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SCADEREA PONDERALA INVOLUNTARA (SPI) 3-5% dintre pacientii internati in er!

icii"e de #edicina interna Vander c$%eren & E%r ' Intern (ed )**5 pe te +** de pacienti in , "%ni %n -ert. cancer /aic% & E%r ' Intern (ed )**0De-initie SPI i#p1rtanta c"inic (care a nece ite in!e ti2atii eti1"12ice). 3 3 5%& in 3-0-4) "%niDe-initie Daca n% ti# #* 5 6 D1!e7i a"e #1di-icarii n%#ar%"%i "a i#8raca#inte 6 E ti#area caderii p1ndera"a de catre r%da9prieten 6 A8i"itatea de a -%rni7a 1 e ti#are n%#erica a caderii p1ndera"e :ernande7& A# ' (ed )**3 6 SPI. in pri#e"e trei (I /aic% & E%r ' Intern (ed )**0 S%prae ti#are a SP in a-ecti%ni"e p i$iatrice S%8e ti#are a SP in 81"i"e #a"i2ne Ra#81er& /(' 4,;5 < dintre pacienti n% "a8i era T$1# 1n& ' A# =eriatr S1c 4,,4 SPI >de 1ri2ine nec%n1 c%ta? 6 i1n12ra#a& $e#1"e%c12ra#a& %#ar %rina& R@ p%"#1nara Led%c& Re! (ed Interne 4,;; 6 $e#1"e%c12ra#a& 2"ice#ia& creatinina& Na& A& R@ p%"#1nara& R@ a8d1#ina"a pe 21" B "ip a c$eie dia2n1 tica care a 1riente7e pre %n 1r2an :ernande7& A# ' (ed )**3Ca%7e 3Ne1p"a7ii #a"i2ne 3/1"i in-"a#at1rii9in-ecti1a e cr1nice 3A-ecti%ni p i$iatrice A"te 81"i -rec!ente ca p1 i8i"a eti1"12ie. :ipertir1idia Dia8et%"Ca%7e C% apetit pa trat9cre c%t Dia8et 7a$arat nec1ntr1"at :ipertir1idie Ce1cr1#1cit1# Sindr1a#e de #a"a8 1rptie Pr18"e#e c% dentitia Ca%tare (EDLINE. 6 C%!inte c$eie (eS:. >Dei2$t "1 ?. +*E53) artic1"e

6 C"inica" F%erie . Eti1"12G& >Dei2$t "1 ? Dia2n1 i & >Dei2$t "1 ? 6 >in!1"%ntarG Dei2$t "1 ? . 43H 6 >%nintenti1na" Dei2$t "1 ? . 4+4 6 Ca%tarea re-erinte"1r "a t%dii"e 2a ite 34*E*** 3nere"e!anteSt%dii P%tineI (J CON) 4) t%dii ( erii de ca7%ri) 6 0 retr1 pecti!e& 0 pr1 pecti!e 6 ) in a#8%"at1ri%& re t%" in pita"e de in2riKire ) i 3 6 , t%dii L 4** pt E 6 SUA +M Spania )M =er#ania& /e"2ia& Cranta& I rae"& (e@ic& R1#aniaESt%di% (art1n 4,H; Ra8in1Dit7 4,H, :%erta 4,;5 T$1# 1n NS Le!ine NS LanNi $ 4,,0 :ernande7 4,,0 /aic% )**3 (eta"idi )**0 Tara US ISR (E US US DE ESP RO / Nr pacienti ,4 45+ 5* +5 4*H 45; )H0 +34 4*4 Cancer )* 30 4* 40 0 )+ 3; )+ )) =I n1n#a"i2ne 4+ 4H 40 44 0 4, 4* 3) 45 A"te 1r2anice n1n#a"i2ne 30 43 )) ), 3* 3* )5 )3 4, P i$iatrice , 4* +) )* )) 44 )3 4) 40 Ca%7a nec%n1 c%ta )0 )3 4* )+ 30 40 5 * ); (1rta"itate ("%ni %r#arire) )5 (4)) 3;

(3*) NS , ()+) 44 (45) 3) ())) NS NS 40 (0)A"21rit# dia2n1 tic LanNi $& ' Int (ed )**4 Etapa I Ana#ne7aBe@ c"inic R@ p%"#1nara EC= Ec1 a8d1#ina"a La81rat1r %7%a"e TS:& CT+ $e#1cc%"t Etapa II EDS C1"1n1 c1pie Te te #a"a8 1r8tie ( ecretina pancre17i#ina) CT a8d1#ina"a Ca%tare in-ectii E!a" depre ie NidirG& E/( )**4 (c1#entari%):ernande7& F'( )**3:ernande7& F'( )**3VS:L),##9$ Ane#ieJ4*2 :8 Var taL0)a Ri c ne1 (CI) (%) Ri c n1n-ne1 (CI) (%) NU NU NU , (*-45) ,4 (;5-4**) DA NU NU 4; (4)-)H) ;) (H3-;;) NU DA NU 4, (4)-3*) ;4 (H*-;;) NU NU DA )3 (45-3)) HH (0;-;5) DA DA NU 30 (40-03) 0+ (3H-;+) DA NU DA +4 ()4-00) 5, (3+-H,) NU DA DA +3 ()4-0;) 5H (3)-H,) DA DA DA 0+ ()H-,*) 30 (4*-H3) Pr18a8i"itatea de a a!ea cancer

(re2re ie "12i ticO) CE/aic% et a"E E%r ' Intern (ed& )**0M 4H.);-34E E!a"%are 8a7a"a (e@E -i7ic& ana"i7e de "a81rat1r %7%a"e& R@ p%"#1nara& ec1 a8d1#ina"a) - n1r#a"a. ri c%" de 81a"a 1r2anica e te #icE Din )5 de pacienti c% e@ n1r#a"e& n%#ai 4 a a!%t cancer i "a ) -a 2a it 1 ca%7a a SPIM "a cei"a"ti )3 n% -a 2a it nici 1 ca%7aE T1ti pac c% cancer i ,+% dintre cei c% a-ecti%ni 1r2anice a% a!%t ce" p%tin 1 ana"i7a de "a81rat1r an1r#a"aE In!er & 1 ana"i7a #1di-icata 3 81a"a eri1a a (49) dintre pacientii -ara d2 1r2anic a% a!%t ce" p%tin 1 ana"i7a #1di-icata)E (eta"idi & E%r ' Intern (ed )**;Sinte7a t%dii"1r O ca%7a 1r2anica a SPI e te de 18icei de7!a"%ita de 1 e!a"%are %#ara& iar %n creenin2 8a7a" n1r#a" e te "ini tit1rE In ce"e #ai #%"te erii& apr1@ P dintre pacientii c% SPI a% a!%t cancer& iar 493 1 a"ta 81a"a 1r2anica& re t%" a!and #ai a"e a-ecti%ni p i$iatrice a% ca%7a a ra#a nec%n1 c%taE Cancere"e dia2n1 ticate in c1nte@t%" SPI a% pr1n1 tic e!er (ti#p de %pra!iet%ire c%rt)& dat1rita tadi%"%i a!an atE 6 S%nt % 1r de dia2n1 ticat 6 Rare1ri %nt 1c%"te Pr12n1 tic%" e!er a" cancere"1r e te inca %n ar2%#ent i#p1tri!a %n%i a"21rit# dia2n1 tic e"a81ratE Sinte7a t%dii"1r O e!a"%are 8a7a"a n1r#a"a (#ai a"e de "a81rat1r) "a pacientii c% SPI cade dra tic pr18a8i"itatea cancer%"%i a% a %nei 81"i 1r2anice 2ra!eE Daca e!a"%area initia"a e te n1r#a"a& e rec1#anda #ai de2ra8a #1nit1ri7are atenta decat c1ntin%area 1r8ea ca a te te"1r dia2n1 tice& de1arece pr12n1 tic%" SPI de ca%7a nedeter#inata e te in 2enera" -a!1ra8i"E C1nc"%7ieSt%di%" SPI (CNCSIS& Idei& Pr1iecte de cercetare e@p"1rat1rie Pr1iect 4*9)**;)4E St%di% de cripti!& de e!a"%are a pectr%"%i eti1"12ic a" SPI )E St%di% dia2n1 tic de e!a"%are a ac%ratetei TNC-a"-a& IL4 8eta& IL-0& aCL ca #arNeri ai cancer%"%i ca i ca%7a a SPI 3E St%di% dia2n1 tic de e!a"%are a -eritinei ca #arNer a" cancer%"%i 2a tr1inte tina"& #ai en i8i" decat ane#ia +E St%di% dia2n1 tic de !a"idare a para#etri"1r c"inici i 8i1"12ici i#p"i (!ar ta& VS:& $e#12"18ina& -1 -ata7e"e a"ca"ine& LD:& a"8%#ina)& care a% -1 t e!identiati in

a"te t%dii ca a!and !a"1are predicti!a pri!ind e@i tenta cancer%"%i ca i ca%7a a SPI5E St%di% dia2n1 tic de e!a"%are a te t%"%i de a8 1r8tie a -ier%"%i pentr% di cri#inarea ane#iei din 81"i"e cr1nice de ane#ia -eripri!a 0E Un t%di% de e!a"%are a pre!a"entei antic1rpi"1r anti-1 -1"ipidici "a pacientii c% SPI& de c1#paratie a -rec!ente"1r aparitiei "1r "a pacientii c% i -ara cancer drept ca%7a a SPI i de e!a"%are a ri c%"%i de tr1#817e "a pacientii c% i -ara acE anticardi1"ipiniciECriterii de inc"%dere Scadere p1ndera"a 3 5% in %"ti#e"e 0 "%ni Intre8are. ati "a8it in %"ti#e"e 0 "%ni5 6 -1arte #%"t 6 #%"t 6 #1derat 6 p%tin 6 de"1cCriterii de e@c"%dere Dia2n1 tic c%n1 c%t care e@p"ica SPI (e@. cancer)Criterii de inc"%dere in %8 t%di%" de e!a"%are a te t%"%i de a8 1r8tie a -ier%"%i :8 J 44 2% Sidere#ie J 0* #c2% Te t%" de a8 1r8tie. 6 T*. idere#ia 6 pE1E 4** #2 %"-at -er1 6 T)$. idere#ia =1"d tandard. #ed%"12ra#a B c1"1ratie Per" SPI !ar ta& :L=& VS:& a"8%#ina& p$a"c& LD:& CeM -eritina& IL4&0& TNC& aCL Ane#ie B Te t de a8 E Ce& (ie"12rBPer" Ane#ie e@ternare 3 "%ni 0 "%ni D2 cancer& TVP D2 cancer& TVP (te"e-1n) aCL II 3 epr%8ete c% d1p r1 % ) epr%8ete c% d1p r1 %