Selecting informative biomarkers for early diagnosis of occupational neurological diseases

Abstract

Introduction. At present, the patterns of changes in the levels of biomarkers and the relationship of changes in their values with the pathogenesis of diseases caused by the impact of adverse factors of labour activity are not sufficiently studied. The most unresolved issues are the choice of informative laboratory indicators and diagnostic test systems in investigating the impact of physical factors on the working environment (vibration and physical overload) neurohumoral regulation: pituitary-adrenal pituitary-thyroid, pituitary-gonadal system and hormonal indicators of carbohydrate metabolism. The aim of the study was to determine diagnostic hormonal markers and integral indices to identify early changes in the neurohumoral status in the body of workers under the influence of working environment factors. Materials and methods. 330 workers of mining and machine-building enterprises were examined. Of these, 128 people with vibration disease, 45 people - with lumbosacral radiculopathy, combined pathology (vibration disease and lumbosacral radiculopathy) was detected in 60 persons. The preclinical stage (initial signs of diseases) was noted in 97 workers. Laboratory studies included hormones and integral indices of the pituitary-adrenal, pituitary-thyroid, pituitary-gonadal system, carbohydrate metabolism. To select the diagnostic significance of laboratory biomarkers, diagnostic sensitivity, prenosological value, pathognomonicity, direction, severity, and selectivity of changes in biomarker levels were evaluated. Results. The combined effect of vibration and physical overload on the body of workers was found to have a unidirectional and systemic impact on the levels of hormones of the pituitary-adrenal, pituitary-thyroid and pituitary-gonadal systems, increases insulin resistance. The severity of changes in neurohumoral regulation indicators depends on the nature and severity of the occupational neurological disease. The highest diagnostic sensitivity (Df = 72-74%) in vibration disease and its combination with lumbosacral radiculopathy was obtained for pituitary-gonadal hormones and indicators of insulin resistance. The lowest values of Dh are typical for the hormones of the pituitary-thyroid system (no more than 14%). To identify early changes in neurohumoral regulation in the body under the influence of vibration and physical exertion, it is most informative to determine the concentration of total testosterone, luteinizing hormone and insulin, as well as the integral pituitary-adrenal index, insulin resistance indices. To identify hidden disorders of the pituitary-thyroid system, the definition of the essential thyroid index can be used. Discussion. The results obtained allowed us to assess the nature of changes in the levels of hormones of the pituitary-adrenal, pituitary-thyroid and pituitary-gonadal systems and carbohydrate metabolism and to propose informative laboratory biomarkers reflecting early changes in neurohumoral regulation under the influence of physical factors of the working environment. Conclusions. To identify early changes in neurohumoral regulation in the body of workers under the influence of vibration and physical exertion, the most informative is the determination of the concentration of total testosterone, luteinizing hormone and insulin, the integral pituitary-adrenal index, and insulin resistance indices. To identify hidden disorders of the pituitary-thyroid system, the definition of the integral thyroid index can be used.