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Научно-практическая ревматология

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Миозит, ассоциированный со злокачественными опухолями

https://doi.org/10.14412/1995-4484-2016-289-298

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Аннотация

Идиопатические воспалительные миопатии (ИВМ) – гетерогенная группа приобретенных системных заболеваний с преимущественным поражением скелетной мускулатуры. Основными представителями ИВМ являются полимиозит (ПМ) и дерматомиозит (ДМ). Эпидемиологические исследования демонстрируют взаимосвязь между ПМ/ДМ и злокачественными новообразованиями (ЗН), риск выявления которых выше, чем в популяции соответствующих возрастных групп. Частота ЗН при ПМ/ДМ колеблется в диапазоне от 9 до 50%. Связь со ЗН описана при каждом подтипе ИВМ, однако наиболее часто они выявляются при ДМ. Пациенты, страдающие ПМ/ДМ, ассоциированным со ЗН, имеют худший прогноз, чем больные ЗН. Раннее выявление ЗН позволило бы улучшить прогноз у этих больных. Опубликованные исследования выделяют демографические, клинические и лабораторные факторы, повышающие риск выявления ЗН у пациентов с ПМ/ДМ. Тем не менее все они охватывают небольшие группы больных, полученные результаты неоднородны и не вполне убедительны, что требует дальнейшего, более масштабного, изучения этой проблемы.

Цель исследования – выявление и идентификация особенностей паранеопластического миозита (ПнМ).

Материал и методы. В исследование включены 320 пациентов с достоверным диагнозом ИВМ, наблюдавшихся за период с 1996 по 2016 г. Пациентам проводили лабораторное исследование, мануальное мышечное тестирование силы проксимальных мышц по 10-балльной шкале и электромиографическое исследование игольчатыми электродами.

Результаты и обсуждение. ПнМ был выявлен у 32 (10%) из 320 больных ИВМ. Среди пациентов с ПнМ было 6 (19%) мужчин и 26 (81%) женщин. Средний возраст дебюта ПнМ составлял 55,4 года. Дебют клинической картины болезни был представлен характерным кожно-мышечным синдромом у 19 (59%) пациентов, у 18 (41%) из них ЗН обнаружено в течение первого года от начала болезни. У 13 (41%) больных манифестация ЗН предшествовала картине ПМ/ДМ. Наиболее часто выявляли рак яичников (37,5%), ЗН легкого и молочной железы (15%), далее следовали ЗН кишечника (12,5%), крови (6,3%), матки (6%) и желудка (3,1%). Медиана выживаемости больных с ПнМ составила 5 лет.

Об авторах

О. А. Антелава
ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России
Россия

кафедра ревматологии Института профессионального образования,

119991 Москва, ул. Трубецкая, 8, стр. 2



А. Н. Хелковская-Сергеева
ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой
Россия
115522 Москва, Каширское шоссе, 34А


Н. В. Чичасова
ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России
Россия

кафедра ревматологии Института профессионального образования,

119991 Москва, ул. Трубецкая, 8, стр. 2



С. Г. Раденска-Лоповок
ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой
Россия
115522 Москва, Каширское шоссе, 34А


С. И. Глухова
ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой
Россия
115522 Москва, Каширское шоссе, 34А


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Для цитирования:


Антелава О.А., Хелковская-Сергеева А.Н., Чичасова Н.В., Раденска-Лоповок С.Г., Глухова С.И. Миозит, ассоциированный со злокачественными опухолями. Научно-практическая ревматология. 2016;54(3):289-298. https://doi.org/10.14412/1995-4484-2016-289-298

For citation:


Antelava O.A., Khelkovskaya-Sergeeva A.N., Chichasova N.V., Radenska-Lopovok S.G., Glukhova S.I. MYOSITIS ASSOCIATED WITH MALIGNANT TUMORS. Rheumatology Science and Practice. 2016;54(3):289-298. (In Russ.) https://doi.org/10.14412/1995-4484-2016-289-298

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ISSN 1995-4484 (Print)
ISSN 1995-4492 (Online)