The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press33610.17650/1818-8338-2018-12-1-17-24REVIEWОБЗОРINFECTIVE ENDOCARDITIS AND MALIGNANT NEOPLASMS: FACTS AND HYPOTHESESИНФЕКЦИОННЫЙ ЭНДОКАРДИТ И ЗЛОКАЧЕСТВЕННЫЕ НОВООБРАЗОВАНИЯ: ФАКТЫ И ГИПОТЕЗЫhttps://orcid.org/0000-0002-2083-0437ChipiginaN. S.ЧипигинаН. С.
Russian Federation

1 Ostrovityanova St., Moscow 117997

Наталия Семеновна Чипигина

117997 Москва, ул. Островитянова, 1

chipigina-natalia56@yandex.ruhttps://orcid.org/0000-0001-7841-8966KarpovaN. Yu.КарповаН. Ю.
Russian Federation

1 Ostrovityanova St., Moscow 117997

117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0003-0592-3181BarsegyanV. А.БарсегянВ. А.
Russian Federation

1 Ostrovityanova St., Moscow 117997

117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0002-3805-5942TimofeevV. Т.ТимофеевВ. Т.
Russian Federation

1 Ostrovityanova St., Moscow 117997

117997 Москва, ул. Островитянова, 1

N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russian FederationФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава России1501201812117241707201817072018Copyright ©; 2018, Chipigina N.S., Karpova N.Y., Barsegyan V.А., Timofeev V.Т.Copyright ©; 2018, Чипигина Н.С., Карпова Н.Ю., Барсегян В.А., Тимофеев В.Т.2018Chipigina N.S., Karpova N.Y., Barsegyan V.А., Timofeev V.Т.Чипигина Н.С., Карпова Н.Ю., Барсегян В.А., Тимофеев В.Т.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/336

The problem of the association of infective endocarditis (IE) and oncological diseases has been discussed for more than 60 years, and is now becoming increasingly relevant because of observed increasing of number IE in elderly patients. The review of the literature presents both data on the incidence of oncological diseases diagnosed with IE and in the long-term follow-up of patients after IE, as well as current estimates of IE incidence in cancer patients, obtained in large population-based studies. The highest risk of IE development was found in patients with tumors of the colon and rectum, and the predominant etiological role of Streptococcus bovis/gallolyticus was proved in such cases. The frequency of concomitant oncological diseases is higher in elderly patients with IE. On the other hand, it is obvious that IE can be considered as a marker of latent oncological pathology, especially gastrointestinal tumors, malignant blood diseases and lymphoproliferative diseases that are most often detected during the period of active IE and in the first 1–2 years later. Therefore, mandatory colonoscopy is recommended for patients with IE caused by Streptococcus bovis/gallolyticus during the period of IE and annually in subsequent years, even if initially the colonoscopy did not reveal pathology. In elderly IE patients we should also be aware of the high likelihood of concomitant oncological pathology and carry out appropriate oncological search. Antimicrobial prophylaxis of IE in patients with gastrointestinal cancer remains unresolved.

Проблема ассоциации инфекционного эндокардита (ИЭ) и онкологических заболеваний обсуждается более 60 лет и в настоящее время становится все более актуальной в связи с наблюдаемым увеличением числа больных ИЭ пожилого возраста. В обзоре литературы представлены как данные о частоте онкологических заболеваний, диагностируемых при ИЭ и при отдаленном наблюдении больных, перенесших ИЭ, так и современные оценки частоты возникновения ИЭ у онкологических больных, полученные в крупных популяционных исследованиях. Наиболее высокий риск развития ИЭ наблюдается у больных с опухолями толстой и прямой кишки, в таких случаях доказана преимущественная этиологическая роль Streptococcus bovis/gallolyticus. Частота сопутствующих онкологических заболеваний выше у больных ИЭ в пожилом возрасте. С другой стороны, очевидно, что ИЭ может рассматриваться в качестве маркера скрытой онкологической патологии, особенно опухолей желудочно-кишечного тракта, злокачественных заболеваний крови и лимфопролиферативных заболеваний, которые наиболее часто выявляются в период заболевания ИЭ и в течение первых 1–2 лет. Поэтому рекомендуется обязательное проведение колоноскопии у больных ИЭ, вызванным Streptococcus bovis/gallolyticus, в период заболевания ИЭ и ежегодно в последующие годы, даже если первоначально колоноскопия не выявила патологии. У пожилых больных ИЭ также следует иметь в виду высокую вероятность сопутствующей онкологической патологии и проводить соответствующий онкопоиск. Вопрос об антимикробной профилактике ИЭ у больных раком желудочно-кишечного тракта остается нерешенным.

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