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J'ai vu un patient cette semaine dans la trentaine pour une douleur dorsale, suite à un accident de travail. Il présente un facies et un corps très chétif, avec une fonte musculaire importante. Il est d'une grandeur dans la moyenne cependant. Il me avoir le colon irritable et avoir de la difficulté à prendre du poids. Comme ce n'est pas la première fois que je vois ce genre de morphologie, j'ai décidé de fouiller un peu plus loin. C'est ainsi que j'ai trouvé un article [1] intéressant sur la pathologie nommée cachexie.

Qu'est-ce que la cachexie? C'est en fait une perte de poids involontaire à prédominance musculaire. Les cytokines semblent jouer un rôle majeur dans la physiologie de cette pathologie, lorsqu'elles sont présentes en trop grand nombre. Elles seront en trop grand nombre lorsqu'il y a présence d'un syndrome inflamatoire ou immunitaire persistant. Ainsi, diverses pathologies sont reliées à la cachexie, telles que certains problèmes cardiaques, une insuffisance rénale, une maladie pulmonaire obstructice chronique, un cancer, le SIDA, et l'arthrite rhumatoïde.

La vieillesse également va amener une cachexie mais il n'est pas clair si l'excès de cytokines est dû à l'âge directement, ou à une pathologie sous-jaçante. Par ailleurs, il faut différencier la cachexie d'une déprivation nutritionnelle. Cette dernière amènera également une perte de poids, mais plus au niveau des tissus graisseux que des tissus musculaires, par opposition à la cachexie.

Malheureusement, la présence de cette pathologie est hautement prédictrice d'un taux de mortalité accru. Pour ce qui est du traitement, évidemment un support nutritionnel est de mise, mais dernièrement certaines études semblent montrer un effet favorable des agents orexigeniques.

Ce n'est pas de très bonnes nouvelles pour mon patient, qui ignorait, semble-t'il qu'il avait une fonte musculaire si importante.

References

  1. Morley J, Thomas D, Wilson M .  2006.  Cachexia: pathophysiology and clinical relevance. American journal of clinical nutrition.

 

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