RU2475749C1 - Method of diagnosing syndrome of endogenic intoxication in workers of petrochemical and chemical enterprises - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention describes method of diagnosing syndrome of endogenic intoxication, which includes blood sampling, determination of medium weight molecules (MWM) in blood serum by direct spectrometry of deproteinised supernatant, obtained after precipitation of proteins with trichloroacetic acid solution, with wavelengths (λ) 280 nm and 254 nm, where MWM is additionally determined at λ 238 nm, index of medium molecules is calculated as the sum of ratio from division of MWM value at λ 280 nm to similar value at λ 254 nm and ratio from division of MWM value at λ 238 to similar value at λ 280 nm, and if value of index of medium molecules is higher than 4.5, endogenic intoxication is diagnosed.

EFFECT: invention application increases accuracy and reliability of syndrome diagnostics and serves as prediction of development of professional diseases in workers of petrochemical and chemical enterprises.

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Description

The invention relates to medicine, namely to occupational medicine, and can be used to diagnose endogenous intoxication syndrome in workers in chemical and petrochemical industries.

The petrochemical and chemical industries are the basic industries in which about 1 million people are employed. Despite the introduction of closed technological processes and highly automated equipment, the petrochemical and chemical industries occupy one of the leading places in terms of the potential danger of chemical exposure, more than 100 thousand harmful substances can be present in the air of the work zone of various industries and have an adverse effect on the body of workers [Karamova, L.M. . Occupational health risk for workers in chemical and petrochemical industries / L.M. Karamova, L.K. Karimova, G.R. Basharova. - Ufa, 2006. - 306 p.].

To date, acute and chronic intoxication with chemicals continues to be recorded in industries, for example, the proportion of diseases caused by exposure to a chemical factor, according to 2009 data, was 19.8% among all industries of the Russian Federation [Occupational diseases and their distribution by classes of working conditions in the Russian Federation in 2009: an information collection of statistical materials. - M., 2010. - 11 p.].

A number of authors have found that the multiple mechanisms of the toxic effects of chemicals are based on their ability to disrupt biochemical processes: protein biosynthesis, lipid peroxidation, etc., which in turn leads to the formation and accumulation of toxic protein fragments - molecules of medium weight ( MSM) [Baranov, BC Testing the detoxification system in the prevention of certain multifactorial diseases / B.C. Baranov, T.E. Ivaschenko, E.V. Baranova // Journal of Obstetrics and Women's Diseases. - 2003. - No. 2. - C.11-16.].

The accumulation of MSM is a marker of endogenous intoxication, which develops in all pathological conditions associated with increased catabolism or blockade of the detoxification systems of the body, including occupational diseases. The level of endogenous intoxication is one of the criteria for the severity of a worker’s condition. In addition, MSM affect the vital activity of all systems and organs, they are able to connect and block the receptors of any cell, inadequately affecting its metabolism and functions, disrupt membrane transport mechanisms, erythropoiesis, microcirculation, and possess immunosuppressive, cytotoxic, neuro- and psychotropic properties.

The assessment of the presence and degree of intoxication in the pathology of occupational origin in workers in the petrochemical and chemical industries is difficult, since in some diseases the pathological foci are local in nature or do not have clear differential diagnostic signs. Conventional laboratory tests in most cases are not very specific, the diagnosis of occupational diseases accompanied by endogenous intoxication syndrome is often established already in advanced stages.

A known method for the diagnosis of endogenous intoxication syndrome, including an assessment of the permeability of erythrocyte membranes, is determined by erythrocytes having a membrane blocked by immune complexes. the number of red blood cells in the chamber of Goryaev, the number of red blood cells in excess of 1.0 with their corresponding concentration of NaCl, take for control in this patient, in a control dilution of NaCl, hemolysis is studied in a concentration of red blood cells 10 times higher than the standard concentration level, a second study is performed in the Goryaev chamber, the number of non-hemolyzed red blood cells is determined and, when their number is more than 10 times higher than the control, they are diagnosed endogenous intoxication syndrome (patent RU 2234095, 2004).

A known method for determining the degree of intoxication by the content in the blood serum of medium-weight molecules at λ 280 nm, λ 254 nm [Gabrielyan NI, Lipatova V.I. Lab case, 1984, N 3, p.138-140]. According to modern concepts, MSM are responsible for the development of intoxication syndrome in patients of the most diverse profiles. This screening method was adopted as a prototype. However, there is a wide range of wavelength ranges for determining MSM, the interpretation of each of which cannot give a complete picture of the presence of endogenous intoxication syndrome in workers in chemical and petrochemical industries.

The objective of the invention was the development of an objective, highly informative method for the diagnosis of endogenous intoxication syndrome, which accompanies most occupational diseases, among workers in the petrochemical and chemical industries.

EFFECT: increased accuracy and reliability by obtaining integral information on the presence of endogenous intoxication syndrome in the conditions of chemical and petrochemical production during examinations for the diagnosis of various forms and stages of occupational pathology.

The proposed method for the diagnosis of endogenous intoxication syndrome is as follows.

1. In a centrifuge tube containing 1 ml of blood serum, in order to precipitate the protein, add 0.5 ml of 10% or 15% trichloroacetic acid (TCA) solution, mix thoroughly, leave for 5 minutes at room t.

2. The mixture is centrifuged for 30 minutes at 3000 rpm.

3. To 0.5 ml of the supernatant add 4.5 ml of distilled water.

4. The measurement is carried out on a spectrophotometer in UV light at λ 280 nm, at λ 254 nm, at λ 238 nm.

5. As a control, use a solution of TCA diluted with distilled water 30 times. The optical density of the control solution against water should be 0.123 ± 0.012 cu at λ 254 nm, t 23-25 ° С.

6. The level of MSM is expressed in units quantitatively equal to the extinction indices.

7. In the future, the average molecule index (IMS) is calculated for each employee - the sum of the quotient of dividing the MSM value at λ 280 nm to the same value at 254 nm and the quotient of dividing the MSM value at λ 238 nm to the same value at 280 nm (norm ≤ 4,5):

An increase in the index of medium molecules of more than 4.5 is a poor prognostic sign and indicates the presence of endogenous intoxication syndrome.

To quantify the prevalence of endogenous intoxication syndrome and a predisposition to the development of occupational diseases, an odds ratio (OR) is calculated. To do this, use the formula proposed by Bland [Bland, J.M. The odds ratio / J. M. Bland, D. G. Altman // Br. Med. J. - 2000. - Vol. 320. - P.1468]:

OR = (a × d) / (b × c),

where a is the number of individuals with the presence of endogenous intoxication syndrome (TS> 4.5), b - with the absence of the syndrome (TS ≤ 4.5) among workers in chemical and petrochemical industries; c and d - the number of people, respectively, with the presence and absence of endogenous syndrome among workers not exposed to the professional factor of chemical etiology. An increased risk of development was observed at OR> 1.

We examined workers (n = 116) of chemical (OAO Steklonit, resp. Bashkortostan) and petrochemical (OAO Nizhnekamskneftekhim, resp. Tatarstan) manufacturing. All the workers surveyed were male, age ranged from 20 to 55 years.

The control group consisted of 46 workers in the chemical and petrochemical industries who were not exposed to the chemical factor. The groups of workers surveyed and controls were comparable by age, gender, and place of work. The average age of the workers surveyed was 37.4 ± 1.3 years with a work experience of 13.7 ± 1.6 years, the average age of workers in the control group was 38.8 ± 0.7 years with a work experience of 14.6 ± 0.7 years .

A study of the prevalence of endogenous intoxication syndrome among workers in chemical and petrochemical industries and in the control group showed statistically significant differences. It was found that most often (13.8%) endogenous intoxication syndrome was detected among workers in chemical and petrochemical industries exposed to a chemical factor, which is 3.2 times more likely (t = 2.16; p <0.05; OR = 3.5) than among employees of the control group (4.3%). The results show that high values of the index of medium molecules in the body of workers exposed to a chemical factor accompany endogenous intoxication syndrome, which can lead to the development of diseases of occupational origin.

We, when studying the prevalence of endogenous intoxication syndrome in workers in petrochemical and chemical industries, found that if workers have a leukocyte intoxication index (LII) value higher than normal (1.5 cu) [Kalf-Kalif Y.Ya. About LII and its practical value / Medical business. 1941. - No. 1. - S.31-33] more often met the value of the ISM of 4.5 or more (p <0.001; OR = 3.04) than with the value of the leukocyte intoxication index, which is within normal limits (0.3-1.5).

The definition of prognostic markers is of great practical importance, since the identification of initial reversible forms, occupational diseases is one of the priority areas of preventive diseases.

The proposed method is illustrated by the following clinical material.

Example 1. Worker X., work experience - 15 years, age - 39 years. Diagnosis: limited skin hyperkeratosis.

Technology: from a vein of patient X. blood sampling was performed in an amount of 3 ml, which was centrifuged to obtain serum. Blood serum with a volume of 1 ml was placed in a centrifuge tube, then 10% TCA in the amount of 0.5 ml was added to it, the contents of the tube were mixed, the tube was centrifuged. 4.5 ml of distilled water was added to the resulting supernatant. The optical density of the obtained supernatant was measured on a spectrophotometer at λ 238 nm, at λ 254 nm, at λ 280 nm. The average molecular indices turned out to be elevated and amounted to MSM at λ 238 nm 1.30 cu, MSM at λ 254 nm 0.286 cu, MSM at λ 280 nm 0.421 cu The calculated ISM was equal to 4.6, the index value exceeded the permissible values. Alleged endogenous intoxication has been confirmed.

Example 2. Worker V., work experience - 28 years, age - 54 years. Diagnosis: occupational chronic toxic hepatitis.

Technology: from a vein of patient B., a blood sampling of 3 ml was carried out, which was centrifuged to obtain serum. Blood serum with a volume of 1 ml was placed in a centrifuge tube, then 10% TCA in the amount of 0.5 ml was added to it, the contents of the tube were mixed, the tube was centrifuged. 4.5 ml of distilled water was added to the resulting supernatant. The optical density of the obtained supernatant was measured on a spectrophotometer at λ 238 nm, at λ 254 nm, at λ 280 nm. The average molecule indices were MSM at λ 238 nm 0.99 cu, MSM at λ 254 nm 0.228 cu, MSM at λ 280 nm 0.312 cu The calculated value (ISM = 4.6) exceeded the permissible value. The alleged endogenous intoxication with medium-mass molecules was confirmed.

Example 3. Worker E., work experience - 33 years, age - 56 years. During a periodic medical examination by the institute’s clinic team, the worker was assigned to the “risk group” for the development of an occupational disease, as a result of which he was sent to the institute’s clinic, where he was admitted with signs of chronic intoxication with a complex of toxic substances in the form of functional disorders of the hepatobiliary system in combination with the syndrome disorders of the autonomic nervous system.

Technology: from a vein of patient E., a blood sampling of 3 ml was carried out, which was centrifuged to obtain serum. Blood serum with a volume of 1 ml was placed in a centrifuge tube, then 10% TCA in the amount of 0.5 ml was added to it, the contents of the tube were mixed, the tube was centrifuged. 4.5 ml of distilled water was added to the resulting supernatant. The optical density of the obtained supernatant was measured on a spectrophotometer at λ 238 nm, at λ 254 nm, and at λ 280 nm. The average molecular indices turned out to be elevated and amounted to MSM at λ 238 nm 1.386 cu, MSM at λ 254 nm 0.271 cu, MSM at λ 280 nm 0.438 cu, ISM = 4.8, the index value exceeded the permissible . The alleged syndrome of endogenous intoxication with medium molecular weight peptides has been confirmed.

Example 4. Worker A., work experience - 1 year, age - 36 years. Diagnosis: healthy.

Technology: from a vein of patient E., a blood sampling of 3 ml was carried out, which was centrifuged to obtain serum. Blood serum with a volume of 1 ml was placed in a centrifuge tube, then 10% TCA in the amount of 0.5 ml was added to it, the contents of the tube were mixed, the tube was centrifuged. 4.5 ml of distilled water was added to the resulting supernatant. The optical density of the obtained supernatant was measured on a spectrophotometer at λ 238 nm, at λ 254 nm, at λ 280 nm. The average molecular weight of MSM at λ 238 nm is 0.76 cu, MSM at λ 254 nm is 0.275 cu, MSM at λ 280 nm is 0.305 cu, ISM = 3.6, the index value did not exceed the permissible values. No endogenous intoxication syndrome has been identified.

Claims (1)

A method for the diagnosis of endogenous intoxication syndrome, including blood sampling, determination of medium-weight molecules (MSM) in blood serum by direct spectrometry of deproteinized supernatant obtained after protein precipitation with trichloroacetic acid solution, at wavelengths (λ) of 280 nm and 254 nm, characterized in that additionally determine the MSM at λ 238 nm, calculate the average molecule index as the sum of the quotient of dividing the values of MSM at λ 280 nm to the same value at λ 254 nm and the quotient of dividing the values of MSM at λ 238 nm to the analog ichnomu value at λ 280 nm and a value of the index of average molecular greater than 4.5 diagnosed endogenous intoxication.