Лекарственно-индуцированная диарея, ассоциированная с применением противоопухолевых препаратов
- Авторы: Сычёв Д.А.1, Остроумова О.Д.1,2, Зиганшина Л.Е.1, Филиппова А.В.1
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Учреждения:
- Российская медицинская академия непрерывного профессионального образования
- Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)
- Выпуск: Том 13, № 3 (2021)
- Страницы: 5-18
- Раздел: Научный обзор
- URL: https://journals.rcsi.science/vszgmu/article/view/84052
- DOI: https://doi.org/10.17816/mechnikov84052
- ID: 84052
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Аннотация
Диарея является наиболее распространенной нежелательной реакцией на прием противоопухолевых препаратов, лучевую терапию органов малого таза или брюшной полости. Частота диареи всех степеней тяжести во время химиотерапии и/или лучевой терапии достигает 80 %, причем у трети пациентов развивается тяжелая диарея (III или IV степени). Чаще всего лекарственно-индуцированная диарея возникает на фоне химиотерапии с использованием 5-фторурацила или иринотекана, а также приема новых противоопухолевых препаратов из классов моноклональных антител и ингибиторов тирозинкиназы. К механизмам, лежащим в основе развития лекарственно-индуцированной диареи, относятся повреждения слизистой оболочки кишечника, нарушение всасывания белков, углеводов и жиров, воспаление, гиперреакивный иммунный ответ, дисбаланс микрофлоры кишечника и др.
Алгоритмы ведения пациентов с тяжелой диареей включают приостановку (при I–III степенях) или полное прекращение (при III–IV степенях) применения противоопухолевого средства — индуктора диареи, а также назначение препаратов, снижающих моторику кишечника, таких как лоперамид (при исключении инфекционной природы диареи) и метилпреднизолон (при диарее, вызванной моноклинальными антителами в отсутствие подозрения в отношении потенциально возможной перфорации кишечника). Если лекарственно-индуцированная диарея длится более 48 ч, пациент сообщает о симптомах обезвоживания или появилась лихорадка, необходима срочная госпитализация.
Цель работы — анализ данных научной литературы о распространенности, патофизиологических механизмах и факторах риска развития диареи, ассоциированной с приемом противоопухолевых лекарственных средств, а также ее профилактике и лечении.
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Дмитрий Алексеевич Сычёв
Российская медицинская академия непрерывного профессионального образования
Email: dimasychev@mail.ru
ORCID iD: 0000-0002-4496-3680
SPIN-код: 4525-7556
д-р мед. наук, профессор, член-кор. РАН, профессор РАН
Россия, 125993, Москва, ул. Баррикадная, д. 2/1, стр. 1Ольга Дмитриевна Остроумова
Российская медицинская академия непрерывного профессионального образования; Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)
Email: ostroumova.olga@mail.ru
ORCID iD: 0000-0002-0795-8225
SPIN-код: 3910-6585
д-р мед. наук, профессор
Россия, 125993, Москва, ул. Баррикадная, д. 2/1, стр. 1; МоскваЛилия Евгеньевна Зиганшина
Российская медицинская академия непрерывного профессионального образования
Email: lezign@gmail.com
ORCID iD: 0000-0003-1999-0705
SPIN-код: 6061-7223
д-р мед. наук, профессор
Россия, 125993, Москва, ул. Баррикадная, д. 2/1, стр. 1Анастасия Витальевна Филиппова
Российская медицинская академия непрерывного профессионального образования
Автор, ответственный за переписку.
Email: filippova.96@mail.ru
ORCID iD: 0000-0003-3081-602X
ординатор кафедры терапии и полиморбидной патологии имени академика М.С. Вовси
Россия, 125993, Москва, ул. Баррикадная, д. 2/1, стр. 1Список литературы
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