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Кардиальная автономная полиневропатия: роль метаболической терапии
Кардиальная автономная полиневропатия: роль метаболической терапии
Котова О.В., Акарачкова Е.С. Кардиальная автономная полиневропатия: роль метаболической терапии. Consilium Medicum. 2016; 18 (4): 28–30. DOI: 10.26442/2075-1753_2016.4.28-30
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Аннотация
Невропатия является одним из наиболее распространенных осложнений сахарного диабета (СД) и встречается примерно у 60% пациентов. Больные СД типа 2 могут быть с данным осложнением уже после нескольких лет плохого гликемического контроля, а иногда эти пациенты уже имеют невропатию на момент постановки диагноза СД. Диабетическая автономная невропатия (ДАН) – разновидность диабетической периферической полиневропатии. В свою очередь, кардиальная автономная полиневропатия (КАН) – разновидность диабетической автономной полиневропатии, наиболее часто диагностируемая форма ДАН. В настоящее время известно, что 50% больных СД с диабетической невропатией имеют бессимптомную КАН – разновидность диабетической автономной полиневропатии (ДАН), в то время как 100% больных с симптоматикой КАН имеют классическую диабетическую невропатию. Ортостатическая гипотензия (ОГ) – классическое проявление КАН. В целом распространенность ОГ среди пожилых пациентов медицинских учреждений – 54–68%, в общей популяции – 6%. ОГ – серьезная проблема в первую очередь – из-за ее влияния на хронические соматические заболевания. Наличие ОГ является независимым фактором риска заболеваемости инфарктом миокарда (и смертности от него), инсультом, сердечной недостаточностью, аритмиями. В статье описаны пять стандартных тестов по Ewing для выявления патологии сердечно-сосудистой системы. В качестве возможной патогенетической терапии ДАН обсуждаются препараты a-липоевой кислоты, витаминов группы В, комплексы витаминов группы В и биологически активных веществ. Кокарнит – комплексный препарат, содержащий витамины группы В и метаболически активные вещества, способный улучшить состояние пациентов с ДАН.
Ключевые слова: сахарный диабет, диабетическая автономная невропатия, кардиальная автономная полиневропатия, ортостатическая гипотензия, Кокарнит.
Ключевые слова: сахарный диабет, диабетическая автономная невропатия, кардиальная автономная полиневропатия, ортостатическая гипотензия, Кокарнит.
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Neuropathy is one of the most common complications of diabetes mellitus (DM) and affects about 60% of patients. Patients with type 2 DM can have this complication after several years of poor glycemic control, and sometimes these patients already have neuropathy at the time of DM diagnosis. Diabetic au- tonomic neuropathy (DAN) is a type of diabetic peripheral neuropathy. Whereas, cardiac autonomic neuropathy (CAN) is a type of diabetic autonomic neu- ropathy and the most commonly form of DAN. It is now known that 50% of patients with DM suffering from diabetic neuropathy have asymptomatic CAN (form of diabetic autonomic neuropathy – DAN), while 100% of patients with symptoms of CAN have classic diabetic neuropathy. Orthostatic hypotension (OH) is a common manifestation of CAN. In general, the prevalence of OH among elderly patients is 54–68% and 6% in the general population. OH is a seri- ous problem primarily because of the impact on the course of chronic somatic diseases. The existence of OH is an independent risk factor for incidence of myocardial infarction (and for mortality as well), stroke, heart failure and arrhythmias. This article deals with Ewing’s five standard tests for diagnosing cardiovascular pathology. This article discusses the possibility of prescribing preparations of lipoic acid, vitamin B preparations, preparations containing vitamin B-complex and biologically active substances in the capacity of possible pathogenetic DAN therapy. Cocarnit is a complex preparation, containing vitamins B and metabolically active compounds, which can improve total somatical state of patients with DAN.
Key words: diabetes mellitus, diabetic autonomic neuropathy, cardiac autonomic neuropathy, orthostatic hypotension, Cocarnit
Key words: diabetes mellitus, diabetic autonomic neuropathy, cardiac autonomic neuropathy, orthostatic hypotension, Cocarnit
Полный текст
Список литературы
1. Dyck PJ, Kratz KM, Karnes JL et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology 1993; 43 (4): 817–24; pmid:8469345 doi: 10.1212/wnl.43.4.817
2. Timar B, Timar R, Gaiă L . The Impact of Diabetic Neuropathy on Balance and on the Risk of Falls in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. PLoS One 2016; 11 (4): e0154654; doi: 10.1371/journal.pone.0154654. eCollection 2016
3. Vinik AI, Erbas T. Recognizing and treating diabetic autonomic neuropathy. Cleve Clin J Med 2001; 68: 928–30.
4. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007; 115: 387–97.
5. Low PA, Vernino S, Suarez G. Autonomic dysfunction in peripheral nerve disease. Muscle Nerve 2003; 27: 646–61.
6. Dyck PJB, Norell JE, Dyck PJ. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology 1999; 53: 2113–21.
7. Vinik AI, Casellini C, Névoret ML. Alternative Quantitative Tools in the Assessment of Diabetic Peripheral and Autonomic Neuropathy. Rev Neurobiol 2016; 127: 235–85; doi: 10.1016/bs.irn.2016.03.010
8. Tahrani AA, Dubb K, Raymond NT et al. Cardiac autonomic neuropathy predicts renal function decline in patients with type 2 diabetes: a cohort study. Diabetologia 2014; 57 (6): 1249–56; doi: 10.1007/s00125-014-3211-2. pmid:24623102
9. Dimitropoulos G, Tahrani AA, Stevens MJ. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes 2014; 5 (1): 17–39; doi: 10.4239/wjd.v5.i1.17. pmid:24567799
10. Shibao C, Grijalva CG, Raj SR et al. Orthostatic hypotension-related hospitalizations in the United Sates. Am J Med 2007; 120 (11): 975–80.
11. Ricci F, De Caterina R, Fedorowski A. Orthostatic Hypotension: Epidemiology, Prognosis, and Treatment. J Am Coll Cardiol 2015; 66 (7): 848–60.
12. Veronese N, De Rui M, Bolzetta F et al. Orthostatic changes in blood pressure and mortality in the elderly: the Pro.V.A Study. Am J Hypertens 2015.
13. Lacigova S, Brozova J, Cechurova D et al. The influence of cardiovascular autonomic neuropathy on mortality in type 1 diabetic patients; 10-year follow-up. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160 (1): 111–7; doi: 10.5507/bp.2015.063
14. Ewing DJ, Martyn CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985; 8: 491–8.
15. Котова О.В. Диабетическая автономная полиневропатия. Фарматека. 2012; 6: 40–4. / Kotova O.V. Diabeticheskaia avtonomnaia polinevropatiia. Farmateka. 2012; 6: 40–4. [in Russian]
16. Котова О.В. Диабетическая нейропатия. Применение нейротропных витаминов. Поликлиника. 2015; 1 (2): 36–9. / Kotova O.V. Diabeticheskaia neiropatiia. Primenenie neirotropnykh vitaminov. Poliklinika. 2015; 1 (2): 36–9. [in Russian]
17. Popov SV, Melekhovets' OK, Demikhova NV, Vynnychenko LB. Drug with a high metabolic activity, cocarnit, in the treatment of diabetic cardiac autonomic neuropathy. Lik Sprava 2012; 3–4: 75–81.
2. Timar B, Timar R, Gaiă L . The Impact of Diabetic Neuropathy on Balance and on the Risk of Falls in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. PLoS One 2016; 11 (4): e0154654; doi: 10.1371/journal.pone.0154654. eCollection 2016
3. Vinik AI, Erbas T. Recognizing and treating diabetic autonomic neuropathy. Cleve Clin J Med 2001; 68: 928–30.
4. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007; 115: 387–97.
5. Low PA, Vernino S, Suarez G. Autonomic dysfunction in peripheral nerve disease. Muscle Nerve 2003; 27: 646–61.
6. Dyck PJB, Norell JE, Dyck PJ. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology 1999; 53: 2113–21.
7. Vinik AI, Casellini C, Névoret ML. Alternative Quantitative Tools in the Assessment of Diabetic Peripheral and Autonomic Neuropathy. Rev Neurobiol 2016; 127: 235–85; doi: 10.1016/bs.irn.2016.03.010
8. Tahrani AA, Dubb K, Raymond NT et al. Cardiac autonomic neuropathy predicts renal function decline in patients with type 2 diabetes: a cohort study. Diabetologia 2014; 57 (6): 1249–56; doi: 10.1007/s00125-014-3211-2. pmid:24623102
9. Dimitropoulos G, Tahrani AA, Stevens MJ. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes 2014; 5 (1): 17–39; doi: 10.4239/wjd.v5.i1.17. pmid:24567799
10. Shibao C, Grijalva CG, Raj SR et al. Orthostatic hypotension-related hospitalizations in the United Sates. Am J Med 2007; 120 (11): 975–80.
11. Ricci F, De Caterina R, Fedorowski A. Orthostatic Hypotension: Epidemiology, Prognosis, and Treatment. J Am Coll Cardiol 2015; 66 (7): 848–60.
12. Veronese N, De Rui M, Bolzetta F et al. Orthostatic changes in blood pressure and mortality in the elderly: the Pro.V.A Study. Am J Hypertens 2015.
13. Lacigova S, Brozova J, Cechurova D et al. The influence of cardiovascular autonomic neuropathy on mortality in type 1 diabetic patients; 10-year follow-up. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160 (1): 111–7; doi: 10.5507/bp.2015.063
14. Ewing DJ, Martyn CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985; 8: 491–8.
15. Kotova O.V. Diabeticheskaia avtonomnaia polinevropatiia. Farmateka. 2012; 6: 40–4. [in Russian]
16. Kotova O.V. Diabeticheskaia neiropatiia. Primenenie neirotropnykh vitaminov. Poliklinika. 2015; 1 (2): 36–9. [in Russian]
17. Popov SV, Melekhovets' OK, Demikhova NV, Vynnychenko LB. Drug with a high metabolic activity, cocarnit, in the treatment of diabetic cardiac autonomic neuropathy. Lik Sprava 2012; 3–4: 75–81.
2. Timar B, Timar R, Gaiă L . The Impact of Diabetic Neuropathy on Balance and on the Risk of Falls in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. PLoS One 2016; 11 (4): e0154654; doi: 10.1371/journal.pone.0154654. eCollection 2016
3. Vinik AI, Erbas T. Recognizing and treating diabetic autonomic neuropathy. Cleve Clin J Med 2001; 68: 928–30.
4. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007; 115: 387–97.
5. Low PA, Vernino S, Suarez G. Autonomic dysfunction in peripheral nerve disease. Muscle Nerve 2003; 27: 646–61.
6. Dyck PJB, Norell JE, Dyck PJ. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology 1999; 53: 2113–21.
7. Vinik AI, Casellini C, Névoret ML. Alternative Quantitative Tools in the Assessment of Diabetic Peripheral and Autonomic Neuropathy. Rev Neurobiol 2016; 127: 235–85; doi: 10.1016/bs.irn.2016.03.010
8. Tahrani AA, Dubb K, Raymond NT et al. Cardiac autonomic neuropathy predicts renal function decline in patients with type 2 diabetes: a cohort study. Diabetologia 2014; 57 (6): 1249–56; doi: 10.1007/s00125-014-3211-2. pmid:24623102
9. Dimitropoulos G, Tahrani AA, Stevens MJ. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes 2014; 5 (1): 17–39; doi: 10.4239/wjd.v5.i1.17. pmid:24567799
10. Shibao C, Grijalva CG, Raj SR et al. Orthostatic hypotension-related hospitalizations in the United Sates. Am J Med 2007; 120 (11): 975–80.
11. Ricci F, De Caterina R, Fedorowski A. Orthostatic Hypotension: Epidemiology, Prognosis, and Treatment. J Am Coll Cardiol 2015; 66 (7): 848–60.
12. Veronese N, De Rui M, Bolzetta F et al. Orthostatic changes in blood pressure and mortality in the elderly: the Pro.V.A Study. Am J Hypertens 2015.
13. Lacigova S, Brozova J, Cechurova D et al. The influence of cardiovascular autonomic neuropathy on mortality in type 1 diabetic patients; 10-year follow-up. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160 (1): 111–7; doi: 10.5507/bp.2015.063
14. Ewing DJ, Martyn CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985; 8: 491–8.
15. Котова О.В. Диабетическая автономная полиневропатия. Фарматека. 2012; 6: 40–4. / Kotova O.V. Diabeticheskaia avtonomnaia polinevropatiia. Farmateka. 2012; 6: 40–4. [in Russian]
16. Котова О.В. Диабетическая нейропатия. Применение нейротропных витаминов. Поликлиника. 2015; 1 (2): 36–9. / Kotova O.V. Diabeticheskaia neiropatiia. Primenenie neirotropnykh vitaminov. Poliklinika. 2015; 1 (2): 36–9. [in Russian]
17. Popov SV, Melekhovets' OK, Demikhova NV, Vynnychenko LB. Drug with a high metabolic activity, cocarnit, in the treatment of diabetic cardiac autonomic neuropathy. Lik Sprava 2012; 3–4: 75–81.
________________________________________________
2. Timar B, Timar R, Gaiă L . The Impact of Diabetic Neuropathy on Balance and on the Risk of Falls in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. PLoS One 2016; 11 (4): e0154654; doi: 10.1371/journal.pone.0154654. eCollection 2016
3. Vinik AI, Erbas T. Recognizing and treating diabetic autonomic neuropathy. Cleve Clin J Med 2001; 68: 928–30.
4. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007; 115: 387–97.
5. Low PA, Vernino S, Suarez G. Autonomic dysfunction in peripheral nerve disease. Muscle Nerve 2003; 27: 646–61.
6. Dyck PJB, Norell JE, Dyck PJ. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology 1999; 53: 2113–21.
7. Vinik AI, Casellini C, Névoret ML. Alternative Quantitative Tools in the Assessment of Diabetic Peripheral and Autonomic Neuropathy. Rev Neurobiol 2016; 127: 235–85; doi: 10.1016/bs.irn.2016.03.010
8. Tahrani AA, Dubb K, Raymond NT et al. Cardiac autonomic neuropathy predicts renal function decline in patients with type 2 diabetes: a cohort study. Diabetologia 2014; 57 (6): 1249–56; doi: 10.1007/s00125-014-3211-2. pmid:24623102
9. Dimitropoulos G, Tahrani AA, Stevens MJ. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes 2014; 5 (1): 17–39; doi: 10.4239/wjd.v5.i1.17. pmid:24567799
10. Shibao C, Grijalva CG, Raj SR et al. Orthostatic hypotension-related hospitalizations in the United Sates. Am J Med 2007; 120 (11): 975–80.
11. Ricci F, De Caterina R, Fedorowski A. Orthostatic Hypotension: Epidemiology, Prognosis, and Treatment. J Am Coll Cardiol 2015; 66 (7): 848–60.
12. Veronese N, De Rui M, Bolzetta F et al. Orthostatic changes in blood pressure and mortality in the elderly: the Pro.V.A Study. Am J Hypertens 2015.
13. Lacigova S, Brozova J, Cechurova D et al. The influence of cardiovascular autonomic neuropathy on mortality in type 1 diabetic patients; 10-year follow-up. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160 (1): 111–7; doi: 10.5507/bp.2015.063
14. Ewing DJ, Martyn CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985; 8: 491–8.
15. Kotova O.V. Diabeticheskaia avtonomnaia polinevropatiia. Farmateka. 2012; 6: 40–4. [in Russian]
16. Kotova O.V. Diabeticheskaia neiropatiia. Primenenie neirotropnykh vitaminov. Poliklinika. 2015; 1 (2): 36–9. [in Russian]
17. Popov SV, Melekhovets' OK, Demikhova NV, Vynnychenko LB. Drug with a high metabolic activity, cocarnit, in the treatment of diabetic cardiac autonomic neuropathy. Lik Sprava 2012; 3–4: 75–81.
Авторы
О.В.Котова*, Е.С.Акарачкова
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*ol_kotova@mail.ru
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*ol_kotova@mail.ru
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*ol_kotova@mail.ru
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I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*ol_kotova@mail.ru
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