mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical University10.21886/2219-8075-2019-10-3-72-82mvjr-895Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПаранеопластические нейромышечные синдромы на амбулаторно-поликлиническом уровне.Paraneoplastic neuromuscular syndromes at the outpatient levelhttps://orcid.org/0000-0001-5498-2415ЧертоусоваА. Е.ChertousovaA. E.

Чертоусова Анастасия Евгеньевна - врач-невролог.

Ростов-на-Дону

Rostov-on-Don

yanasata@yandex.ruЧерниковаИ. В.ChernikovaI. V.

Черникова Ирина Владимировна - к.м.н., доцент, заведующая кафедрой неврологии и нейрохирургии с курсами мануальной терапии и рефлексотерапии ФПК и ППС.

Rostov-on-Don

Chernikowa2015@yandex.ruОбластной консультативно-диагностический центрРоссияRostov Regional Advisory and Diagnostic CentreRussian FederationРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian Federation2019111020191037282Copyright © Чертоусова А.Е., Черникова И.В., 20192019Чертоусова А.Е., Черникова И.В.Chertousova A.E., Chernikova I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medicalherald.ru/jour/article/view/895Цель исследования

Цель исследования: разработать тактику дифференциальной диагностики паранеопластических нейромышечных синдромов у пациентов на амбулаторно-поликлиническом уровне.

Материалы и методы

Материалы и методы: выборочным методом в исследование включены 25 пациентов с классическими нейромышечными паранеопластическими синдромами (опытная группа) и 25 пациентов  с нейромышечными синдромами непаранеопластической природы (контрольная группа). Всем пациентам проведено комплексное лабораторно-инструментальное обследование в государственном автономном учреждении Ростовской области «Областной консультативно-диагностический центр» Минздрава  Ростовской области с 2014 по 2018 гг.

Результаты

Результаты: Выполнена оценка клинических различий у пациентов опытной и контрольной групп. При сравнении лабораторных  показателей  выявлено, что  уровни РФМК, D-димер, CRP-2 значимо повышаются у пациентов с паранеопластическими поражениями (p<0,05). В опытной группе отмечено значимое увеличение амплитуды  М-ответа от сенсорных нервов  (>5,25 мВ). На основании анализа полученных данных разработаны алгоритмы дифференциальной диагностики для пациентов с изучаемыми нейромышечными поражениями на амбулаторно-поликлиническом уровне.

Выводы

Выводы: проведенное исследование позволяет внедрить алгоритмы несерологической диагностики классических нейромышечных паранеопластических синдромов в амбулаторной практике.

Objective

Objective: to develop tactics for the differential diagnosis of paraneoplastic neuromuscular syndromes in patients at the outpatient level.

Materials and methods

Materials and methods: the study included 50 patients with classical neuromuscular paraneoplastic syndromes (experimental group) and 50 patients with neuromuscular syndromes of non-paraneoplastic nature (control group). All patients underwent a comprehensive laboratory and instrumental examination at the Regional Consultative and Diagnostic Center of the Ministry of Health of the Rostov Region from 2014 to 2018.

Results

Results: the evaluation of clinical differences in patients of the experimental and control groups was created. When comparing the laboratory parameters, it was revealed that the SFMC, D-dimer, CRP-2 levels significantly increased in patients with paraneoplastic lesions (p <0.05). In the experimental group, a significant increase in the amplitude of the M-response from the sensory nerves (> 5.25 mV) was noted. Based on obtained data, differential diagnosis algorithms for patients with studied neuromuscular lesions at the outpatient level have been developed.

Conclusions

Conclusions: the conducted study allows the implementation of non-serological diagnostics algorithms for classical neuromuscular paraneoplastic syndromes in outpatient practice.

паранеопластические нейромышечные синдромызлокачественные опухолиполинейропатиямиастенический синдромдерматомиозитparaneoplastic neuromuscular syndromesmalignant tumorspolyneuropathymyasthenic syndromedermatomyositisReferencesDarnell R.B., Posner J.B. eds. Paraneoplastic syndromes. New York: Oxford University Press, 2011; 7–17.Darnell R.B., Posner J.B. eds. Paraneoplastic syndromes. New York: Oxford University Press, 2011; 7–17.Yu H, Fu R, Wang H, Liu H & Shao Z Paraneoplastic Evans syndrome in a patient with adenocarcinoma of the lung: A case report. Thoracic cancer. 2017; 8: 57-60. doi: 10.1111/1759-7714.12398Yu H, Fu R, Wang H, Liu H & Shao Z Paraneoplastic Evans syndrome in a patient with adenocarcinoma of the lung: A case report. Thoracic cancer. 2017; 8: 57-60. doi: 10.1111/1759-7714.12398Pelosof L.C., Gerber D.E. Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clin Proc. 2010; 85(9): 838-854.Pelosof L.C., Gerber D.E. Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clin Proc. 2010; 85(9): 838-854.doi: 10.4065/mcp.2010.0099.doi: 10.4065/mcp.2010.0099.Vedeler CA et al. Management of paraneoplastic neurological syndromes: report of an EFNS Task Force. Eur J Neurol. 2006 Jul;13(7):682-90. doi: 10.1111/j.1468-1331.2006.01266.xVedeler CA et al. Management of paraneoplastic neurological syndromes: report of an EFNS Task Force. Eur J Neurol. 2006 Jul;13(7):682-90. doi: 10.1111/j.1468-1331.2006.01266.xKuntzer T., Antoine J.C., A. Steck J. Clinical features and pathophysiological basis of sensory neuronopathies (ganglionopathies). Muscle Nerve. 2004 Sep; 30(3): 255–268.Kuntzer T., Antoine J.C., A. Steck J. Clinical features and pathophysiological basis of sensory neuronopathies (ganglionopathies). Muscle Nerve. 2004 Sep; 30(3): 255–268.doi: 10.1002/mus.20100doi: 10.1002/mus.20100Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic neuropathy: mechanisms to management. Pharmacol Ther 2008; 120: 1– 34. doi: 10.1016/j.pharmthera.2008.05.005Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic neuropathy: mechanisms to management. Pharmacol Ther 2008; 120: 1– 34. doi: 10.1016/j.pharmthera.2008.05.005Boulton AJ, Vinik AI, Arezzo JC et al. American Diabetes Association Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 2005; 28: 956–962.Boulton AJ, Vinik AI, Arezzo JC et al. American Diabetes Association Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 2005; 28: 956–962.Yasuda H, Terada M, Maeda K et al. Diabetic neuropathy and nerve regeneration. Prog Neurobiol 2003; 69: 229–285.Yasuda H, Terada M, Maeda K et al. Diabetic neuropathy and nerve regeneration. Prog Neurobiol 2003; 69: 229–285.Duby JJ, Campbell RK, Setter SM, White JR, Rasmussen KA: Diabetic neuropathy: an intensive review. Am J Health Syst Pharm 2004; 61: 160–173. doi: 10.1093/ajhp/61.2.160Duby JJ, Campbell RK, Setter SM, White JR, Rasmussen KA: Diabetic neuropathy: an intensive review. Am J Health Syst Pharm 2004; 61: 160–173. doi: 10.1093/ajhp/61.2.160Wirtz PW, Smallegange TM, Wintzen AR, Verschuuren JJ. Differences in clinical features between the Lambert-Eaton myasthenic syndrome with and without cancer: an analysis of 227 published cases. Clin Neurol Neurosurg. 2002 Sep;104(4):359-63Wirtz PW, Smallegange TM, Wintzen AR, Verschuuren JJ. Differences in clinical features between the Lambert-Eaton myasthenic syndrome with and without cancer: an analysis of 227 published cases. Clin Neurol Neurosurg. 2002 Sep;104(4):359-63Sanders DB. Lambert-eaton myasthenic syndrome: diagnosis and treatment. Ann N Y Acad Sci. 2003 Sep;998:500-8.Sanders DB. Lambert-eaton myasthenic syndrome: diagnosis and treatment. Ann N Y Acad Sci. 2003 Sep;998:500-8.Burns TM, Russell JA, LaChance DH, Jones HR. Oculobulbar involvement is typical with Lambert-Eaton myasthenic syndrome.Ann Neurol. 2003 Feb;53(2):270-3. doi: 10.1002/ana.10477Burns TM, Russell JA, LaChance DH, Jones HR. Oculobulbar involvement is typical with Lambert-Eaton myasthenic syndrome.Ann Neurol. 2003 Feb;53(2):270-3. doi: 10.1002/ana.10477Toyka KV, Schneider-Gold C. Oculomotor signs in Lambert-Eaton myasthenic syndrome-coincidence with myasthenia gravis. Ann Neurol. 2003 Jul;54(1):135-6; author reply 136-7. doi: 10.1002/ana.10640Toyka KV, Schneider-Gold C. Oculomotor signs in Lambert-Eaton myasthenic syndrome-coincidence with myasthenia gravis. Ann Neurol. 2003 Jul;54(1):135-6; author reply 136-7. doi: 10.1002/ana.10640Titulaer MJ, Wirtz PW, Willems LN, van Kralingen KW, Smitt PA, Verschuuren JJ. Screening for small-cell lung cancer: a follow-up study of patients with Lambert-Eaton myasthenic syndrome. J Clin Oncol. 2008 Sep 10;26(26):4276-81. doi: 10.1200/JCO.2008.17.5133.Titulaer MJ, Wirtz PW, Willems LN, van Kralingen KW, Smitt PA, Verschuuren JJ. Screening for small-cell lung cancer: a follow-up study of patients with Lambert-Eaton myasthenic syndrome. J Clin Oncol. 2008 Sep 10;26(26):4276-81. doi: 10.1200/JCO.2008.17.5133.Smith AG, Wald J. Acute ventilatory failure in Lambert-Eaton myasthenic syndrome and its response to 3,4-diaminopyridine. Neurology. 1996 Apr;46(4):1143-5.Smith AG, Wald J. Acute ventilatory failure in Lambert-Eaton myasthenic syndrome and its response to 3,4-diaminopyridine. Neurology. 1996 Apr;46(4):1143-5.Tseng A, Claussen GC, Oh SJ. Respiratory failure in lambert-eaton myasthenic syndrome precipitated by calcium-channel blockers: report of a case and literature review. J Clin Neuromuscul Dis. 2002 Dec;4(2):60-3.Tseng A, Claussen GC, Oh SJ. Respiratory failure in lambert-eaton myasthenic syndrome precipitated by calcium-channel blockers: report of a case and literature review. J Clin Neuromuscul Dis. 2002 Dec;4(2):60-3.Komurcuoglu B, Ulusoy S, Gayaf M, Guler A, Ozden E. Prognostic value of plasma D-dimer levels in lung carcinoma. Tumori 2011;97:743-748. doi: 10.1700/1018.11091.Komurcuoglu B, Ulusoy S, Gayaf M, Guler A, Ozden E. Prognostic value of plasma D-dimer levels in lung carcinoma. Tumori 2011;97:743-748. doi: 10.1700/1018.11091.Wang Y, Wang Z. Predictive value of plasma D-dimer levels in patients with advanced non-small-cell lung cancer. Onco Targets Ther 2015;8:805-808. doi: 10.2147/OTT.S78154Wang Y, Wang Z. Predictive value of plasma D-dimer levels in patients with advanced non-small-cell lung cancer. Onco Targets Ther 2015;8:805-808. doi: 10.2147/OTT.S78154Fukumoto K, Taniguchi T, Usami N et al. Preoperative plasma D-dimer level is an independent prognostic factor in patients with completely resected non-small cell lung cancer. Surg Today 2015;45:63-67. doi: 10.1007/s00595-014-0894-4Fukumoto K, Taniguchi T, Usami N et al. Preoperative plasma D-dimer level is an independent prognostic factor in patients with completely resected non-small cell lung cancer. Surg Today 2015;45:63-67. doi: 10.1007/s00595-014-0894-4Nakashima J, Tachibana M, Ueno M, Baba S, Tazaki H: Tumor necrosis factor and coagulopathy in patients with prostate cancer. Cancer Res 1995;55:4881-4885.Nakashima J, Tachibana M, Ueno M, Baba S, Tazaki H: Tumor necrosis factor and coagulopathy in patients with prostate cancer. Cancer Res 1995;55:4881-4885.Okajima K, Kohno I, Tsuruta J, Okabe H, Takatsuki K, Binder BR. Direct evidence for systemic fibrinogenolysis in a patient with metastatic prostatic cancer. Thromb Res 1992;66:717-727.Okajima K, Kohno I, Tsuruta J, Okabe H, Takatsuki K, Binder BR. Direct evidence for systemic fibrinogenolysis in a patient with metastatic prostatic cancer. Thromb Res 1992;66:717-727.Ferroni P, Roselli M, Portarena I et al. Plasma plasminogen activator inhibitor-1 (PAI-1) levels in breast cancer - relationship with clinical outcome. Anticancer Res 2014;34:1153-1161.Ferroni P, Roselli M, Portarena I et al. Plasma plasminogen activator inhibitor-1 (PAI-1) levels in breast cancer - relationship with clinical outcome. Anticancer Res 2014;34:1153-1161.Stender MT, Larsen TB, Sorensen HT, Thorlacius-Ussing O. Preoperative plasma D-dimer predicts 1-year survival in colorectal cancer patients with absence of venous thromboembolism (VTE): a prospective clinical cohort study. J Thromb Haemost 2012;10:2027-2031. doi: 10.1111/j.1538-7836.2012.04887.x.Stender MT, Larsen TB, Sorensen HT, Thorlacius-Ussing O. Preoperative plasma D-dimer predicts 1-year survival in colorectal cancer patients with absence of venous thromboembolism (VTE): a prospective clinical cohort study. J Thromb Haemost 2012;10:2027-2031. doi: 10.1111/j.1538-7836.2012.04887.x.W. Li, Y. Tang, Y. Song et al. Prognostic Role of Pretreatment Plasma D-Dimer in Patients with Solid Tumors: a Systematic Review and Meta-Analysis. Cell Physiol Biochem 2018;45:1663-1676 doi: 10.1159/000487734.W. Li, Y. Tang, Y. Song et al. Prognostic Role of Pretreatment Plasma D-Dimer in Patients with Solid Tumors: a Systematic Review and Meta-Analysis. Cell Physiol Biochem 2018;45:1663-1676 doi: 10.1159/000487734.Dempfle CE. The use of soluble fibrin in evaluating the acute and chronic hypercoagulable state. Thromb Haemost. 1999 Aug;82(2):673-83.Dempfle CE. The use of soluble fibrin in evaluating the acute and chronic hypercoagulable state. Thromb Haemost. 1999 Aug;82(2):673-83.Koga S. A novel molecular marker for thrombus formation and life prognosis--clinical usefulness of measurement of soluble fibrin monomer-fibrinogen complex (SF). Rinsho Byori. 2004 Apr; 52(4):355-61.Koga S. A novel molecular marker for thrombus formation and life prognosis--clinical usefulness of measurement of soluble fibrin monomer-fibrinogen complex (SF). Rinsho Byori. 2004 Apr; 52(4):355-61.Leko M. Soluble fibrin monomer degradation products as a potential useful marker for hypercoagulable states with accelerated fibrinolysis. Clinica Chimica Acta 2007;386:38Leko M. Soluble fibrin monomer degradation products as a potential useful marker for hypercoagulable states with accelerated fibrinolysis. Clinica Chimica Acta 2007;386:38doi: 10.1016/j.cca.2007.07.023doi: 10.1016/j.cca.2007.07.023K-J Park, E-H Kwon, H-J Kim, and S-H Kim. Evaluation of the Diagnostic Performance of Fibrin Monomer in Disseminated Intravascular Coagulation. Korean J Lab Med 2011;31:143-147K-J Park, E-H Kwon, H-J Kim, and S-H Kim. Evaluation of the Diagnostic Performance of Fibrin Monomer in Disseminated Intravascular Coagulation. Korean J Lab Med 2011;31:143-147doi: 10.3343/kjlm.2011.31.3.143doi: 10.3343/kjlm.2011.31.3.143

The authors declare that there are no conflicts of interest present.