RU-2861529-C1 - METHOD FOR ASSESSING SEVERITY OF REPARATIVE REGENERATION DISORDERS OF MUCOUS MEMBRANE IN INFLAMMATORY DISEASES OF NASAL CAVITY

RU2861529C1RU 2861529 C1RU2861529 C1RU 2861529C1RU-2861529-C1

Abstract

FIELD: medicine; otorhinolaryngology. SUBSTANCE: invention can be used to assess the severity of reparative regeneration disorders of the mucous membrane (MM) in inflammatory diseases of the nasal cavity. To do this, an objective assessment of the rhinoscopic picture of the nasal cavity is carried out on a scale from 0 to 3 points with the calculation of a total clinical score for the following indicators - the amount, nature of nasal secretion, the severity of MM oedema, MM colour, the presence of crusts. For dryness of the nasal cavity MM, the indicator is assigned 0 points, for moist nasal cavity MM - 1 point, for a moderate amount of discharge - 2 points, for abundant discharge - 3 points. If the nature of the nasal secretion is mucous - 0 points, serous watery - 1 point, mucopurulent - 2 points, purulent - 3 points. In the absence of oedema of the nasal cavity MM, the indicator is assigned 0 points, for mild oedema - 1 point, moderate oedema - 2 points, severe oedema - 3 points. If the colour of the nasal cavity MM is pink - 0 points, mild hyperaemia - 1 point, moderate hyperaemia - 2 points, severe hyperaemia - 3 points. In the absence of crusts in the nose - 0 points, the presence of a small number of crusts - 1 point, a moderate number of crusts - 2 points, an abundant number of crusts - 3 points. The total clinical score is assessed as a mild degree of inflammatory reaction of the nasal cavity MM if the number of points is less than or equal to 6, a moderate degree - from 7 to 12 points, a severe degree - more than 12 points. Then, the state of the mucociliary clearance is assessed according to the saccharin test: less than 15 minutes - 0 points, 15-20 minutes - 1 point, 21-30 minutes - 2 points, more than 30 minutes - 3 points. The severity of crystallisation disorders of the nasal secretion obtained by the wedge-shaped dehydration method according to changes in the central and transition zones of the facies. When analysing the facies of the nasal secretion, 3 degrees of crystallisation disorder of the nasal secretion are distinguished: mild, moderate and severe. Each studied parameter is assigned from 0 to 3 points according to the table presented in the description. The resulting indicator of the severity of reparative regeneration disorders of the MM in inflammatory diseases of the nasal cavity is calculated. The result is assessed as a mild degree of regeneration disorders if the total number of points is 2-7 points, a moderate degree - from 8 to 14 points, a severe degree - more than 14 points. EFFECT: objective, comprehensive assessment of the state of reparative regeneration, based on the results of morphological examination, clinical, functional data, while excluding traumatic intravital morphological examination of the nasal MM in patients with the possibility of dynamic monitoring of MM regeneration. 1 cl, 3 dwg, 1 tbl, 3 ex

Inventors

Berest Irina Evgenevna

Dates

Publication Date: 20260505
Application Date: 20251225

Claims (1)

A method for assessing the severity of disorders in the reparative regeneration of the mucous membrane (MM) in inflammatory diseases of the nasal cavity, including taking material from the surface of the mucous membrane using the smear-print method for cytological examination, calculating the average destruction index, the index of cytolysis of ciliated epithelial cells, the specific gravity of squamous epithelium, characterized in that the rhinocytogram parameters are ranked by points: 0 points - the specific gravity of ciliated epithelium is 50-60%, the specific gravity of squamous epithelium is 2-4%, the average destruction index of ciliated epithelium is 0.60-0.85, the index of cytolysis of ciliated epithelium cells is 0.02-0.04; 1 point - the specific gravity of the ciliated epithelium is 35-49%, the specific gravity of the squamous epithelium is 5-9%, the average index of ciliated epithelium destruction is 0.86-0.99, the index of ciliated epithelial cell cytolysis is 0.05-0.06; 2 points - the specific gravity of the ciliated epithelium is 25-34%, the specific gravity of the squamous epithelium is 10-15%, the average index of ciliated epithelium destruction is 1.0-1.3, the index of ciliated epithelial cell cytolysis is 0.07-0.08; 3 points - the specific gravity of the ciliated epithelium is less than 25%, the specific gravity of the squamous epithelium is more than 15%, the average index of ciliated epithelium destruction is more than 1.3, the index of ciliated epithelial cell cytolysis is more than 0.08; Additionally, the activity level of the inflammatory reaction of the mucous membrane is determined by assessing the rhinoscopic picture of the nasal cavity on a scale from 0 to 3 points, with the total clinical score calculated based on the following indicators: the amount and nature of nasal discharge, the severity of swelling and the color of the mucous membrane, and the presence of crusts: 0 points for dry nasal mucosa, 1 point for moist nasal mucosa, 2 points for moderate discharge, and 3 points for abundant discharge; 0 points for mucous nasal discharge, 1 point for serous (watery) discharge, 2 points for mucopurulent discharge, and 3 points for purulent discharge; 0 points for no swelling of the nasal mucosa, 1 point for mild swelling, 2 points for moderate swelling, and 3 points for severe swelling. if the color of the nasal cavity mucosa is pink - 0 points, mild hyperemia - 1 point, moderate hyperemia - 2 points, severe hyperemia - 3 points; in the absence of crusts in the nose - 0 points, the presence of a small amount of crusts - 1 point, a moderate amount of crusts - 2 points, a large amount of crusts - 3 points; the overall clinical score is assessed as a mild degree of inflammatory reaction of the nasal mucosa if the number of points is less than or equal to 6, moderate degree - from 7 to 12 points, severe degree - more than 12 points; the state of mucociliary clearance is assessed according to the saccharin test: less than 15 minutes - 0 points, 15-20 minutes - 1 point, 21-30 minutes - 2 points, more than 30 minutes - 3 points; the severity of the crystallization disorders of the nasal secretion obtained by the wedge-shaped dehydration method, while three degrees of crystallization disorders of the nasal secretion are distinguished: mild degree - the central zone is made over the entire surface by a network of shortened crystals that have different shapes - tree-like, stellate - with well-visualized boundaries, but limited in growth, in the transition zone, the closer to the periphery, the smaller the crystalline structures become in size with a curved axial process, a small number or absence of first-order processes and a practical absence of 2-4 order processes, and also reveal small crystalline structures and amorphous formations, moderate severity - in the central and transition zones, crystals with 2-3 order branches of various shapes in the form of spears, rhombuses, branches are formed, severe severity - in the central zone there are no central crystals or single unbranched crystals predominate among protein inclusions, in the transition zone, protein inclusions are noted and thin unbranched crystals; each parameter studied is assigned from 0 to 3 points according to the table presented in the description, and the resulting indicator of the severity of reparative regeneration disorders of the mucous membrane in inflammatory diseases of the nasal cavity is calculated, the values of which are assessed as a mild degree of regeneration disorders if the total number of points is 2-7 points, a moderate degree - from 8 to 14 points, a severe degree - more than 14 points.

Description

The invention relates to the field of medicine, namely, to otolaryngology, and describes a method for assessing the severity of disorders of the reparative regeneration of the mucous membrane (MM) in inflammatory diseases of the nasal cavity, which makes it possible to predict the outcome of the inflammatory reaction in the nasal cavity and evaluate the effectiveness of the prescribed therapy. A well-known method for assessing the regeneration process is based on the cytological study of wound exudate, the so-called "fingerprint method" (M.P. Pokrovskaya, M.S. Makarov. Cytology of Wound Exudate as an Indicator of the Wound Healing Process. Main Military Health Directorate of the Red Army. Moscow, Medgiz, 1942, 43 p.). The authors provide a detailed description of the cytology and quantitative assessment of cells and microflora in the wound, which characterizes the progression of the wound healing process. However, when using the "wound fingerprint method," only the wound exudate is analyzed, allowing for a thorough study of the cellular reactions of only the superficial layer of the wound. A method of cytological examination of the healing of planar wounds is known - superficial wound biopsy (M.F. Kamaev. Infected wound and its treatment. Moscow, Medicine, 1970, 159 p.). The technique of this method differs from the technique of the "wound prints" method in that the material for study is taken not by applying a glass slide to the wound, but by lightly scraping the surface layer of the wound with a special spatula. According to different periods of wound healing, 5 types of cytograms are distinguished: I - necrotic type (N), II - degenerative-inflammatory (D-B) type, III - inflammatory type (B), IV - inflammatory-regenerative (B-P) or regenerative-inflammatory type (depending on the predominance of one or another component), V - regenerative type (P). A disadvantage of this method is the low reliability of the results obtained, due to the fact that the number of neutrophils and microflora are highly variable and do not always reflect the true picture of the wound. Only a bacteriological examination provides an objective assessment of microbial contamination, and the number of neutrophils in some cases may indicate the progression of the inflammatory process, while in others, conversely, it may indicate the activation of nonspecific tissue resistance factors (V.I. Bulynin, A.A. Glukhov, I.P. Manurov. Wound Treatment. Voronezh, 1998, 248 p.). A method for calculating the coefficient of reparation of the nasal mucosa is known, which we took as a prototype (E.A. Balakireva, D.Yu. Bugrimov, O.Yu. Filatov, O.V. Kashaeva, V.A. Nazarov. Immunomodulatory and reparative therapy of influenza and acute respiratory infections in children. Doctor, 2015, No. 6, pp. 72-76). The authors collect material from the surface of the mucosa using smears-prints for cytological examination with the definition of 5 classes of destruction (0, 1, 2, 3, 4, 5) of squamous epithelium, calculating the cell destruction indices (CDI), average destruction index (ADI), cell cytolysis index (CCI) of squamous epithelium, the specific gravity of squamous epithelium and neutrophils according to the method of L.A. Matveeva (L.A. Matveeva, A.Ya. Osin. Local immunity in lung diseases in children. Tomsk, Tomsk University Press, 1986. 104 p.). In addition, the concentration of secretory immunoglobulin A in nasal washes is determined. Based on the data obtained, the generalized logarithmic index (GLI) of the reparation coefficient is calculated. The values of this index are interpreted as the norm: satisfactory reparation at 0-0.05, active reparation at 0.05-2.0, unsatisfactory reparation at 0.2-0.58, and reparation failure at GLI of 0.5-1.0. A disadvantage of this method is the limited parameters considered, as it does not take into account clinical and functional data on nasal mucosal restoration. Furthermore, the interpretation of OLP values between 0.5 and 0.58 is unclear, as these values fall into the categories of both unsatisfactory repair and repair failure. The purpose of the invention is to increase the reliability of assessing the severity of disorders of reparative regeneration of the nasal mucosa by objectifying morphological methods and determining additional clinical and functional parameters of its restoration. The stated objective is achieved in that the method for assessing the severity of disorders in the reparative regeneration of the nasal mucosa according to the invention additionally determines the degree of activity of the inflammatory reaction of the nasal mucosa in points based on the results of the rhinoscopic picture, evaluates the state of mucociliary clearance based on the saccharin test, the severity of disorders in the crystallization of nasal secretion (NS) obtained by the wedge dehydration method, and, based on the obtained clinical, morphological and functional data, calculates the resulting index of severity of disorde