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Место ферментозаместительной терапии при экзокринной и нутритивной недостаточности у пациентов с онкологическими заболеваниями
Место ферментозаместительной терапии при экзокринной и нутритивной недостаточности у пациентов с онкологическими заболеваниями
Хатьков И.Е., Маев И.В., Бордин Д.С., Кононенко И.Б., Кучерявый Ю.А., Покатаев И.А., Снеговой А.В., Трякин А.А., Феоктистова П.С., Жукова Л.Г. Место ферментозаместительной терапии при экзокринной и нутритивной недостаточности у пациентов с онкологическими заболеваниями. Современная Онкология. 2024;26(3):380–389. DOI: 10.26442/18151434.2024.3.203007
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
DOI: 10.26442/18151434.2024.3.203007
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
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DOI: 10.26442/18151434.2024.3.203007
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Аннотация
Экзокринную недостаточность поджелудочной железы (ЭНПЖ) определяют как состояние, при котором количества секретируемых панкреатических ферментов недостаточно для поддержания нормального пищеварения. ЭНПЖ является частым осложнением как злокачественных новообразований поджелудочной железы, так и злокачественных опухолей любой локализации. Заподозрить ЭНПЖ у онкологического пациента можно при наличии симптомов мальдигестии, мальабсорбции и изменении нутритивных маркеров, однако важно отметить, что симптоматика ЭНПЖ может быть стерта. На ранних стадиях ЭНПЖ может быть латентной и проявляться мальнутрицией, но даже на более поздних стадиях симптомы ЭНПЖ могут быть схожи с симптомами онкологических заболеваний или маскироваться состоянием после прохождения химиолучевой терапии. Противоопухолевая терапия сама по себе может также приводить к ЭНПЖ. Стандартом лечения при ЭНПЖ является ферментозаместительная терапия (ФЗТ), однако онкологическим больным ее назначают нечасто. В то же время сопроводительная терапия должна занимать важное место в лечении онкологических больных, потому что качество и продолжительность жизни пациентов во многом зависят от адекватности проводимого комплексного лечения. В обзоре обсуждаются возможные причины ЭНПЖ, ее диагностика и лечение у онкологических пациентов. Отдельное внимание уделяется режимам ФЗТ, в том числе для улучшения пищеварения, и лекарственной форме препарата. Показано, что в качестве препарата выбора для ФЗТ выступает панкреатин в минимикросферах, в связи с тем что минимальный размер частиц обеспечивает наиболее физиологичный процесс пищеварения.
Ключевые слова: ферментозаместительная терапия, экзокринная недостаточность поджелудочной железы, нутритивная недостаточность, онкологические заболевания, сопроводительная терапия онкологических больных, панкреатин в минимикросферах
Keywords: enzyme replacement therapy, pancreatic exocrine insufficiency, nutritional insufficiency, oncological diseases, supporting therapy for oncological patients, pancreatin in minimicrospheres
Ключевые слова: ферментозаместительная терапия, экзокринная недостаточность поджелудочной железы, нутритивная недостаточность, онкологические заболевания, сопроводительная терапия онкологических больных, панкреатин в минимикросферах
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Keywords: enzyme replacement therapy, pancreatic exocrine insufficiency, nutritional insufficiency, oncological diseases, supporting therapy for oncological patients, pancreatin in minimicrospheres
Полный текст
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Авторы
И.Е. Хатьков1,2, И.В. Маев2, Д.С. Бордин*1–3, И.Б. Кононенко4, Ю.А. Кучерявый5, И.А. Покатаев6, А.В. Снеговой2,4, А.А. Трякин7, П.С. Феоктистова1,8, Л.Г. Жукова1
1ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
2ФГБОУ ВО «Российский университет медицины», Москва, Россия;
3ФГБОУ ВО «Тверской государственный медицинский университет» Минздрава России, Тверь, Россия;
4Научно-исследовательский институт урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России, Москва, Россия;
5АО «Ильинская больница», Красногорск, Россия;
6ГБУЗ «Городская клиническая больница им. С.С. Юдина» Департамента здравоохранения г. Москвы, Москва, Россия;
7ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия;
8ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ, Москва, Россия
*dbordin@mail.ru
1Loginov Moscow Clinical Scientific Center, Moscow, Russia;
2Russian University of Medicine, Moscow, Russia;
3Tver State Medical University, Tver, Russia;
4Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of National Medical Research Radiological Centre, Moscow, Russia;
5Ilyinskaya Hospital, Krasnogorsk, Russia;
6Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department, Moscow, Russia;
7Blokhin National Medical Research Center of Oncology, Moscow, Russia;
8Central State Medical Academy of the President of the Russian Federation, Moscow, Russia
*dbordin@mail.ru
1ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
2ФГБОУ ВО «Российский университет медицины», Москва, Россия;
3ФГБОУ ВО «Тверской государственный медицинский университет» Минздрава России, Тверь, Россия;
4Научно-исследовательский институт урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России, Москва, Россия;
5АО «Ильинская больница», Красногорск, Россия;
6ГБУЗ «Городская клиническая больница им. С.С. Юдина» Департамента здравоохранения г. Москвы, Москва, Россия;
7ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия;
8ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ, Москва, Россия
*dbordin@mail.ru
________________________________________________
1Loginov Moscow Clinical Scientific Center, Moscow, Russia;
2Russian University of Medicine, Moscow, Russia;
3Tver State Medical University, Tver, Russia;
4Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of National Medical Research Radiological Centre, Moscow, Russia;
5Ilyinskaya Hospital, Krasnogorsk, Russia;
6Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department, Moscow, Russia;
7Blokhin National Medical Research Center of Oncology, Moscow, Russia;
8Central State Medical Academy of the President of the Russian Federation, Moscow, Russia
*dbordin@mail.ru
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