Структура патологии желудочно-кишечного тракта больных, получающих лечение программным гемодиализом

ВВЕДЕНИЕ. Для пациентов, получающих лечение программным гемодиализом, характерен широкий спектр сопутствующих заболеваний, включая кардиоваскулярные, минерально-костные, нутриционные, когнитивные, различные метаболические нарушения и анемию. Между тем, патология желудочно-кишечного тракта (ЖКТ) у этой категории больных остается в значительной степени неисследованной.

ЦЕЛЬ: изучить структуру патологии ЖКТ у больных, получающих лечение программным гемодиализом.

ПАЦИЕНТЫ И МЕТОДЫ. У 180 гемодиализных больных (102 мужчины, медиана возраста 60[47;68] лет) с помощью опросника GSQ (Gastrointestinal Symptoms Questionnaire) оценены распространенность и степень выраженности гастроинтестинальных симптомов (ГИС), частота и консистенция стула за последний месяц. Также проанализированы результаты ультразвукового исследования (УЗИ), фиброгастродуоденоскопии (ФГДС), комплексного лабораторного обследования.

РЕЗУЛЬТАТЫ. Общая распространенность ГИС составила 77,2 % (139/180). Наиболее частыми жалобами были запоры и боли в животе, которые отметили, соответственно, 65(46,8 %) и 57(41 %) больных. Наиболее распространенным вариантом частоты стула было одно опорожнение кишечника в день. Чаще всего выявляли третий, четвертый и пятый типы консистенции стула по Бристольской шкале формы кала. При УЗИ органов брюшной полости у 115(63,9 %) больных обнаружены диффузные изменения печени, у 7(3,9 %) – признаки цирроза. Изменения желчного пузыря при УЗИ были представлены аномалиями его формы в 11,1 %, признаками хронического холецистита – в 10 %, конкрементами (сладжем) – в 7,2 %, полипами – в 2,2 % случаев. Диффузные изменения поджелудочной железы, ее стеатоз, псевдокисты и дилатация главного панкреатического протока были диагностированы, соответственно, у 39(21,7 %), 21(11,7 %), 10(5,6 %) и 3(1,7 %) больных. По данным 154 гастроскопий наиболее частой эндоскопической находкой в желудке был хронический поверхностный гастрит, выявленный у 86(55,8 %) обследуемых. Эро зивный гастрит диагностирован у 22(14,3 %), язва желудка – у 3(2,0 %) пациентов. Эндоскопическая патология двенадцатиперстной кишки была представлена поверхностным дуоденитом у 53(34,4 %), эрозивным дуоденитом – у 15(9,7 %), язвой – у 2(1,3 %), рубцовой деформацией луковицы двенадцатиперстной кишки – у 23(14,9 %) пациентов. Сочетанное поражение желудка и двенадцатиперстной кишки встречалось у 88(57,1 %) больных. ФКС была выполнена 56 пациентам, из которых у 15(26,8 %) – отмечались признаки катарального колита (преимущественно сигмоидита), у 2(3,6 %) – выявлен дивертикулит, у 10(17,9 %) – дивертикулез, у 12(21,4 %) – полипы толстой кишки, у 8(14,3 %) – ангиодисплазия слизистой оболочки, у 3(5,4 %) – долихоколон. Несмотря на обилие жалоб и инструментальных находок, значимых отклонений в лабораторных показателях (в том числе, повышение АСТ, АЛТ, общего билирубина, амилазы, липазы) в изучаемой когорте пациентов установлено не было.

ЗАКЛЮЧЕНИЕ. Для гемодиализных больных характерна высокая распространенность ГИС и различных патологический изменений ЖКТ, диагностика и лечение которых требуют индивидуального мультидисциплинарного подхода.

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