В связи с ростом распространенности сахарного диабета во всем мире растет и число пациентов с осложнениями. Диабетическая ретинопатия (ДР) имеется у 25–33% пациентов и, являясь ведущей причиной слепоты и слабовидения у лиц трудоспособного возраста, представляет собой острую проблему. Стандартные методы лечения ДР проводятся в основном уже на поздних стадиях и не всегда являются безопасными и успешными. Это заставляет искать новые подходы к решению данной проблемы и обратить внимание на профилактику поздних осложнений сахарного диабета. В статье обсуждаются патогенетические механизмы развития ДР и возможности снижения риска ее прогрессирования. Особое внимание уделяется применению препарата кальция добезилата, имеющего широкий спектр воздействия на звенья патогенеза ДР.
The number of patients with complications is growing with the increase of diabetes mellitus (DM) prevalence worldwide. 25–33% of patients have diabetic retinopathy (DR). DR is a leading cause of blindness and low vision among people of working age and it is a serious problem. Standard treatment methods for DR are mainly used in patients with advanced-stage of disease and are not always safe and successful. This makes us search new approaches to solve this problem and pay attention to prevent late DR complications. This article discusses the pathogenetic mechanisms of DR development and the possibility of reducing the risk of its progression. Special attention is paid to the application of drug calcium dobesilate possessing a wide range of effects on DR pathogenesis.
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1. Dedov I.I., Shestakova M.V. Sakharnyi diabet: ostrye i khronicheskie oslozhneniia. M.: Med. inform. agentstvo, 2012. [in Russian]
2. Solov'eva G.A. Rol' preparata Doksi-khem v lechenii diabeticheskoi retinopatii. Klin. oftal'mologiia. 2003; 4 (1): 43–5. [in Russian]
3. Stitt AW. Histological and ultrastructural investigation of retinal microaneurysm development in diabetic patients. Brit J Ophthalmol 1995; 79: 362–7.
4. Dedov I.I., Shestakova M.V., Maiorov A.Iu. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. Pod red. I.I.Dedova, M.V.Shestakovoi, A.Iu.Maiorova. Vypusk 8-i. Sakharnyi diabet. 2017; 20 (1S): 1–112. [in Russian]
5. Lipatov D.V., Aleksandrova V.K., Atarshchikov D.S. i dr. Epidemiologiia i registr diabeticheskoi retinopatii v Rossiiskoi Federatsii. Sakharnyi diabet. 2014; 1: 4–7. [in Russian]
6. UK Prospective Diabetes Study (UKPDS) Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ 1998; 317: 703–13.
7. Wilczynski M, Dziegielewski K. Glycaemic control and microvascular complications in a large cohort of Italian Type 1 diabetic out-patients. Klin Oczna 2005; 107 (10–12): 672–4.
8. Al-Till MI, Al-Bdour MD, Ajlouni KM. Prevalence of blindness and visual impairment among Jordanian diabetics. Eur J Ophthalmol 2005; 15 (1): 62–8.
9. Mensah E, Kohner E. Diagnosis and management of diabetic retinopathy. Topic Endocrinol 2002; 19: 14–8.
10. Olivarius N, Nielsen NV, Andreasen AH. Diabetic retinopathy in newly diagnosed middle-age dandle derly diabetic patients. Prevalence and interrelationship with microalbuminuria and triglycerides. Graefes Arch Clin Exp Ophthalmol 2001; 239 (9): 664–72.
11. International Diabetes Federation. IDF Diabetes Atlas, 6th ed. Brussels, Belgium: International Diabetes Federation, 2013.
12. Yau JWY, Rogers SL, Kawasaki R et al. Meta-Analysis for Eye Disease (META-EYE).
13. Study Group. Global prevalence and majority risk factors of diabetic retinopathy. Diabetes Care 2012; 35: 556–64.
14. Dedov I.I., Suntsov Iu.I., Kudriakova C.B. Ekonomicheskie problemy sakharnogo diabeta v Rossii. Sakharnyi diabet. 2000; 3: 56–8. [in Russian]
15. Xu J, Wei WB, Yuan MX et al. Prevalence and risk factors for diabetic retinopathy: the Beijing Communities Diabetes Study 6. Retina 2012; 32: 322–9.
16. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001; 414: 813–20.
17. Tang J, Kern TS. Inflammation in diabetic retinopathy. Prog Retin Eye Res 2011; 30: 343–58.
18. Simo R, Ballarini S, Cunha-Vaz J et al. Non-traditional systemic treatments for diabetic retinopathy: an evidence-based review. Curr Med Chem 2015; 22: 2580–9.
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Авторы
О.В.Кольчик1, С.В.Немирова*2, К.С.Петрова2
1 ГБУЗ НО «Нижегородская областная клиническая больница им. Н.А.Семашко». 603126, Россия, Нижний Новгород, ул. Родионова, д. 190;
2 ФГБОУ ВО «Нижегородская государственная медицинская академия» Минздрава России. 603005, Россия, Нижний Новгород, пл. Минина и Пожарского, д. 10/1
*nemirova.info@gmail.com
________________________________________________
O.V.Kolchik1, S.V.Nemirova*2, K.S.Petrova2
1 Nizhny Novgorod Regional Clinical Psychiatric Hospital №1. 603126, Russian Federation, Nizhny Novgorod, ul. Rodionova, d. 190;
2 Nizhny Novgorod State Medical Academy of the Ministry of Health of the Russian Federation. 603005, Russian Federation, Nizhny Novgorod, pl. Minina i Pozharskogo, d. 10/1
*nemirova.info@gmail.com