cause of structural rearrangement of liver tissue (hepatocytes, blood vessels) are viral hepatitis (B, C, D), virus carrier. Aggravating factors that violate the morphology of the liver are mixed hepatitis, drug addiction, alcoholism, drug damage to the liver (S. N. Sorinson. Viral hepatitis. S. Petersburg, 1998).

Structural changes in the liver during viral chronic hepatitis are accompanied by a violation of the integrity of the border plate, its breakthrough, violation of the architectonics of the liver lobule, destructive changes due to necrosis (A.S. Loginov, L.I. Aruin. Clinical morphology of the liver. M., 1985).

Morphological signs of viral CG are used to determine the stage of the disease. In biopsy specimens with puncture biopsy, hepatocyte dystrophy and necrosis, inflammatory cell infiltration and fibrotic changes in lobules and portal tracts are found, which are confirmed by instrumental studies (A.S. Loginov, Aruin L.I., Shepeleva D.S., Tkachev V.D. Puncture biopsy in the diagnosis of chronic liver diseases. Therapeutic archive. - 1996. - No. 2, C.5-7; V.V. Serov. Morphological studies in the diagnosis and treatment of acute and chronic liver diseases. Russian medical journal. - 1996. - No. 3, P.173; Guide to ultrasonic di agnostics.Edited by V.V. Mitkov, IV volume, M., Vidar, 1997. - P.132-135).

The possibilities for identifying HCG are different. These include a puncture biopsy of the liver with the study of histopreparations (V. Serov, K. Lapshin. Morphological diagnosis of liver diseases. M., 1989. - P.29-30), instrumental studies of the liver - ultrasound diagnostics (V.V. Mitkov. Clinical manual for ultrasound examination. M., 1996. - S.35-38, S.52-58), tomography - (R.I. Gabunia, E.K. Kolesnikova. Computed tomography in clinical diagnosis. M., 1995. - S.352).

A known method for the diagnosis of hepatitis by morphological studies of liver biopsy samples (Loginov A.S., Aruin L.I. Clinical morphology of the liver. M., 1985. - S.5-16). Methods of biopsy: percutaneous puncture, transvenous, sighting (during laparoscopy) and marginal (during surgery). The biopsy is obtained by puncture needles or special tweezers, then it is processed:

- fixed in 10% formalin buffered by the Lily method;

- pour the material into paraffin, from each block prepare up to 25-30 slices, mounting them on 4-5 slides.

Sections were stained with hematoxylin and eosin, as well as picrofuxin according to the Van Gieson method.

The last stage is the microscopy of the drug.

The disadvantages of the method.

- trauma to the patient (invasiveness of the study);

- the need for a large number of technical means;

- the use of needles, laparoscopy, ultrasound machines;

- the use of a series of chemicals for the preparation of material;

- the duration of execution, which does not allow for operational monitoring of treatment;

- contraindications: severe coagulopathy, ascites, biliary obstruction, pleurisy.

Ultrasound examination of the liver using a sensor with a frequency of 3.5-5 MHz is accepted as the closest analogue (V.V.Mitkov. Clinical Guide to Ultrasound Diagnostics. M., 1996, v. 1, S.35-38. 52-58) .

The essence of the method is based on the study of the echostructure of the liver using an ultrasound scanner.

The study is as follows:

1. The patient is placed on his back.

2. The sensor is installed parallel to the right costal arch and the angle of inclination of the sensor is gradually changed.

3. The condition of the liver is assessed by determining its contour, shape, size, echogenicity, structure, vascular pattern.

The disadvantages of the method:

- the use of an ultrasound scanner that affects the physiological state of the subject, and also increases the cost of the study;

- mutual influence on the image of the liver of surrounding organs, which reduces the reliability of the results of the study;

- occurrence of artifacts during scanning;

- stimulation of the growth of some neoplasms in the liver (cyst, hemangioma, etc.).

The objectives of the invention:

1. Ensuring differentiation of the diagnosis of chronic viral hepatitis B, depending on the severity of the pathological process.

2. Increasing the information content of diagnostics by visualizing the results of diagnostics.

3. Operational monitoring of the effectiveness of treatment.

4. The exclusion of invasiveness and radiation in the diagnosis of chronic viral hepatitis B.

The technical result of the proposal is the express registration of the wave biological radiation of the liver in the form of certain structures of the biological test system, which allows you to quickly register the dynamics of the structural defects in the liver caused by chronic viral hepatitis B, differentiate these disorders, completely eliminate the morbidity and reduce the cost of diagnosis.

A significant novelty of the proposal is the registration of liver radiation using a biological test system (BPS), for which, unlike the known method (ultrasound of the liver), BTS is preliminarily prepared (a mixture of a 0.1% aqueous solution of amino acids - asparagine, glutamine, glycine, tryptophan, valine , leucine, proline, arginine, threonine, series; 0.5% aqueous solution of dopamine neurotransmitter; aqueous 1 mM mixture of DNA nucleotide bases (guanine, cytosine, thymine, adenine); 25% aqueous solution of magnesium sulfate in a ratio of 4: 1: 1 : 4, which is applied to 6-7 glass plates, place them on the skin surface of the right hypochondrium in the area of the projection of the liver, stand for 2-3 minutes, dry at T = + 18-20 ° C, examine in polarized light with a quartz compensator and if the preparations have deformed chambers: fragmented , mosaic and elongated mottled color diagnose structural changes in the liver in chronic viral hepatitis B.

The method is as follows:

1. Apply the energy-informational biological test system (model) to register the radiation of the liver. A mixture is prepared consisting of a 0.1% aqueous solution of 10 amino acids (aspartic, glutamine, glycine, tryptophan, valine, leucine, proline, arginine, threonine, series; 0.5% aqueous solution of the dopamine neurotransmitter; aqueous 1 mM DNA nucleotide base mixture (guanine, cytosine, thymine, adenine); 25% aqueous solution of magnesium sulfate in a ratio of 4: 1: 1: 4.

2. A BTS pipette pipette with a volume of 0.01-0.02 ml is applied to 7-8 glass slides in the form of a track.

3. Slides (glass plates) with BTS deposited on them are placed on the skin surface of the right hypochondrium, maintained for 2-3 minutes, dried at T = + 18-20 ° C for 2-3 minutes.

4. The drugs are examined in polarized light with a quartz compensator and, in the presence of deformed chambers in the preparations: fragmented, mosaic and elongated, structural changes in the liver are diagnosed in chronic viral hepatitis B.

We present data on the BIM (bioinformation model that records the radiation of a biological object) - a variant of a biological liquid crystal that responds to radiation by the appearance of a specific structure.

The research of A.S. Presman, HLKonig et al. (Electromagnetic signaling in wildlife. M., 1974; Bioinformation-electrophysical aspects // Electromagnetic Bio-mfonnation. Munchen-Baltimore: Urban 8. Schwarzenberg, 1989, p 42-73 ) it is proved that there are electromagnetic fields around humans and animals, the radiation of which, being a product of life, with its low energy characteristics, are carriers of information about the state of the organism itself.

Information radiation from various objects (living, biocosal, inert) is one of the general principles of the manifestation of energy-informational interaction in nature.

Information influence is understood as a specific reaction of systems to a weak material-energy stimulus, which is perceived as a signal in the form of a code (Raimes N.F. Systematic approach to solving the problem of the interaction of a medium with a biological object. In: Electromagnetic fields in the biosphere, v. 1, S.294-300, M., 1984).

Structure - a snapshot of the internal interactions in the system (A.A. Malinovsky. Theory of structure and its place in the systems approach. In the book: System Studies. Yearbook. M., 1970, pp. 10-31).

The authors developed BTS (a variant of a biological liquid crystal, energy-information matrix). The proposed model is a complex biological system with self-organization and high spatial orientation. The amino acids included in it, the nucleotide bases of DNA, the dopamine neurotransmitter and the sulfuric acid magnesium builder are themselves sources of information, they are capable of perceiving information on electronic conformational interactions occurring in other substances, and transmitting information in the form of structures. Liquid crystals are used as biosensor devices (Yu.M. Evdokimov. Liquid-crystalline forms of nucleic acids // Bulletin of the Russian Academy of Sciences. - 2003. - No. 8. P.712-721; S.D. Varfolomeev, Yu.M. Evdokimov , M.A. Ostrovsky, Sensory biology, sensory technologies and the creation of new human senses // Bulletin of the Russian Academy of Sciences. - 2000. - No. 2. - P.99-108).

Amino acids perceive the information of the wave radiation of an organ (liver) and transmit it in the form of a convertible structure fixed by BPS.

Amino acids, having a high ability of imprinting (memorization) of the information-energy stimulus due to the course of metabolic processes in the organ, allow us to follow its structural reorganization during the pathological process (viral hepatitis B).

Figure 1 shows the initial structure (model) of the BPS, the cellular type of assembly of the drug is visible. Figure 2 shows the structure of the BPS obtained by placing glass plates with BTS deposited on them on the liver zone of a healthy person. The plates were held for 3 minutes, dried in a thermostat at Т = + 18-20 ° С for 3 minutes, and examined in polarized light with a quartz compensator (CC). There is a rounded chamber, the external appearance of which resembles the structure of the liver lobule of a healthy person, figure 3 (The structure of the liver lobule. Histology, edited by Yu.I. Afanasyev, N.A. Yurina. M., 1984. - S. 544).

The proposed method is compared with known methods for determining structural changes in the liver in chronic hepatitis of viral etiology B. 420 studies were conducted. It was revealed that the statistical significance was p <0.05.

In the examples cited, microscopy of BTS preparations in polarized light with QC, liver biopsy, ultrasound, and biochemical screening (bilirubin level, serum transaminase content, and γ-globulin level) were used. Viral The etiology of chronic hepatitis has been verified with the identification of viral markers.

Example 1, figure 4. B. B. Diagnosis: chronic hepatitis of viral etiology B. Medical history (IB) No. 729. Figure 4 shows the structure of BTS obtained by placing glass plates (SP) on the skin of the right hypochondrium in the area of the projection of the liver. There are fragmented cameras of variegated color.

Technology. On 0 glass plates (SP), 0.02 ml of BTS was applied and placed in the right hypochondrium in the area of the projection of the liver, kept for 2 minutes, dried in a thermostat for 3 minutes at T = + 20 ° C and examined in polarized light with CC. There are fragmented cameras of variegated color.

At the same time, a liver biopsy was performed with a biopsy and ultrasound of the liver, a biochemical blood test.

Biopsy: opaque vitreous hepatocytes. Porto-central bridge necrosis.

Ultrasound: the right lobe (oblique vertical size) - 153 mm (N <150 mm), increased, the left lobe (thickness) - 50 mm (N <60 mm), not increased. The contours are even, clear, echogenicity is moderately elevated, the structure is fine-grained. Normal vascular pattern, portal vein (V. portae) 9 mm (N = 8-12 mm), maximum linear blood flow velocity (V max) - 26.2 cm / s (N = 23 ± 5 cm / s, during deep inspiration). The hepatic veins are not dilated - 6-7 mm (N <10 mm at a distance of 2 cm from the mouth), a three-phase blood flow spectrum is recorded.

Conclusion: ultrasound - signs of diffuse changes in the liver.

Biochemical examination of blood serum: total bilirubin 34.4 mmol / L (N5-21.0 μmol / L), direct bilirubin 8.3 μmol / L (N 0-5 μmol / L), ACT 48 units. (N up to 40 units), ALT 54 units. (N up to 40 units), γ-globulin 24 g / l (N up to 18 g / l).

Diagnosed and confirmed structural changes in the liver inherent in chronic hepatitis of viral etiology B.

Example 2, Fig. 5. B-naya D. Diagnosis: chronic hepatitis of viral etiology B. IB No. 209. Figure 5 shows the structure of the BPS; fragmented cells of motley color are present.

Technology. On 6 glass plates (SP), 0.01 ml of BTS was applied as a track and placed in the right hypochondrium in the area of the liver projection, kept for 3 minutes, dried in an thermostat at T = + 19 ° C for 3 minutes, examined in polarized light with QC. Fragmented cameras of motley coloring were found.

A puncture biopsy of the liver was simultaneously performed with a biopsy study and a biochemical blood test.

Biopsy: Step necrosis, lymphohistiocytic infiltration of the portal tract and lobular periphery.

Ultrasound: the right lobe is 155 mm, the left lobe is 55 mm, not enlarged. The contours are even, clear, echogenicity is moderately elevated, the structure is fine-grained. The vascular pattern is strengthened, V. portae 10 mm, V max - 24 cm / s. The hepatic veins are not dilated - 5-7 mm, a three-phase spectrum of blood flow is recorded.

Conclusion: ultrasound signs of diffuse changes in the liver.

Biochemical study of blood serum: total bilirubin 38.5 μmol / l, direct bilirubin 10 μmol / l, ACT 52 units, ALT 61 units, γ-globulin 21.2 g / l.

Diagnosed and confirmed structural changes in the liver inherent in chronic hepatitis of viral etiology B.

Example 3, Fig.6. B-th U. Diagnosis: chronic hepatitis of viral etiology B. IB No. 398. Figure 6 shows the structure of the BTS, there are mosaic chambers of motley color.

Technology: 0.02 ml of BTS were applied to the joint venture in the form of a track, placed in the right hypochondrium, in the zone of the projection of the liver, kept for 3 minutes, dried in an thermostat at Т = + 20 ° С for 2 minutes, examined in polarized light with CC . Mosaic cameras of motley coloring were found.

Biopsy: opaque hepatocytes.

Ultrasound: right lobe 160 mm, left lobe 63 mm, enlarged. The contours are even, clear, echogenicity is increased, the structure is fine-grained, diffusely heterogeneous. Normal vascular pattern, v.portae 11 mm, V max 21 cm / s. The hepatic veins are not dilated - 5-8 mm, a three-phase spectrum of blood flow is recorded.

Conclusion: ultrasound - signs of diffuse changes in the liver.

Biochemical analysis of blood serum: total bilirubin 40.1 μmol / l, direct bilirubin 9.2 μmol / l, ACT 58 units, ALT 64 units, γ-globulin 25.4 g / l.

Structural changes in the liver were diagnosed and confirmed in chronic hepatitis of viral etiology B.

Example 4, Fig.7. B. I. Diagnosis: chronic hepatitis of viral etiology B. Information security No. 196. Figure 7 shows the structure of the BTS; mosaic chambers of motley color are visible.

Technology: 0.02 ml of BTS was applied to the joint venture in the form of a track, placed in the right hypochondrium, in the zone of the projection of the liver, kept for 2 minutes, dried in an thermostat at T = + 18 ° С for 2 minutes, studied in polarized light with CC . Mosaic cameras of motley coloring were found.

A liver biopsy and an ultrasound scan were performed simultaneously, and the biochemical parameters of blood serum were examined.

Biopsy: hepatocytes with sand nuclei. Portal tract with weak lymphohistiocytic infiltration, without fibrotic changes.

Ultrasound: Right lobe - 168 mm, left lobe - 66 mm, enlarged. The contours are even, clear, the rounding of the lower edge is determined, the echogenicity is increased, the structure is diffusely heterogeneous, with zones of increased echogenicity (altered tissue) and isoechoic (areas of unchanged parenchyma) zones. The vascular pattern is depleted, v.portae 12 mm, V max 19 cm / s. The hepatic veins are not dilated - 6-7 mm, a three-phase spectrum of blood flow is recorded.

Conclusion: ultrasound - signs of diffuse changes in the liver.

Biochemical analysis of blood serum: total bilirubin 45.2 μmol / l, direct bilirubin 10.5 μmol / l, ACT 61 units, ALT 64 units, γ-globulin 27.2 g / l.

Diagnosed and confirmed structural changes in the liver, characteristic of chronic hepatitis of viral etiology B.

Example 5, Fig. 8. B-naya 3. Diagnosis: chronic hepatitis of viral etiology B. IB No. 891. On Fig. 8 shows the structure of the BPS, elongated colored cameras are visible.

Technology: 0.02 ml of BTS were applied to 6 SPs in the form of a track, placed in the right hypochondrium, in the area of the projection of the liver, kept for 2 minutes, dried in an thermostat at Т = + 20 ° С for 3 minutes, studied in polarized light with QC. There are elongated cameras of variegated color.

A liver biopsy and an ultrasound scan were performed simultaneously, and the biochemical parameters of blood serum were examined.

Biopsy: fibro-porto-portal septa. In the portal tract, expressed lymphohistiocytic infiltration with aggregation of lymphoid elements.

Ultrasound: Right lobe - 164 mm, left lobe - 65 mm, enlarged. The contours are even, clear, echogenicity is increased, the structure is diffusely heterogeneous, with small hyperechoic zones, zones of increased echogenicity (altered tissue) and isoechogenic (areas of unchanged parenchyma) zones. The vascular pattern is depleted, v.portae 12 mm, V max 19 cm / s. The hepatic veins are not dilated - 6-7 mm, a three-phase spectrum of blood flow is recorded.

Serum biochemistry: total bilirubin 59.7 μmol / L, direct bilirubin 11.0 μmol / L, ACT 64 units, ALT 72 units, γ-globulin 29.1 g / L.

Structural changes in the liver were diagnosed and confirmed in chronic hepatitis of viral etiology B.

Example 6, Fig.9. B. B. Diagnosis: chronic hepatitis of viral etiology V. IB No. 615. Figure 9 shows the structure of the BPS; elongated, motley colored chambers are visible.

Technology: 0.02 ml of BTS were applied to the joint venture in the form of a track, placed in the right hypochondrium, in the zone of the projection of the liver, kept for 3 minutes, dried in an thermostat at Т = + 18 ° С for 3 minutes, studied in polarized light with QC. Elongated cameras of variegated coloring were found.

A liver biopsy and an ultrasound scan were performed simultaneously, and the biochemical parameters of blood serum were examined.

Biopsy: fibrotic changes and marked cellular infiltration of the portal tract with the development of aggregation of lymphoid elements.

Ultrasound: Right lobe - 164 mm, left lobe - 65 mm, enlarged. The contours are even, crisp, echogenicity is increased, the structure is diffusely heterogeneous, with small hyperechoic zones, zones of increased echogenicity (altered tissue) and isoechoic (areas of unchanged parenchyma) zones. The vascular pattern is depleted, v.portae 12 mm, V max 19 cm / s. The hepatic veins are not dilated - 6-7 mm, a three-phase spectrum of blood flow is recorded.

Serum biochemistry: total bilirubin 81 μmol / l, direct bilirubin 12.3 μmol / l, ACT 72 units, ALT 80 units, γ-globulin 37 g / l.

Structural changes in the liver were diagnosed and confirmed in chronic hepatitis of viral etiology B.

The use of a highly sensitive biological sensor of the course of metabolic processes (BPS), a marker of structural changes in the liver in chronic hepatitis of viral etiology B, allows for high information content and effectiveness, nativeness and physiology, non-invasiveness of the method.

Compared with the basic methods of diagnosing structural changes in the liver with chronic hepatitis of viral etiology, the study reduces by 80%, and material costs by 70%. The method is convenient, available for screening studies.

Claims (1)

A method for the rapid diagnosis of structural changes in the liver in chronic viral hepatitis B, including obtaining information about changes in the structure of the liver, characterized in that the diagnosis is carried out by recording the radiation of the liver, while a number of glass plates are placed in the area of the projection of the liver onto the skin surface of the right hypochondrium which applied biological test system consisting of a composition of a 0.1% aqueous solution of amino acids - aspartic, glutamine, glycine, tryptophan, valine, leucine, proline, arginine and, threonine, serine; 0.5% aqueous solution of dopamine neurotransmitter; aqueous 1 mM mixture of DNA nucleotide bases (guanine, cytosine, thymine, adenine); 25% aqueous solution of magnesium sulfate in a ratio of 4: 1: 1: 4, incubated for 2-3 minutes, then dried at T = + 18-20 ° C for 2-3 minutes, examined in polarized light with a quartz compensator and in the presence of deformed chambers in the samples: fragmented, or mosaic, or elongated with a mottled color, structural changes in the liver are diagnosed in chronic viral hepatitis B.

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