Прегравидарная подготовка, беременность и роды, особенности течения послеродового периода при рассеянном склерозе (обзор литературы)
Прегравидарная подготовка, беременность и роды, особенности течения послеродового периода при рассеянном склерозе (обзор литературы)
Купина А.Д., Петров Ю.А. Прегравидарная подготовка, беременность и роды, особенности течения послеродового периода при рассеянном склерозе (обзор литературы). Гинекология. 2020; 22 (2): e. 30.
DOI: 10.26442/20795696.2020.2.190711
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Kupina A.D., Petrov U.A. Pregravid preparation, pregnancy and childbirth, especially the course of the postpartum period in patients with multiple sclerosis (literature review). Gynecology. 2020; 22 (2): e. 30.
DOI: 10.26442/20795696.2020.2.190711
Прегравидарная подготовка, беременность и роды, особенности течения послеродового периода при рассеянном склерозе (обзор литературы)
Купина А.Д., Петров Ю.А. Прегравидарная подготовка, беременность и роды, особенности течения послеродового периода при рассеянном склерозе (обзор литературы). Гинекология. 2020; 22 (2): e. 30.
DOI: 10.26442/20795696.2020.2.190711
________________________________________________
Kupina A.D., Petrov U.A. Pregravid preparation, pregnancy and childbirth, especially the course of the postpartum period in patients with multiple sclerosis (literature review). Gynecology. 2020; 22 (2): e. 30.
DOI: 10.26442/20795696.2020.2.190711
Рассеянный склероз (РС) является хроническим аутоиммунным заболеванием, характеризующимся образованием очагов поражения в белом веществе мозга в результате аутоиммунного воспаления, нейродегенерации и демиелинизации и приводящим к тяжелой инвалидизации пациентов. Женщины болеют чаще, чем мужчины, около 2/3 всех пациентов с РС составляют молодые женщины репродуктивного возраста. Установлено, что беременность и роды при РС оказывают благоприятное воздействие на течение заболевания, однако пациенткам с РС необходима прегравидарная подготовка, которая позволит снизить риск развития обострений. Экзацербации наблюдаются в большинстве случаев в течение первых 3–6 мес послеродового периода, что связано с изменением гормонального статуса, эмоциональной и физической нагрузкой на организм женщины, а также с прекращением физиологической иммуносупрессии у беременной. Проведен анализ современных источников литературы, посвященных вопросам прегравидарной подготовки, беременности и родов, особенностей течения послеродового периода при рассеянном склерозе, а также новым представлениям об этиологии и патогенезе заболевания. Проанализировано 47 источников литературы (отечественных и зарубежных) с использованием различных баз данных (PubMed, PubMed Central, Google Scholar, UpToDate). Ключевые слова: аутоиммунное воспаление, прегравидарная подготовка, послеродовой период, экзацербация.
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Multiple sclerosis (MS) is a chronic autoimmune disease characterized by the formation of lesions in the white matter as a result of autoimmune inflammation, neurodegeneration and demyelination and leading to severe disability of patients. Women get sick more often than men; young women of reproductive age account for about 2/3 of all MS patients. It was established that pregnancy and childbirth with MS have a beneficial effect on the course of the disease, however, patients with MS need pregravid preparation, which will reduce the risk of exacerbations. Exacerbations are observed in most cases during the first 3–6 months of the postpartum period, which is associated with a change in hormonal status, emotional and physical stress on the woman's body, and also with the cessation of physiological immunosuppression in a pregnant woman. The analysis of modern literature sources on the issues of pregravid preparation, pregnancy and childbirth, and the features of postpartum period in multiple sclerosis, as well as new ideas concerning the disease etiology and pathogenesis. 47 literature sources (national and foreign) were analyzed using various databases (PubMed, PubMed Central, Google Scholar, UpToDate). Key words: autoimmune inflammation, pregravid preparation, postpartum period, exacerbation.
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7. Gelfand JM. Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation. Handbook Clin Neurol 2014; 122: 269–90. https://doi.org/10.1016/B978-0-444-52001-2.00011-X
8. Mullin AP, Cui Ch,Wang Yu et al. rHIgM22 enhances remyelination in the brain of the cuprizone mouse model of demyelination. Neurobiol Dis 2017; 105: 142–55. https://doi.org/10.1016/j.nbd.2017.05.015
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17. O'Gorman C, Bukhari W, Todd A et al. Smoking increases the risk of multiple sclerosis in Queensland, Australia. J Clin Neurosci 2014; 21 (10): 1730–3. https://doi.org/10.1016/j.jocn.2014.01.009
18. Wang Z, Sadovnick AD, Traboulsee AL et al. Nuclear Receptor NR1H3 in Familial Multiple Sclerosis. Neuron 2016; 92 (2): 555. https://doi.org/10.1016/j.neuron.2016.09.028
19. Ghasemi N, Razavi Sh, Nikzad E. Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy. Cell Journal 2017; 19 (1): 1–10. https://doi.org/10.22074/cellj.2016.4867
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21. Bäärnhielm M, Olsson T, Alfredsson L. Fatty fish intake is associated with decreased occurrence of multiple sclerosis. Multiple Sclerosis J 2014; 20 (6): 726–32. https://doi.org/10.1177/1352458513509508
22. Bilbaoa MM, Durána SB, Llonaa JB, Rodriguez-Antigüedad A. Multiple sclerosis: pregnancy and women's health issues. Neurologia 2019; 34 (4): 259–69. https://doi.org/10.1016/j.nrleng.2016.06.014
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[Yakushina T.I., Kotov S.V., Yakushin M.A. Analysis of the course of pregnancy, delivery and postpartum period in women with multiple sclerosis. Al'manakh klinicheskoi meditsiny. 2015; 39: 82–8. https://doi.org/10.18786/2072-0505-2015-39-82-89 (in Russian).]
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1. Parfenov V.A., Yakhno N.N., Evzikov G.Yu. Nervous Diseases. A Textbook. Moscow: Meditsinskoe informatsionnoe agentstvo, 2018 (in Russian).
2. Morozova S.N., Bryukhov V.V., Trifonova O.V. et al. A DTI study of the spinal cord lesion in patients with multiple sclerosis during the follow-up after relapse. Zhurn. nevrologii i psikhiatrii im. S.S. Korsakova. Spetsvypuski. 2016; 116 (2): 21–6. https://doi.org/10.17116/jnevro20161162221-26 (in Russian).
3. Prozherina Yu. Multiple sclerosis: history, diagnosis, treatment. Remedium. 2016; 8 (7): 21–5 (in Russian).
4. Kumar V, Abbas A, Fausto N, Aster J. Robbins and Cotran Pathologic Basis of Disease. Saunders Elsevier Publ 2014; p. 1473–5.
5. Malik O, Donnelly A, Barnett М. Fast Facts Multiple Sclerosis. Health Press Ltd Publ. 2014; 136.
6. Fourcade J, Sun Z, Kudela P et al. Human tumor antigen-specific helper and regulatory T-cells share common epitope specificity but exhibit distinct T-cell repertoire. J Immunology 2010; 184 (12): 6709–18. https://doi.org/ 10.4049/jimmunol.0903612
7. Gelfand JM. Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation. Handbook Clin Neurol 2014; 122: 269–90. https://doi.org/10.1016/B978-0-444-52001-2.00011-X
8. Mullin AP, Cui Ch,Wang Yu et al. rHIgM22 enhances remyelination in the brain of the cuprizone mouse model of demyelination. Neurobiol Dis 2017; 105: 142–55. https://doi.org/10.1016/j.nbd.2017.05.015
9. Plemel JR, Liu WQ, Yong WV. Remyelination therapies: a new direction and challenge in multiple sclerosis. Nature Reviews Drug Discovery 2017; 16: 617–34. https://doi.org/10.1038/nrd.2017.115
10. Gubarev Yu.D., Yatsenko E.A., Chefranova Zh.Yu. Clinical efficiency of Azilekt in the therapy of primary progressing multiple sclerosis. Nauchnyi rezul'tat. 2015; 1 (4): 5–12. https://doi.org/10.18413/2313-8955-2015-1-4-5-12 (in Russian).
11. Alamouti MA, Bakhtiyari M, Moradi F et al. Remyelination of the corpus callosum by olfactory ensheathing cell in an experimental model of multiple sclerosis. Acta Medica Iranica 2015; 53 (9): 533–9.
12. Atlas of multiple sclerosis 2013. http://www.msif.org/wp-content/uploads/2014/09/Atlas-of-MS.pdf
13. Baranov A.A., Namazova-Baranova L.S. Atlas of rare diseases. FSBI "Scientific Center for Children's Health" RAMS. Moscow: Pediatr"", 2013; p. 304 (in Russian).
14. Langer-Gould A, Brara SM, Beaber BE, Koebnick C. Childhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndrome. Neurology 2013; 80 (6): 548–52. https://doi.org/10.1212/WNL.0b013e3182a7af5f
15. Chzhu M.B. Multiple Sclerosis Comorbidity. Molodoi uchenyi. 2018; 44: 225–7 (in Russian).
16. Shirinskii V.S., Shirinskii I.V. Comorbid diseases as an important problem of clinical medicine. Sib. med. zhurn. 2014; 29 (1): 7–12. https://doi.org/10.29001/2073-8552-2014-29-1-7-12 (in Russian).
17. O'Gorman C, Bukhari W, Todd A et al. Smoking increases the risk of multiple sclerosis in Queensland, Australia. J Clin Neurosci 2014; 21 (10): 1730–3. https://doi.org/10.1016/j.jocn.2014.01.009
18. Wang Z, Sadovnick AD, Traboulsee AL et al. Nuclear Receptor NR1H3 in Familial Multiple Sclerosis. Neuron 2016; 92 (2): 555. https://doi.org/10.1016/j.neuron.2016.09.028
19. Ghasemi N, Razavi Sh, Nikzad E. Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy. Cell Journal 2017; 19 (1): 1–10. https://doi.org/10.22074/cellj.2016.4867
20. Korobko D.S., Malkova N.A., Sokolova E.A., Filipenko M.L. Phenotype and genotype of familial multiple sclerosis1cbgh. Meditsina i obrazovanie v Sibiri. 2012; 6 (in Russian).
21. Bäärnhielm M, Olsson T, Alfredsson L. Fatty fish intake is associated with decreased occurrence of multiple sclerosis. Multiple Sclerosis J 2014; 20 (6): 726–32. https://doi.org/10.1177/1352458513509508
22. Bilbaoa MM, Durána SB, Llonaa JB, Rodriguez-Antigüedad A. Multiple sclerosis: pregnancy and women's health issues. Neurologia 2019; 34 (4): 259–69. https://doi.org/10.1016/j.nrleng.2016.06.014
23. Sharova I.V., Kutashov V.A. Multiple sclerosis, pregnancy and childbirth. Medicine: today's challenges: proceedings of the III International Scientific Conference. Moscow: Buki-Vedi, 2016; p. 57–60 (in Russian).
24. Tikhonovskaya O.A., Kochetkova A.Yu., Alifirova V.M. The features of reproductive health in women with multiple sclerosis. Acta Biomedica Scientifica. 2017; 2 (5): 26–31 (in Russian).
25. McCombe PA. The Short and Long-Term Effects of Pregnancy on Multiple Sclerosis and Experimental Autoimmune Encephalomyelitis. J Clin Med 2018; 7 (12): 494. https://doi.org/10.3390/jcm7120494
26. Yakushina T.I., Kotov S.V., Yakushin M.A. Analysis of the course of pregnancy, delivery and postpartum period in women with multiple sclerosis. Al'manakh klinicheskoi meditsiny. 2015; 39: 82–8. https://doi.org/10.18786/2072-0505-2015-39-82-89 (in Russian).
27. Shmidt T.E. Early diagnosis of multiple sclerosis. Rus. med. zhurn. Nevrologiya. 2010; 18 (5): 224 (in Russian).
28. Karnaukh V.N., Barabash I.A. Is pregnancy a risk factor of multiple sclerosis? Its influence on the prognosis of the disease. Dal'nevostochnyi med. zhurn. 2010; 1: 131–4 (in Russian).
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Авторы
А.Д. Купина, Ю.А. Петров*
ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава России, Ростов-на-Дону, Россия
*mr.doktorpetrov@mail.ru