RU2449731C1 - Method of diagnosing stage of urogenital trichomoniasis in men based on microcirculatory changes in urethra by means of laser doppler flowmetry - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to dermatovenerology and can be used for determination of stage of urogenital trichomoniasis in men. Laser Doppler flowmetry is performed, index of microcirculation in urethra is determined. If its value is 24±1.2 perf. units, spastic type of microcirculation and acute stage of urogenital trichomoniasis are diagnosed; 21±1.05 perf. units - spastico-atonic type and acute stage of urogenital trichomoniasis; 14±0.84 perf.units - torpid type and chronic stage of urogenital trichomoniasis; 4.8±0.24 perf.units - stasis type and chronic stage of urogenital trichomoniasis.

EFFECT: method makes it possible to increase accuracy of diagnostic due to objectivation of indices of microcirculation in urethra.

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Description

The invention relates to medicine, namely to dermatovenerology, and can be used to determine the type of microcirculation in the urethra and the stages of the course of urogenital trichomoniasis in men.

A known method for the diagnosis of manifest and latent forms of chronic urogenital chlamydia in men is that in the presence of negative confirmatory tests for chlamydia in men (PCR and IgA), Chlamydia trachomatis DNA, immunoglobulins (G, A) to Chlamydia trachomatis and the presence of foci are additionally determined of a chronic infectious process in a woman who has had constant sexual intercourse (for at least 3 months) without barrier methods of protection, determine the manifest or latent form of HUGH in a woman, and in a man under the condition of The presence of one or more chronic foci of infection and the diagnostic titer of IgG diagnoses the manifest form of urogenital chlamydia, and in the absence of clinical and laboratory signs of infection in a man, they diagnose the latent form (patent RU 2222018, 2004).

A known method for the diagnosis of trichomoniasis, including determining the presence of Trichomonas vaginalis DNA in the test sample by polymerase chain reaction with detection by gel electrophoresis (patent RU 2389016, 2010).

It is known that the stage of urogenital trichomoniasis is determined anamnestically: the duration of the disease up to 2 months is the acute stage, more than 2 months is chronic, and also on the basis of the clinic: the acute stage is a pronounced clinical picture in the form of urethral edema, hyperemia, foaming secretions; chronic stage - the clinical picture is poorly expressed in the form of rare secretions in the morning or absent (Adaskevich V.P. Sexually transmitted infections. - Nizhny Novgorod: Publishing House of the State Medical Academy of Moscow, Moscow: MEDICAL BOOK, 2004. - 416 s, p. 181). This method is taken as a prototype.

However, this method of determining the stage of trichomoniasis is subjective: the history may be inaccurate, the clinic is worn out. Determining the stage of urogenital trichomoniasis is a very important point, since the treatment being carried out depends on the stage of the infectious process.

The objective of the invention is to develop a new diagnostic method for determining the stage of urogenital trichomoniasis in men.

EFFECT: increased accuracy of diagnosis of the stage of urogenital trichomoniasis in men.

The specified technical result is achieved by the fact that in the method for diagnosing the stage of urogenital trichomoniasis in men according to the invention, laser Doppler flowmetry is performed, the microcirculation in the urethra is determined and at its value 24 ± 1.2 perf. diagnose a spastic type of microcirculation and the acute stage of urogenital trichomoniasis; 21 ± 1.05 perf. - spastic-atonic type and acute stage of urogenital trichomoniasis; 14 ± 0.84 perf. - stagnant type and chronic stage of urogenital trichomoniasis; 4.8 ± 0.24 perf. - stasic type and chronic stage of urogenital trichomoniasis

The proposed method for diagnosing the stage of urogenital trichomoniasis is as follows. Laser Doppler flowmetry is performed, the microcirculation index in the urethra is determined and at its value 24 ± 1.2 perf.ed. diagnose a spastic type of microcirculation and the acute stage of urogenital trichomoniasis; 21 ± 1.05 perf. - spastic-atonic type and acute stage of urogenital trichomoniasis; 14 ± 0.84 perf. - stagnant type and chronic stage of urogenital trichomoniasis; 4.8 ± 0.24 perf. - stasic type and chronic stage of urogenital trichomoniasis.

The proposed method for determining microcirculation in the urethra is carried out using a laser-Doppler analyzer of capillary blood flow LAKK-01, which is an apparatus consisting of a radiator, a control unit, a photodetector and an external light guide cable. The device is approved for use by the Ministry of Health of the Russian Federation (Protocol No. 1 of January 13, 1993 of the Commission for Clinical Diagnostic Devices and Devices).

Laser Doppler flowmetry (LDF) is a modern method for assessing the state of microcirculation, based on a change in the frequency characteristics of the laser beam probing the tissue when it is reflected from moving blood components, in particular erythrocytes. The laser beam penetrates into the tissues to a depth of 1.5 mm, so the dopplerogram characterizes blood flow in the surface microvessels. The method is based on the fact that the laser signal reflected from static components does not change its frequency, and that reflected from moving particles has a Doppler shift relative to the probing signal, which makes it possible to determine the velocity of red blood cells in the probed tissue volume. The reflected laser signal, characterizing the perfusion of tissues with blood, reflects the total processes that occur in all microvessels in the measurement zone. The change in the frequency of laser radiation is directly proportional to the speed of blood in the measured volume of tissue.

The main parameter studied is the microcirculation index (PM), which is measured in perfusion units (perf. Unit).

The physiological classification of microcirculatory disorders according to V.I.Kozlov is used: physiological norm, spastic, spastic-atonic, stagnant and stasic forms.

The study involved 129 patients who complained to the police department. After laboratory confirmation of the presence of the pathogen Trichomonas vaginalis, they were screened out in the study group. Using LDF, several types of microcirculation were determined (table), which made it possible to determine the following stages of the infection process.

Acute period.

Some of the patients studied had a spastic (PM: 24 ± 1.2 perf. Unit) and spastic-atonic (PM: 21 ± 1.05 perf. Unit) type of microcirculation, which corresponds to the acute period of the disease and was confirmed anamnestically (from the beginning the disease has passed no more than 2 months) and clinically (complaints of itching, tickling, burning, sometimes pain when urinating, discharge from the urethra is transparent or grayish-white, by nature it is watery or mucopurulent).

Chronic period.

In some of the studied patients, congestive (PM: 14 ± 0.84 perf. Units) and stasic (PM: 4.8 ± 0.24 perf. Units) type of microcirculation was determined, which corresponds to the chronic course of urogenital trichomoniasis and is confirmed anamnestically (from more than 2 months have passed since the onset of the disease) and clinically (there are practically no complaints, except for rare complaints of mucopurulent scanty discharge in the morning in the form of a drop; rapid urination, discomfort in the urethra, on the glans penis, scrotum, perineum, rectum, lumbar region). In this group, the lowest microcirculation indices were determined, which testified to the prescription of the process and irreversible changes in the urethra - strictures.

Example 1. Patient B., 33 years old, applied for the purpose of a routine check for the presence of STIs, as he plans to conceive a child with his wife. At the time of inspection, complaints of minor scanty discharge. When collecting an anamnesis, it turned out that he had regular sexual intercourse for 8 months with his wife, the presence of random sexual intercourse during this period denied. A more thorough examination revealed that it is rare, but there are scanty discharge from the urethra, discomfort on the glans penis that does not bother him. Laboratory results revealed the presence of urogenital trichomoniasis. The result of determining the microcirculation index is 14.6 perf.ed., which corresponds to a stagnant type of microcirculation. The combination of anamnesis data and research results suggests a chronic process. Accordingly, spouses were treated according to the treatment regimen for chronic urogenital trichomoniasis. In this case, the LDF data make it possible to establish the duration of the process up to 12 months (stagnant type of microcirculation), when identifying a stasic type, one could think about the course of the disease for more than a year and the presence of complications. Accordingly, there would be a need for additional research and intensification of treatment.

Example 2. Patient S., 26 years old, turned in to test for the presence of STIs. No complaints. From the anamnesis: it works on a rotational basis, where there is no possibility and time to undergo any examinations. For 3 years, has erratic sexual relations. Remedies are not always used. Last sexual contact (unprotected) marks a month ago. Periodically abuses alcohol. After the study, urogenital trichomoniasis was revealed. LDF data showed: 20.4 perf.ed, microcirculation disorders according to the spastic-atonic type. Accordingly, the diagnosis: fresh urogenital trichomoniasis, torpid form. In this patient, based on the anamnesis (worn out clinic, constant erratic sexual intercourse) and the presence of trichomoniasis, it is difficult to judge the prescription of the process, and the use of LDF allows you to make an accurate diagnosis and select the necessary treatment methods.

METHOD FOR DIAGNOSTIC OF THE STAGE OF UROGENITAL TRICHOMONIASIS IN MEN BASED ON MICROCIRCULATOR CHANGES IN THE URETHRAS BY LASER DOPPLER FLOWMETRY

Table Types of microcirculation in urogenital trichomoniasis in men Types of Microcirculation PM (perf. unit) Spastic type (acute stage) 24 ± 1,2 Spastic-atonic type (acute stage) 21 ± 1.05 Stagnant type (chronic stage) 14 ± 0.84 Stasic type (chronic stage) 4.8 ± 0.24 Norm 15 ± 1,1

Claims (1)

A method for diagnosing the stage of urogenital trichomoniasis in men, characterized in that they perform laser Doppler flowmetry, determine the microcirculation in the urethra and at its value 24 ± 1.2 perf. units diagnose a spastic type of microcirculation and the acute stage of urogenital trichomoniasis; 21 ± 1.05 perf. units - spastic-atonic type and acute stage of urogenital trichomoniasis; 14 ± 0.84 perf. units - stagnant type and chronic stage of urogenital trichomoniasis; 4.8 ± 0.24 perf. units - stasic type and chronic stage of urogenital trichomoniasis.