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Болезнь мелких сосудов: патогенетические подтипы, возможные лечебные стратегии
Есин Р.Г., Есин О.Р., Хайруллин И.Х. Болезнь мелких сосудов: патогенетические подтипы, возможные лечебные стратегии. Consilum Mediсum. 2016; 18 (2): 104–108. DOI: 10.26442/2075-1753_2016.2.104-108
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Esin R.G., Esin O.R., Khairullin I.Kh. Small vessel disease: pathogenic subtypes and possible therapeutic strategies. Consilum Mediсum. 2016; 18 (2): 104–108. DOI: 10.26442/2075-1753_2016.2.104-108
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Аннотация
В обзоре рассмотрены клинические и нейровизуализационные критерии состояний, объединяемых в группу болезней мелких сосудов головного мозга, и отличия терапевтических возможностей их лечения для профилактики прогрессирования неврологических симптомов, когнитивного снижения от иных причин острой и хронической ишемии головного мозга. Авторы рассматривают потенциал новой формы выпуска – диспергируемые таблетки винпоцетина (Кавинтон Комфорте) как препарата, способного оказать воздействие на разные патогенетические факторы, содействующие прогрессированию болезни мелких сосудов.
Ключевые слова: болезнь мелких сосудов, магнитно-резонансная томография, винпоцетин, Кавинтон, нейропротекция.
Ключевые слова: болезнь мелких сосудов, магнитно-резонансная томография, винпоцетин, Кавинтон, нейропротекция.
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In this review the clinical and neuroimaging criteria states are united in a group of diseases of small vessels of the brain, and unlike the therapeutic possibilities of their treatment for the prevention of progression of neurological symptoms, cognitive impairment from other causes of acute and chronic brain ischemia. The authors examine the potential of a new form of release - dispersible tablets vinpocetine (Cavintonum comfort) as a drug that can have an impact on different pathogenetic factors contributing to the progression of small vessel disease.
Key words: small vessel disease, magnetic resonance imaging, vinpocetine, Cavintonum, neuroprotection.
Полный текст
Список литературы
1. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010; 9: 689–701.
2. Wardlaw J, Smith E, Biessels G et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12 (8): 822–38. Doi: 10.1016/s1474-4422(13)70124-8.
3. Gouw A, Seewann A, Van der Flier W et al. Heterogeneity of small vessel disease: a systematic review of MRI and histopathology correlations. J Neurol Neurosurg Psychiatry 2010; 82 (2): 126–35. Doi: 10.1136/jnnp.2009.204685.
4. Shoamanesh A, Kwok C, Benavente O. Cerebral Microbleeds: Histopathological Correlation of Neuroimaging. Cerebrovasc Dis. 2011; 32 (6): 528–34. Doi: 10.1159/000331466.
5. De Reuck J, Auger F, Cordonnier C et al. Comparison of 7.0-T T2*-Magnetic Resonance Imaging of Cerebral Bleeds in Post-Mortem Brain Sections of Alzheimer Patients with Their Neuropathological Correlates. Cerebrovasc Dis 2011; 31 (5): 511–7. Doi: 10.1159/000324391.
6. Warlow C, Sudlow C, Dennis M et al. Stroke. Lancet 2003; 362: 1211–24.
7. Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2010; 341: c3666.
8. Morris Z, Whiteley WN, Jr. Longstreth WT et al. Incidental findings on brain magnetic resonance imaging: systematic review and metaanalysis. BMJ 2009; 339: b3016.
9. Jackson CA, Hutchison A, Dennis MS et al. Differences between ischemic stroke subtypes in vascular outcomes support a distinct lacunar ischemic stroke arteriopathy: a prospective, hospital-based study. Stroke 2009; 40: 3679–84.
10. Makin SD, Turpin S, Dennis MS, Wardlaw JM. Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry 2013; 84: 893–900.
11. Windham BG, Griswold ME, Shibata D et al. Covert neurological symptoms associated with silent infarcts from midlife to older age: the Atherosclerosis Risk in Communities study. Stroke 2012; 43: 1218–23.
12. Bath PM, Wardlaw JM. Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions. Int J Stroke 2015; 10 (4): 469–78.
13. Фисенко В.П. Кавинтон (винпоцетин): новые возможности клинического применения. Эксперим. и клин. фармакология. 2015; 78 (10): 31–9. / Fisenko V.P. Kavinton (vinpotsetin): novye vozmozhnosti klinicheskogo primeneniia. Eksperim. i klin. farmakologiia. 2015; 78 (10): 31–9. [in Russian]
14. Topol E, Easton D, Harrington R et al. Randomised, double-blind,placebo-controlled, international trial of the oral IIb/IIIa antagonist lotrafiban in coronary and cerebrovascular disease. Am Heart Assoc 2003; 108: 399–406.
15. Bath PMW, Blann A, Smith N, Butterworth RJ. Von Willebrand factor, p-selectin and fibrinogen levels in patients with acute ischaemic and haemorrhagic stroke, and their relationship with stroke sub-type and functional outcome. Platelets 1998; 9: 155–9.
16. Lavallee PC, Labreuche J, Faille D et al. Circulating markers of endothelial dysfunction and platelet activation in patients with severe symptomatic cerebral small vessel disease. Cerebrovasc Dis 2013; 36: 131–8.
17. Allen CL, Bayraktutan U. Antioxidants attenuate hyperglycaemiamediated brain endothelial cell dysfunction and blood-brain barrier ghypermeability. Diabetes Obes Metab 2009; 11: 480–90.
18. Allen C, Srivastava K, Bayraktutan U. Small GTPase RhoA and its effector rho kinase mediate oxygen glucose deprivation-evoked in vitro cerebral barrier dysfunction. Stroke 2010; 41: 2056–63.
19. Shao B, Bayraktutan U. Hyperglycaemia promotes cerebral barrier dysfunction through activation of protein kinase C-beta. Diabetes Obes Metab 2013; 15: 993–9.
20. Farrall AJ, Wardlaw JM. Blood-brain barrier: ageing and microvascular disease–systematic review and meta-analysis. Neurobiol Aging 2009; 30: 337–52.
21. Böhm M, Cotton D, Foster L et al. Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemicstroke. Eur Heart J 2012; 33: 2804–12.
22. Rothwell PM, Howard SC, Dolan E et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375: 895–905.
23. Козловский В.И., Фисенко В.П. Кавинтон (Винпоцетин): фармакологические эффекты, принципы действия и применение в клинической практике. М.: Коти-Принт, 2014. / Kozlovskii V.I., Fisenko V.P. Kavinton (Vinpotsetin): farmakologicheskie effekty, printsipy deistviia i primenenie v klinicheskoi praktike. M.: Koti-Print, 2014. [in Russian]
24. Bereczki D, Fekete I. A systematic review of vinpocetine therapy in acute ischaemic stroke. Eur J Clin Pharmacol 1999; 55: 349–52.
25. Kiss B, Kárpáti E. Mechanism of action of vinpocetine. Acta Pharm Hung 1996; 66 (5): 213–24.
26. Milusheva E, Sperlagh B, Kiss B et al. Inhibitory effect of hypoxic condition on acetylcholine release is partly due to the effect of adenosine released from the tissue. Brain Res Bull 1990; 24: 369–73.
27. Yan C. Cyclic nucleotide phosphodiesterase 1 and vascular aging. Clin Sci (Lond) 2015; 129 (12): 1077–81. Doi: 10.1042/CS20150605.
28. Vas A, Christer H, Sóvágó J et al. Human positron emission tomography with oral 11C-vinpocetine. Orv Hetil 2003; 144 (46): 2271–6.
29. Szakáll S, Boros I, Balkay L et al. Cerebral effects of a single dose of intravenous vinpocetine in chronic stroke patients: A PET study. J Neuroimaging 1998; 8: 197–204.
30. Hadjiev D. Asymptomatic ischemic cerebrovascular disorders and neuroprotection with vinpocetine. Ideggyogy Sz 2003; 56: 166–72.
31. Бурцев Е.М., Савков В.С., Ширах В.В., Бурцев М.Е. 10-летний опыт применения кавинтона при цереброваскулярных нарушениях. Журн. невропатологии и психиатрии им. С.С.Корсакова. 1992; 92 (1): 56–60. / Burcev E.M., Savkov V.S., Shirah V.V., Burcev M.E. 10-letnij opyt primenenija kavintona pri cerebrovaskuljarnyh narushenijah. Zhurn. nevropatologii i psihiatrii im. S.S.Korsakova. 1992; 92 (1): 56–60. [in Russian]
32. Ваизова O.E., Венгеровский А.И., Алифирова В.М. Влияние винпоцетина (Кавинтона) на эндотелиальную функцию у больных с хронической недостаточностью мозгового кровообращения. Журн. неврологии и психиатрии им. С.С.Корсакова. 2006; 16: 46–50. / Vaizova O.E., Vengerovskij A.I., Alifirova V.M. Vlijanie vinpocetina (Kavintona) na jendotelial'nuju funkciju u bol'nyh s hronicheskoj nedostatochnost'ju mozgovogo krovoobrashhenija. Zhurn. nevrologii i psihiatrii im. S.S.Korsakova. 2006; 16: 46–50. [in Russian]
33. Szobor A, Klein M. Ethyl apovincaminate therapy in neurovascular diseases. Arzneimittelforschung 1976; 26: 1984–9.
34. Feher G, Koltai K, Kesmarky G et al. Effect of parenteral or oral vinpocetine on the hemorheological parameters of patients with chronic cerebrovascular diseases. Phytomedicine 2009; 16: 111–7.
35. Szapary L, Horvath B, Marton Zs et al. Hemorheological disturbances in patients with chronic cerebrovascular diseases. Clin Hemorheol Microcirc 2004; 31: 1–9.
36. Hayakawa M. Effect of vinpocetine on red blood cell deformability in stroke patients. Arzneimittelforschung 1992; 42: 425–7.
37. Sitges M, Aldana BI, Reed RC. Effect of the Anti-depressant Sertraline, the Novel Anti-seizur Drug Vinpocetine and Several Conventional Antiepileptic Drugs on the Epileptiform EEG Activity Induced by 4-Aminopyridine. Neurochem Res 2016. [Epub ahead of print].
38. Клинические рекомендации по ведению больных с ишемическим инсультом и транзиторными ишемическими атаками. Утверждены решением Президиума Всероссийского общества неврологов. 17.02.2015. (Под ред. Л.В.Стаховской). М., 2015. / Klinicheskie rekomendatsii po vedeniiu bol'nykh s ishemicheskim insul'tom i tranzitornymi ishemicheskimi atakami. Utverzhdeny resheniem Prezidiuma Vserossiiskogo obshchestva nevrologov. 17.02.2015. (Pod red. L.V.Stakhovskoi). M., 2015. [in Russian]
39. Карпов А.В. Применение препарата кавинтон Форте у больных с дисциркуляторной энцефалопатией. http://www.rmj.ru/articles/nevrologiya/Primenenie_preparata_kavinton_Forte_u_bolynyh_s_discirkulyato... / Karpov A.V. Primenenie preparata kavinton Forte u bol'nykh s distsirkuliatornoi entsefalopatiei. http://www.rmj.ru/articles/nevrologiya/Primenenie_preparata_kavinton_Forte_u_bolynyh_s_discirkulyato...) [in Russian]
40. Танашян М.М., Домашенко М.А. Опыт применения винпоцетина (Кавинтона) в клинической ангионеврологии. Атмосфера. Нервные болезни. 2011; 2: 12–4. / Tanashian M.M., Domashenko M.A. Opyt primeneniia vinpotsetina (Kavintona) v klinicheskoi angionevrologii. Atmosfera. Nervnye bolezni. 2011; 2: 12–4. [in Russian]
41. Patyar S, Prakash A, Modi M, Medhi B. Role of vinpocetine in cerebrovascular diseases. Pharmacol Rep 2011; 63 (3): 618–28.
42. Табеева Г.Р. Клиническая феноменология, механизмы формирования и патогенетическая терапия ранних проявлений хронической ишемии мозга. Клин. фармакология и терапия. 2015; 24 (4): 11–7. / Tabeeva G.R. Klinicheskaia fenomenologiia, mekhanizmy formirovaniia i patogeneticheskaia terapiia rannikh proiavlenii khronicheskoi ishemii mozga. Klin. farmakologiia i terapiia. 2015; 24 (4): 11–7. [in Russian]
43. Государственный реестр лекарственных средств. Инструкция по применению лекарственного препарата для медицинского применения Кавинтон® Комфорте. http://grls.rosminzdrav.ru/Grls_View_v2.aspx?idReg=143680&t= / Gosudarstvennyi reestr lekarstvennykh sredstv. Instruktsiia po primeneniiu lekarstvennogo preparata dlia meditsinskogo primeneniia Kavinton® Komforte. http://grls.rosminzdrav.ru/Grls_View_v2.aspx?idReg=143680&t=
2. Wardlaw J, Smith E, Biessels G et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12 (8): 822–38. Doi: 10.1016/s1474-4422(13)70124-8.
3. Gouw A, Seewann A, Van der Flier W et al. Heterogeneity of small vessel disease: a systematic review of MRI and histopathology correlations. J Neurol Neurosurg Psychiatry 2010; 82 (2): 126–35. Doi: 10.1136/jnnp.2009.204685.
4. Shoamanesh A, Kwok C, Benavente O. Cerebral Microbleeds: Histopathological Correlation of Neuroimaging. Cerebrovasc Dis. 2011; 32 (6): 528–34. Doi: 10.1159/000331466.
5. De Reuck J, Auger F, Cordonnier C et al. Comparison of 7.0-T T2*-Magnetic Resonance Imaging of Cerebral Bleeds in Post-Mortem Brain Sections of Alzheimer Patients with Their Neuropathological Correlates. Cerebrovasc Dis 2011; 31 (5): 511–7. Doi: 10.1159/000324391.
6. Warlow C, Sudlow C, Dennis M et al. Stroke. Lancet 2003; 362: 1211–24.
7. Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2010; 341: c3666.
8. Morris Z, Whiteley WN, Jr. Longstreth WT et al. Incidental findings on brain magnetic resonance imaging: systematic review and metaanalysis. BMJ 2009; 339: b3016.
9. Jackson CA, Hutchison A, Dennis MS et al. Differences between ischemic stroke subtypes in vascular outcomes support a distinct lacunar ischemic stroke arteriopathy: a prospective, hospital-based study. Stroke 2009; 40: 3679–84.
10. Makin SD, Turpin S, Dennis MS, Wardlaw JM. Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry 2013; 84: 893–900.
11. Windham BG, Griswold ME, Shibata D et al. Covert neurological symptoms associated with silent infarcts from midlife to older age: the Atherosclerosis Risk in Communities study. Stroke 2012; 43: 1218–23.
12. Bath PM, Wardlaw JM. Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions. Int J Stroke 2015; 10 (4): 469–78.
13. Фисенко В.П. Кавинтон (винпоцетин): новые возможности клинического применения. Эксперим. и клин. фармакология. 2015; 78 (10): 31–9. / Fisenko V.P. Kavinton (vinpotsetin): novye vozmozhnosti klinicheskogo primeneniia. Eksperim. i klin. farmakologiia. 2015; 78 (10): 31–9. [in Russian]
14. Topol E, Easton D, Harrington R et al. Randomised, double-blind,placebo-controlled, international trial of the oral IIb/IIIa antagonist lotrafiban in coronary and cerebrovascular disease. Am Heart Assoc 2003; 108: 399–406.
15. Bath PMW, Blann A, Smith N, Butterworth RJ. Von Willebrand factor, p-selectin and fibrinogen levels in patients with acute ischaemic and haemorrhagic stroke, and their relationship with stroke sub-type and functional outcome. Platelets 1998; 9: 155–9.
16. Lavallee PC, Labreuche J, Faille D et al. Circulating markers of endothelial dysfunction and platelet activation in patients with severe symptomatic cerebral small vessel disease. Cerebrovasc Dis 2013; 36: 131–8.
17. Allen CL, Bayraktutan U. Antioxidants attenuate hyperglycaemiamediated brain endothelial cell dysfunction and blood-brain barrier ghypermeability. Diabetes Obes Metab 2009; 11: 480–90.
18. Allen C, Srivastava K, Bayraktutan U. Small GTPase RhoA and its effector rho kinase mediate oxygen glucose deprivation-evoked in vitro cerebral barrier dysfunction. Stroke 2010; 41: 2056–63.
19. Shao B, Bayraktutan U. Hyperglycaemia promotes cerebral barrier dysfunction through activation of protein kinase C-beta. Diabetes Obes Metab 2013; 15: 993–9.
20. Farrall AJ, Wardlaw JM. Blood-brain barrier: ageing and microvascular disease–systematic review and meta-analysis. Neurobiol Aging 2009; 30: 337–52.
21. Böhm M, Cotton D, Foster L et al. Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemicstroke. Eur Heart J 2012; 33: 2804–12.
22. Rothwell PM, Howard SC, Dolan E et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375: 895–905.
23. Козловский В.И., Фисенко В.П. Кавинтон (Винпоцетин): фармакологические эффекты, принципы действия и применение в клинической практике. М.: Коти-Принт, 2014. / Kozlovskii V.I., Fisenko V.P. Kavinton (Vinpotsetin): farmakologicheskie effekty, printsipy deistviia i primenenie v klinicheskoi praktike. M.: Koti-Print, 2014. [in Russian]
24. Bereczki D, Fekete I. A systematic review of vinpocetine therapy in acute ischaemic stroke. Eur J Clin Pharmacol 1999; 55: 349–52.
25. Kiss B, Kárpáti E. Mechanism of action of vinpocetine. Acta Pharm Hung 1996; 66 (5): 213–24.
26. Milusheva E, Sperlagh B, Kiss B et al. Inhibitory effect of hypoxic condition on acetylcholine release is partly due to the effect of adenosine released from the tissue. Brain Res Bull 1990; 24: 369–73.
27. Yan C. Cyclic nucleotide phosphodiesterase 1 and vascular aging. Clin Sci (Lond) 2015; 129 (12): 1077–81. Doi: 10.1042/CS20150605.
28. Vas A, Christer H, Sóvágó J et al. Human positron emission tomography with oral 11C-vinpocetine. Orv Hetil 2003; 144 (46): 2271–6.
29. Szakáll S, Boros I, Balkay L et al. Cerebral effects of a single dose of intravenous vinpocetine in chronic stroke patients: A PET study. J Neuroimaging 1998; 8: 197–204.
30. Hadjiev D. Asymptomatic ischemic cerebrovascular disorders and neuroprotection with vinpocetine. Ideggyogy Sz 2003; 56: 166–72.
31. Бурцев Е.М., Савков В.С., Ширах В.В., Бурцев М.Е. 10-летний опыт применения кавинтона при цереброваскулярных нарушениях. Журн. невропатологии и психиатрии им. С.С.Корсакова. 1992; 92 (1): 56–60. / Burcev E.M., Savkov V.S., Shirah V.V., Burcev M.E. 10-letnij opyt primenenija kavintona pri cerebrovaskuljarnyh narushenijah. Zhurn. nevropatologii i psihiatrii im. S.S.Korsakova. 1992; 92 (1): 56–60. [in Russian]
32. Ваизова O.E., Венгеровский А.И., Алифирова В.М. Влияние винпоцетина (Кавинтона) на эндотелиальную функцию у больных с хронической недостаточностью мозгового кровообращения. Журн. неврологии и психиатрии им. С.С.Корсакова. 2006; 16: 46–50. / Vaizova O.E., Vengerovskij A.I., Alifirova V.M. Vlijanie vinpocetina (Kavintona) na jendotelial'nuju funkciju u bol'nyh s hronicheskoj nedostatochnost'ju mozgovogo krovoobrashhenija. Zhurn. nevrologii i psihiatrii im. S.S.Korsakova. 2006; 16: 46–50. [in Russian]
33. Szobor A, Klein M. Ethyl apovincaminate therapy in neurovascular diseases. Arzneimittelforschung 1976; 26: 1984–9.
34. Feher G, Koltai K, Kesmarky G et al. Effect of parenteral or oral vinpocetine on the hemorheological parameters of patients with chronic cerebrovascular diseases. Phytomedicine 2009; 16: 111–7.
35. Szapary L, Horvath B, Marton Zs et al. Hemorheological disturbances in patients with chronic cerebrovascular diseases. Clin Hemorheol Microcirc 2004; 31: 1–9.
36. Hayakawa M. Effect of vinpocetine on red blood cell deformability in stroke patients. Arzneimittelforschung 1992; 42: 425–7.
37. Sitges M, Aldana BI, Reed RC. Effect of the Anti-depressant Sertraline, the Novel Anti-seizur Drug Vinpocetine and Several Conventional Antiepileptic Drugs on the Epileptiform EEG Activity Induced by 4-Aminopyridine. Neurochem Res 2016. [Epub ahead of print].
38. Клинические рекомендации по ведению больных с ишемическим инсультом и транзиторными ишемическими атаками. Утверждены решением Президиума Всероссийского общества неврологов. 17.02.2015. (Под ред. Л.В.Стаховской). М., 2015. / Klinicheskie rekomendatsii po vedeniiu bol'nykh s ishemicheskim insul'tom i tranzitornymi ishemicheskimi atakami. Utverzhdeny resheniem Prezidiuma Vserossiiskogo obshchestva nevrologov. 17.02.2015. (Pod red. L.V.Stakhovskoi). M., 2015. [in Russian]
39. Карпов А.В. Применение препарата кавинтон Форте у больных с дисциркуляторной энцефалопатией. http://www.rmj.ru/articles/nevrologiya/Primenenie_preparata_kavinton_Forte_u_bolynyh_s_discirkulyato... / Karpov A.V. Primenenie preparata kavinton Forte u bol'nykh s distsirkuliatornoi entsefalopatiei. http://www.rmj.ru/articles/nevrologiya/Primenenie_preparata_kavinton_Forte_u_bolynyh_s_discirkulyato...) [in Russian]
40. Танашян М.М., Домашенко М.А. Опыт применения винпоцетина (Кавинтона) в клинической ангионеврологии. Атмосфера. Нервные болезни. 2011; 2: 12–4. / Tanashian M.M., Domashenko M.A. Opyt primeneniia vinpotsetina (Kavintona) v klinicheskoi angionevrologii. Atmosfera. Nervnye bolezni. 2011; 2: 12–4. [in Russian]
41. Patyar S, Prakash A, Modi M, Medhi B. Role of vinpocetine in cerebrovascular diseases. Pharmacol Rep 2011; 63 (3): 618–28.
42. Табеева Г.Р. Клиническая феноменология, механизмы формирования и патогенетическая терапия ранних проявлений хронической ишемии мозга. Клин. фармакология и терапия. 2015; 24 (4): 11–7. / Tabeeva G.R. Klinicheskaia fenomenologiia, mekhanizmy formirovaniia i patogeneticheskaia terapiia rannikh proiavlenii khronicheskoi ishemii mozga. Klin. farmakologiia i terapiia. 2015; 24 (4): 11–7. [in Russian]
43. Государственный реестр лекарственных средств. Инструкция по применению лекарственного препарата для медицинского применения Кавинтон® Комфорте. http://grls.rosminzdrav.ru/Grls_View_v2.aspx?idReg=143680&t= / Gosudarstvennyi reestr lekarstvennykh sredstv. Instruktsiia po primeneniiu lekarstvennogo preparata dlia meditsinskogo primeneniia Kavinton® Komforte. http://grls.rosminzdrav.ru/Grls_View_v2.aspx?idReg=143680&t=
________________________________________________
1. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010; 9: 689–701.
2. Wardlaw J, Smith E, Biessels G et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12 (8): 822–38. Doi: 10.1016/s1474-4422(13)70124-8.
3. Gouw A, Seewann A, Van der Flier W et al. Heterogeneity of small vessel disease: a systematic review of MRI and histopathology correlations. J Neurol Neurosurg Psychiatry 2010; 82 (2): 126–35. Doi: 10.1136/jnnp.2009.204685.
4. Shoamanesh A, Kwok C, Benavente O. Cerebral Microbleeds: Histopathological Correlation of Neuroimaging. Cerebrovasc Dis. 2011; 32 (6): 528–34. Doi: 10.1159/000331466.
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Авторы
Р.Г.Есин*1,2, О.Р.Есин2, И.Х.Хайруллин2
1 ГБОУ ДПО Казанская государственная медицинская академия Минздрава России. 420012, Россия, Казань, ул. Муштари, д. 11;
2 ФГАОУ ВО Казанский (Приволжский) федеральный университет. 420008, Россия, Казань, ул. Кремлевская, д. 18
*ksma@mi.ru
1 ГБОУ ДПО Казанская государственная медицинская академия Минздрава России. 420012, Россия, Казань, ул. Муштари, д. 11;
2 ФГАОУ ВО Казанский (Приволжский) федеральный университет. 420008, Россия, Казань, ул. Кремлевская, д. 18
*ksma@mi.ru
________________________________________________
R.G.Esin*1,2, O.R.Esin2, I.Kh.Khairullin2
1 Kazan State Medical Academy of the Ministry of Health of the Russian Federation. 420012, Russian Federation, Kazan, ul. Mushtari, d. 11;
2 Kazan (Volga region) Federal University. 420008, Russian Federation, Kazan, ul. Kremlevskaia, d. 18
*ksma@mi.ru
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