Воспалительные заболевания кишечника: трансформация представлений
- Авторы: Маев И.В.1, Бакулин И.Г.2, Скалинская М.И.2, Сказываева Е.В.2
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Учреждения:
- ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России
- ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России
- Выпуск: Том 95, № 12 (2023)
- Страницы: 1064-1074
- Раздел: Обзоры
- URL: https://journals.rcsi.science/0040-3660/article/view/249440
- DOI: https://doi.org/10.26442/00403660.2023.12.202507
- ID: 249440
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Аннотация
Глобальное бремя воспалительных заболеваний кишечника (ВЗК) значительно и продолжает расти в связи повышением распространенности язвенного колита (ЯК) и болезни Крона (БК), с увеличением затрат на диагностику и лечение, а также из-за высокого уровня инвалидизации, что обусловливает поиск факторов риска и предикторов агрессивного течения, развития внекишечных проявлений (ВКП). По последним данным, распространенность ЯК в России составляет 16,6 на 100 тыс. населения, ежегодный регистрируемый прирост – 11,3%, распространенность БК – 5,6 на 100 тыс. населения, а прирост – 13,7%. В российской популяции пациентов с ВЗК средний возраст дебюта заболевания составляет 35,3 года для ЯК и 31,2 года – для БК. При этом у 89,3% пациентов с ЯК для верификации диагноза потребовался период не менее 2 лет, а при БК в течение 2 лет от момента начала клинических симптомов диагноз установлен только у 72,6% пациентов. Одна из доминирующих характеристик ВЗК – их мультисистемность, что приводит к развитию ВКП, которые могут отмечаться у 50–60% больных, причем до 25% пациентов с ВЗК имеют несколько ВКП, и наиболее частыми вариантами являются поражения суставов. Бόльшая частота ВКП отмечается при БК (до 45% пациентов), у пациентов женского пола, курильщиков и при большей продолжительности заболевания. Для прогноза клинической ремиссии имеют значение уровень фекального кальпротектина и C-реактивного белка, потребность в глюкокортикостероидах, для прогноза эндоскопической ремиссии – уровень фекального кальпротектина, а для прогноза гистологической ремиссии имеет значение эндоскопический индекса Шредера ≤1 баллу. Абсолютный риск развития колоректального рака при ВЗК остается относительно низким, составляя от 1,1 до 5,4% через 20 лет заболевания. Основными факторами риска при ВЗК считаются тотальное поражение кишки, высокая активность воспаления, стриктурирующий фенотип БК и наличие первичного склерозирующего холангита.
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Игорь Вениаминович Маев
ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России
Автор, ответственный за переписку.
Email: igormaev@rambler.ru
ORCID iD: 0000-0001-6114-564X
акад. РАН, доктор медицинских наук, профессор, зав. кафедрой пропедевтики внутренних болезней и гастроэнтерологии
Россия, МоскваИгорь Геннадьевич Бакулин
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России
Email: igormaev@rambler.ru
ORCID iD: 0000-0002-6151-2021
доктор медицинских наук, профессор, зав. кафедрой пропедевтики внутренних болезней, гастроэнтерологии и диетологии
Россия, Санкт-ПетербургМария Игоревна Скалинская
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России
Email: igormaev@rambler.ru
ORCID iD: 0000-0003-0769-8176
кандидат медицинских наук, доц. каф. пропедевтики внутренних болезней, гастроэнтерологии и диетологии
Россия, Санкт-ПетербургЕкатерина Васильевна Сказываева
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России
Email: igormaev@rambler.ru
ORCID iD: 0000-0002-8563-6870
кандидат медицинских наук, доцент каф. пропедевтики внутренних болезней, гастроэнтерологии и диетологии
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