RU2407018C2 - Method of laboratory diagnostics of hypertension and diabetes mellitus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: content of sodium, potassium, calcium, ratio of sodium concentration to content of potassium in saliva of examined person are determined. If calcium content is more than 0.07 g/l and value of Na/K ratio is 0.12 and less -diabetes mellitus of 2-nd type is diagnosed.

EFFECT: method application allows to increase efficiency of diagnosing diabetes mellitus of second type.

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Description

The invention relates to medicine, in particular to dentistry, and is intended to detect deviations of the structural properties of the oral fluid from the norm, depending on the underlying disease.

The condition of the organs of the oral cavity to a large extent depends on the composition and properties of the surrounding fluid, namely saliva. Saliva plays a crucial role in maintaining the physiological balance of the processes of mineralization and demineralization in tooth enamel. In the oral cavity, saliva is present as a thin film of liquid on various surfaces. It is known that diseases of the oral cavity arise due to imbalance in the system of “tooth enamel - saliva” under the influence of various adverse factors. These factors include the presence of a underlying disease in the human body, in particular diabetes mellitus, hypertension, kidney disease, etc.

Known methods for diagnosing a number of diseases by examining the oral fluid: desquamative glossitis on the content of norepinephrine (RF application 2004132590, IPC G01N 33/48), odontogenic osteoflegmon and adenoflegmon (RF patent 2230327, IPC G01N 33/84), the inflammatory process in the respiratory system (patent RF 2140080, IPC G01N 33/487), chronic gastroduodenitis and functional dyspepsia in children (RF patent 2270610, IPC AB 10/00, G01N 33/483). Also known are methods for predicting the course of diseases by a number of parameters of the oral fluid, in particular inflammatory diseases (RF patent 2286572, IPC G01N 33/52) and diseases accompanied by disturbance of the microflora of the oral cavity (RF patent 2229130, IPC G01N 33/48). There is also a method for diagnosing the development of myocardial necrosis by the content of arachidonic acid in the blood and saliva (RF patent 2293328, IPC G01N 33/50). All these methods allow you to diagnose the disease by a number of specific parameters of the oral fluid, often requiring sophisticated equipment and qualified personnel to perform analyzes.

Closest to the claimed method is a method for determining the degree of violation of carbohydrate metabolism in diabetes mellitus by the sugar content in saliva (RF application 94038225, IPC АВВ 10/00).

This method is used to assess the condition of a patient with impaired carbohydrate metabolism if the main diagnosis is known - diabetes mellitus, it is simpler and more informative than the determination of sugar in human blood.

This method does not connect the state of organs and tissues of the oral cavity with the presence of the underlying disease in the patient, does not provide the possibility of early diagnosis of the underlying disease by laboratory indicators of oral fluid and the identification of predisposition to this disease, and also does not provide the possibility of simultaneous diagnosis of a number of diseases.

The task of the invention is to develop a laboratory method for diagnosing the underlying disease (diabetes mellitus) by deviating the structural properties of the oral fluid from the norm and identifying a predisposition to this disease.

The specified technical result is achieved by the fact that in the method of laboratory diagnosis of diabetes mellitus determine the content of sodium, potassium and calcium and the ratio of the concentration of sodium to the potassium content in the saliva of the subject and when the calcium content is more than 0.07 g / l and the values of the ratio Na / K 0.12 and less - type 2 diabetes is diagnosed.

To determine the diagnostic indicators, 5 groups of people of three ages are examined, and 1 group - people with hypertension; Group 2 - patients with diabetes; 3 group - patients with pyelonephritis; 4 group - people with dental deposits in the oral cavity; 5 group - control - people with the same somatic status “practically healthy” without periodontal disease and oral mucosa; each person determines the composition and structural properties of the oral fluid, in particular the concentration of sodium, potassium, calcium, inorganic phosphorus, protein content, viscosity and surface tension; as a result, diagnostic parameters are revealed that do not intersect for different groups and change in different directions, and determine the concentration limits characterizing the risk of type 2 diabetes mellitus.

The method is as follows.

The following studies were performed to determine the parameters of the oral fluid. The study material was the saliva of 200 patients. Saliva was taken in the morning, on an empty stomach, before brushing your teeth in a sterile test tube with a tight-fitting lid. The collected saliva was centrifuged for 10 minutes at a speed of 3000 rpm in a laboratory medical centrifuge OPL-8. To determine the physico-chemical parameters of the oral fluid, we used methods adapted in dentistry to study the oral fluid [Pitaeva A.N., Korshunov A.P., Distel V.A. and others. "Physico-chemical methods for the study of mixed saliva in clinical and experimental dentistry" (textbook) - Omsk, 2001. - 71 p.]. Inorganic phosphorus in the oral fluid was determined by the method of Bolz and Luke [Bolz DM, Luke Ch.G. “Colorimetric methods for the determination of non-metals”, M., 1963. - 167 p.], A biuret reaction was used to quantify the protein [P. Leus. "Clinical and experimental study of pathogenesis, pathogenetic conservative therapy and prevention of dental caries." Abstract dis. Drs. honey. sciences. - M., 1977. - 32 p.].

The study identified five groups of people:

1) group 1 - patients with hypertension (GB) - 40 people (20%);

2) group 2 - patients with diabetes mellitus (DM) type 2 - 40 people (20%);

3) group 3 - patients with chronic pyelonephritis (CP) - 40 people (20%);

4) group 4 - people with dental deposits in the oral cavity. The saliva of 40 people (20%) was examined;

5) group 5 - control group - 40 people (20%).

The group of persons resistant to diseases, taken as a comparison, was composed of people with the same somatic status of “practically healthy,” as well as those without periodontal and oral mucosa diseases.

The results of a clinical study of the selected groups of patients indicate that the most unfavorable situation in the oral cavity develops in patients with diabetes mellitus. In such patients, deterioration of periodontal tissues is noted, the hygienic condition of the oral cavity is worse. Less unfavorable, but comparable, is the situation in the oral cavity in patients with hypertension. With this disease, the highest incidence of dental caries was noted. In patients with chronic pyelonephritis, there were no significant differences from the comparison groups.

In this regard, the next stage of the study included the study of the composition and properties of the oral fluid in the studied somatic pathology. Table 1 shows the main laboratory parameters of the oral fluid of the studied groups of patients.

Table 1 Comparative characteristics of the composition of the oral fluid in individuals with various somatic pathologies (average value and range of variation of the parameter) Impressions
tel GB
n is 40; t = 1.96 SD
n is 40; t = 1.96 HP
n is 40; t = 1.96 NZK
n is 40; t = 1.96 Ozk
n is 40; t = 1.96 pH 7.21 7.25 7.54 7.15 6.93 7.17-7.25 6.21-8.29 7.50-7.58 7.07-7.23 6.88-6.98 C (Na), g / l 0,305 0.148 0.170 0,203 0.239 0.248-0.362 0.140-0.156 0.159-0.181 0.190-0.216 0.223-0.255 C (K), g / l 1,230 1,312 1,266 0,993 0.656 1,213-1,247 1,281-1,343 1,234-1,298 0.936-1.050 0.625-0.687 Total calcium, g / l 0,053 0,080 0,064 0,067 0,045 0.051-0.055 0.078-0.082 0,061-0,067 0,064-0,070 0.044-0.046 Phosphorus, g / l 0.206 0.252 0.218 0,203 0.173 0.199-0.213 0.246-0.260 0.210-0.226 0.195-0.211 0.167-0.179 Viscosity, cP 0.942 1,040 0.985 0,905 0.822 0.908-0.976 1.013-1.067 0.964-1.006 0.891-0.919 0.764-0.880 Surface tension, mn / m 61.30 61.12 62.79 62.46 64,99 60.21-64.39 60.69-61.55 62.31-63.27 61.94-62.98 64.69-65.29 Protein, mg / ml 0,906 0.801 0.751 0.931 1,201 0.851-0.961 0.744-0.858 0.700-0.802 0.852-1.010 1,133-1,269

Thus, a laboratory study of the oral fluid is an important material indicating significant differences in the physicochemical properties of the oral fluid and its elemental composition, which is the basis of the laboratory differential diagnosis of individual laboratory signs corresponding to a specific somatic pathology.

The results of a laboratory study indicate that the most adverse changes in the composition and properties of the oral fluid occur in patients with diabetes (see table 1). Less unfavorable, but comparable, is the situation in the oral cavity in patients with GB and CP.

To assess the possibility of clarifying somatic pathology, laboratory parameters of oral fluid were studied. It turned out that the content of total calcium, sodium, and potassium in the oral fluid was significantly different in patients with diabetes and hypertension, where zones of disjoint values were present, while the calcium content in the oral fluid of patients with diabetes was almost twice as high as in patients with hypertension. Sodium and potassium levels in the oral fluid showed the opposite trend.

Calcium content of 0.05-0.06 g / l was observed in patients with GB, more than 0.07 g / l - only in patients with diabetes (see tables 1 and 2). Since the concentrations of potassium and sodium in the studied samples varied in opposite directions, it became possible to increase the significance of the differences by calculating the ratios of the studied Na / K indices.

table 2 Diagnostic parameters of oral fluid in individuals with various somatic pathologies Indicator GB
n is 40; t = 1.96 SD
n is 40; t = 1.96 HP
n is 40; t = 1.96 NZK
n is 40; 1 = 1.96 Ozk
n is 40; t = 1.96 Na / K 0,200-0,298 0.104-0.120 0.122-0.147 0.181-0.231 0.325-0.408 Total calcium, g / l 0.051-0.055 0.078-0.082 0,061-0,067 0,064-0,070 0.044-0.046

Thus, with the ratio values of 0.2-0.3, the studied patients suffered only GB, and with the ratio values of 0.12 or less - diabetes. Healthy people (OZK group) had a calcium content of less than 0.05 g / l, and a Na / K ratio of more than 0.3. In the group of patients with CP and NSC, the calcium content was in the range of 0.06-0.07 g / l, while the Na / K ratio for the CP group was 0.12-0.15, NPC was 0.18-0.25, which also allows them to be divided among themselves.

In Table 3, as an example of diagnosis according to the proposed parameters, laboratory indicators of the oral fluid of the studied groups of patients are given (selectively 3 people from each group).

Table 3 The elemental composition of the oral fluid of patients of various groups Group Total calcium, g / l Sodium, g / l Potassium, g / l Na / K Diagnosis 1-1 0.051 (0.05-0.06) 0.270 1,215 0.222 (0.2-0.3) GB 1-2 0.054 (0.05-0.06) 0.340 1,234 0.276 (0.2-0.3) GB 1-3 0.052 (0.05-0.06) 0.254 1,241 0.205 (0.2-0.3) GB 2-1 0.079> 0.07 0.148 1,289 0.115 <0.12 SD 2-2 0.082> 0.07 0.142 1,324 0.107 <0.12 SD 2-3 0.081> 0.07 0.151 1,308 0.115 <0.12 SD 3-1 0.066 (0.06-0.07) 0.174 1,242 0.140 (0.12-0.15) HP 3-2 0.064 (0.06-0.07) 0.168 1,292 0.130 (0.12-0.15) HP 3-3 0.062 (0.06-0.07) 0.180 1,258 0.143 (0.12-0.15) HP 4-1 0.068 (0.06-0.07) 0.210 0.957 0.219 (0.18-0.25) NZK 4-2 0.064 (0.06-0.07) 0.204 1,032 0.198 (0.18-0.25) NZK 4-3 0.070 (0.06-0.07) 0.197 0,994 0.198 (0.18-0.25) NZK 5-1 0.046 <0.05 0.221 0.632 0.350> 0.30 OZK (norm) 5-2 0.045 <0.05 0.215 0.685 0.314> 0.30 OZK (norm) 5-3 0.045 <0.05 0.249 0.657 0.379> 0.30 OZK (norm) Note. The first digit is the group number, the second is the patient number.

The final stage of the study included the differentiation of diabetes from hypertension. For this, an independent expert investigated the content of total calcium, potassium and sodium in the oral fluid. The calculation of the laboratory diagnostic index showed 93.2% of matches according to the forecast of GB and 78.6% of matches according to the forecast of diabetes.

Claims (1)

A laboratory diagnostic method for diabetes mellitus, based on the study of the composition of the oral fluid, characterized in that the sodium, potassium and calcium content and the ratio of sodium to potassium content in the saliva of the subject are determined and when the calcium content is more than 0.07 g / l and the ratio Na / K 0.12 or less - type 2 diabetes is diagnosed.