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Сахарный диабет и полиморбидные неврологические осложнения
Сахарный диабет и полиморбидные неврологические осложнения
Воробьева О.В. Сахарный диабет и полиморбидные неврологические осложнения. Неврология и Ревматология (Прил. к журн. Consilium Medicum). 2018; 2: 51–56.
DOI: 10.26442/2414357X.2018.2.180101
DOI: 10.26442/2414357X.2018.2.180101
DOI: 10.26442/2414357X.2018.2.180101
________________________________________________
DOI: 10.26442/2414357X.2018.2.180101
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Сахарный диабет и ассоциированные метаболические нарушения характеризуются широким спектром неврологических осложнений. Пациент с сахарным диабетом должен рассматриваться под призмой неврологической полиморбидности, обусловленной церебральной и периферической эндотелиальной дисфункцией. В статье обсуждаются возможности ранней диагностике основных неврологических осложнений диабета и комплексный подход к их профилактике и лечению. Результаты терапии значительно улучшаются, если уже при составлении плана лечения приоритет отдается препаратам, направленным на все коморбидные состояния пациента.
Ключевые слова: сахарный диабет, атеротромбоз, диабетическая церебральная микроангиопатия, диабетическая невропатия, дипиридамол,
α-липоевая кислота.
Key words: diabetes mellitus, atherothrombosis, diabetic cerebral microangiopathy, diabetic neuropathy, dipyridamole, alpha-lipoic acid.
Ключевые слова: сахарный диабет, атеротромбоз, диабетическая церебральная микроангиопатия, диабетическая невропатия, дипиридамол,
α-липоевая кислота.
________________________________________________
Key words: diabetes mellitus, atherothrombosis, diabetic cerebral microangiopathy, diabetic neuropathy, dipyridamole, alpha-lipoic acid.
Полный текст
Список литературы
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2. Gu K, Cowie CC, Harris MI. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993. Diabetes Care 1998; 21: 1138–45.
3. Folsom AR, Rasmussen ML, Chambless LE et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care 1999; 22 (7): 1077–83.
4. Selvin E, Coresh J, Zhu H et al. Measurement of HbA1c from stored whole blood samples in the Atherosclerosis Risk in Communities study. J Diabetes 2010; 2 (2): 118–24.
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15. Grasso S, Bramanti V, Tomassoni D et al. Effect of lipoic acid and α-glyceryl-phosphoryl-choline on astroglial cell proliferation and differentiation in primary culture. J Neurosci Res 2014; 92: 86–94.
16. Nickander KK, McPhee BR, Low PA, Tritschler H. Alpha-lipoic acid: antioxidant potency against lipid peroxidation of neural tissues in vitro and implication for diabetic neuropathy. Free Radic Biol Med 1996; 21: 631–9.
17. Rochette L, Ghibu S, Muresan A, Vergely C. α-Lipoic acid: Molecular mechanisms and therapeutic potential in diabetes. Can J Physiol Pharmacol 2015; 93: 1021–7.
18. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med 2004; 21 (2): 114–21.
19. Ziegler D, Reljanovic M, Mehnert H et al. α-Lipoic acid in the treatment of diabetic polyneuropathy in Germany: Current evidence from clinical trials. Exp Clin Endocrinol Diabetes 1999; 107: 421–30.
20. Аль-Замиль М.Х, Брежнева Е.В. Применение препаратов альфа-липоевой кислоты в лечении диабетической нейропатии. Журн. неврологии и психиатрии им. C.C.Корсакова. 2008; 2: 28–30. / Al'-Zamil' M.Kh, Brezhneva E.V. Primenenie preparatov al'fa-lipoevoi kisloty v lechenii diabeticheskoi neiropatii. Zhurn. nevrologii i psikhiatrii im. C.C.Korsakova. 2008; 2: 28–30. [in Russian]
21. Аметов А.С., Мамедова И.Н. Клиническая фармакологическая терапия. 2003; 12 (2): 74–80. / Ametov A.S., Mamedova I.N. Klinicheskaia farmakologicheskaia terapiia. 2003; 12 (2): 74–80. [in Russian]
22. Щеплев П.А., Кузнецкий Ю.Я. Опыт применения препарата Берлитион в коррекции эректильной дисфункции у больных сахарным диабетом 2 типа. Андрология и генитальная хирургия. 2004; 3: 40–2. / Shcheplev P.A., Kuznetskii Yu.Ya. Opyt primeneniia preparata Berlition v korrektsii erektil'noi disfunktsii u bol'nykh sakharnym diabetom 2 tipa. Andrologiia i genital'naia khirurgiia. 2004; 3: 40–2. [in Russian]
2. Gu K, Cowie CC, Harris MI. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993. Diabetes Care 1998; 21: 1138–45.
3. Folsom AR, Rasmussen ML, Chambless LE et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care 1999; 22 (7): 1077–83.
4. Selvin E, Coresh J, Zhu H et al. Measurement of HbA1c from stored whole blood samples in the Atherosclerosis Risk in Communities study. J Diabetes 2010; 2 (2): 118–24.
5. Yaffe K, Blackwell T, Whitmer RA et al. Glycosylated hemoglobin level and development of mild cognitive impairment or dementia in older women. J Nutr Health Aging 2006; 10 (4): 293–5.
6. Dejgaard A, Gade A, Larsson H et al. Evidence for diabetic encephalopathy. Diabet Med 1991; 8 (2): 162–7.
7. Ferguson SC, Blane A, Perros P et al. Cognitive ability and brain structure in type 1 diabetes: Relation to microangiopathy and preceding severe hypoglycemia. Diabetes 2003; 52 (1): 149–56.
8. Kastrup J, Rørsgaard S, Parving HH, Lassen NA. Impaired autoregulation of cerebral blood flow in long-term type I (insulin-dependent) diabetic patients with nephropathy and retinopathy. Clin Physiol 1986; 6 (6): 549–59.
9. Tseng MT, Chiang MC, Chao CC et al. fMRI evidence of degeneration-induced neuropathic pain in diabetes: enhanced limbic and striatal activations. Hum Brain Mapp 2013; 34: 2733–46.
10. Clinical Practice Recommendation on the Diabetic Foot: A guide for health care professionals. International Diabetes Federation, 2017.
11. Aktas B, Utz A, Hoenig-Liedl P et al. Dipyridamole enhances NO/cGMP-mediated vasodilator-stimulated phosphoprotein phosphorylation and signaling in human platelets: in vitro and in vivo/ex vivo studies. Stroke 2003; 34: 764–9.
12. Chakrabarti S, Freedman JE. Dipyridamole, cerebrovascular disease, and the vasculature. Vasc Pharmacol 2008; 48: 143–9.
13. Nelson CW, Wei EP, Povlishock JT et al. Oxygen radicals in cerebral ischemia. Am J Physiol 1992; 263: H1356–H1362.
14. Weisbrot-Lefkowitz M, Reuhl K, Perry B et al. Overexpression of human glutathione peroxidase protects transgenic mice against focal cerebral ischemia/reperfusion damage. Brain Res Mol Brain Res 1998; 53: 333–8.
15. Grasso S, Bramanti V, Tomassoni D et al. Effect of lipoic acid and α-glyceryl-phosphoryl-choline on astroglial cell proliferation and differentiation in primary culture. J Neurosci Res 2014; 92: 86–94.
16. Nickander KK, McPhee BR, Low PA, Tritschler H. Alpha-lipoic acid: antioxidant potency against lipid peroxidation of neural tissues in vitro and implication for diabetic neuropathy. Free Radic Biol Med 1996; 21: 631–9.
17. Rochette L, Ghibu S, Muresan A, Vergely C. α-Lipoic acid: Molecular mechanisms and therapeutic potential in diabetes. Can J Physiol Pharmacol 2015; 93: 1021–7.
18. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med 2004; 21 (2): 114–21.
19. Ziegler D, Reljanovic M, Mehnert H et al. α-Lipoic acid in the treatment of diabetic polyneuropathy in Germany: Current evidence from clinical trials. Exp Clin Endocrinol Diabetes 1999; 107: 421–30.
20. Al'-Zamil' M.Kh, Brezhneva E.V. Primenenie preparatov al'fa-lipoevoi kisloty v lechenii diabeticheskoi neiropatii. Zhurn. nevrologii i psikhiatrii im. C.C.Korsakova. 2008; 2: 28–30. [in Russian]
21. Ametov A.S., Mamedova I.N. Klinicheskaia farmakologicheskaia terapiia. 2003; 12 (2): 74–80. [in Russian]
22. Shcheplev P.A., Kuznetskii Yu.Ya. Opyt primeneniia preparata Berlition v korrektsii erektil'noi disfunktsii u bol'nykh sakharnym diabetom 2 tipa. Andrologiia i genital'naia khirurgiia. 2004; 3: 40–2. [in Russian]
2. Gu K, Cowie CC, Harris MI. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993. Diabetes Care 1998; 21: 1138–45.
3. Folsom AR, Rasmussen ML, Chambless LE et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care 1999; 22 (7): 1077–83.
4. Selvin E, Coresh J, Zhu H et al. Measurement of HbA1c from stored whole blood samples in the Atherosclerosis Risk in Communities study. J Diabetes 2010; 2 (2): 118–24.
5. Yaffe K, Blackwell T, Whitmer RA et al. Glycosylated hemoglobin level and development of mild cognitive impairment or dementia in older women. J Nutr Health Aging 2006; 10 (4): 293–5.
6. Dejgaard A, Gade A, Larsson H et al. Evidence for diabetic encephalopathy. Diabet Med 1991; 8 (2): 162–7.
7. Ferguson SC, Blane A, Perros P et al. Cognitive ability and brain structure in type 1 diabetes: Relation to microangiopathy and preceding severe hypoglycemia. Diabetes 2003; 52 (1): 149–56.
8. Kastrup J, Rørsgaard S, Parving HH, Lassen NA. Impaired autoregulation of cerebral blood flow in long-term type I (insulin-dependent) diabetic patients with nephropathy and retinopathy. Clin Physiol 1986; 6 (6): 549–59.
9. Tseng MT, Chiang MC, Chao CC et al. fMRI evidence of degeneration-induced neuropathic pain in diabetes: enhanced limbic and striatal activations. Hum Brain Mapp 2013; 34: 2733–46.
10. Clinical Practice Recommendation on the Diabetic Foot: A guide for health care professionals. International Diabetes Federation, 2017.
11. Aktas B, Utz A, Hoenig-Liedl P et al. Dipyridamole enhances NO/cGMP-mediated vasodilator-stimulated phosphoprotein phosphorylation and signaling in human platelets: in vitro and in vivo/ex vivo studies. Stroke 2003; 34: 764–9.
12. Chakrabarti S, Freedman JE. Dipyridamole, cerebrovascular disease, and the vasculature. Vasc Pharmacol 2008; 48: 143–9.
13. Nelson CW, Wei EP, Povlishock JT et al. Oxygen radicals in cerebral ischemia. Am J Physiol 1992; 263: H1356–H1362.
14. Weisbrot-Lefkowitz M, Reuhl K, Perry B et al. Overexpression of human glutathione peroxidase protects transgenic mice against focal cerebral ischemia/reperfusion damage. Brain Res Mol Brain Res 1998; 53: 333–8.
15. Grasso S, Bramanti V, Tomassoni D et al. Effect of lipoic acid and α-glyceryl-phosphoryl-choline on astroglial cell proliferation and differentiation in primary culture. J Neurosci Res 2014; 92: 86–94.
16. Nickander KK, McPhee BR, Low PA, Tritschler H. Alpha-lipoic acid: antioxidant potency against lipid peroxidation of neural tissues in vitro and implication for diabetic neuropathy. Free Radic Biol Med 1996; 21: 631–9.
17. Rochette L, Ghibu S, Muresan A, Vergely C. α-Lipoic acid: Molecular mechanisms and therapeutic potential in diabetes. Can J Physiol Pharmacol 2015; 93: 1021–7.
18. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med 2004; 21 (2): 114–21.
19. Ziegler D, Reljanovic M, Mehnert H et al. α-Lipoic acid in the treatment of diabetic polyneuropathy in Germany: Current evidence from clinical trials. Exp Clin Endocrinol Diabetes 1999; 107: 421–30.
20. Аль-Замиль М.Х, Брежнева Е.В. Применение препаратов альфа-липоевой кислоты в лечении диабетической нейропатии. Журн. неврологии и психиатрии им. C.C.Корсакова. 2008; 2: 28–30. / Al'-Zamil' M.Kh, Brezhneva E.V. Primenenie preparatov al'fa-lipoevoi kisloty v lechenii diabeticheskoi neiropatii. Zhurn. nevrologii i psikhiatrii im. C.C.Korsakova. 2008; 2: 28–30. [in Russian]
21. Аметов А.С., Мамедова И.Н. Клиническая фармакологическая терапия. 2003; 12 (2): 74–80. / Ametov A.S., Mamedova I.N. Klinicheskaia farmakologicheskaia terapiia. 2003; 12 (2): 74–80. [in Russian]
22. Щеплев П.А., Кузнецкий Ю.Я. Опыт применения препарата Берлитион в коррекции эректильной дисфункции у больных сахарным диабетом 2 типа. Андрология и генитальная хирургия. 2004; 3: 40–2. / Shcheplev P.A., Kuznetskii Yu.Ya. Opyt primeneniia preparata Berlition v korrektsii erektil'noi disfunktsii u bol'nykh sakharnym diabetom 2 tipa. Andrologiia i genital'naia khirurgiia. 2004; 3: 40–2. [in Russian]
________________________________________________
2. Gu K, Cowie CC, Harris MI. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993. Diabetes Care 1998; 21: 1138–45.
3. Folsom AR, Rasmussen ML, Chambless LE et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care 1999; 22 (7): 1077–83.
4. Selvin E, Coresh J, Zhu H et al. Measurement of HbA1c from stored whole blood samples in the Atherosclerosis Risk in Communities study. J Diabetes 2010; 2 (2): 118–24.
5. Yaffe K, Blackwell T, Whitmer RA et al. Glycosylated hemoglobin level and development of mild cognitive impairment or dementia in older women. J Nutr Health Aging 2006; 10 (4): 293–5.
6. Dejgaard A, Gade A, Larsson H et al. Evidence for diabetic encephalopathy. Diabet Med 1991; 8 (2): 162–7.
7. Ferguson SC, Blane A, Perros P et al. Cognitive ability and brain structure in type 1 diabetes: Relation to microangiopathy and preceding severe hypoglycemia. Diabetes 2003; 52 (1): 149–56.
8. Kastrup J, Rørsgaard S, Parving HH, Lassen NA. Impaired autoregulation of cerebral blood flow in long-term type I (insulin-dependent) diabetic patients with nephropathy and retinopathy. Clin Physiol 1986; 6 (6): 549–59.
9. Tseng MT, Chiang MC, Chao CC et al. fMRI evidence of degeneration-induced neuropathic pain in diabetes: enhanced limbic and striatal activations. Hum Brain Mapp 2013; 34: 2733–46.
10. Clinical Practice Recommendation on the Diabetic Foot: A guide for health care professionals. International Diabetes Federation, 2017.
11. Aktas B, Utz A, Hoenig-Liedl P et al. Dipyridamole enhances NO/cGMP-mediated vasodilator-stimulated phosphoprotein phosphorylation and signaling in human platelets: in vitro and in vivo/ex vivo studies. Stroke 2003; 34: 764–9.
12. Chakrabarti S, Freedman JE. Dipyridamole, cerebrovascular disease, and the vasculature. Vasc Pharmacol 2008; 48: 143–9.
13. Nelson CW, Wei EP, Povlishock JT et al. Oxygen radicals in cerebral ischemia. Am J Physiol 1992; 263: H1356–H1362.
14. Weisbrot-Lefkowitz M, Reuhl K, Perry B et al. Overexpression of human glutathione peroxidase protects transgenic mice against focal cerebral ischemia/reperfusion damage. Brain Res Mol Brain Res 1998; 53: 333–8.
15. Grasso S, Bramanti V, Tomassoni D et al. Effect of lipoic acid and α-glyceryl-phosphoryl-choline on astroglial cell proliferation and differentiation in primary culture. J Neurosci Res 2014; 92: 86–94.
16. Nickander KK, McPhee BR, Low PA, Tritschler H. Alpha-lipoic acid: antioxidant potency against lipid peroxidation of neural tissues in vitro and implication for diabetic neuropathy. Free Radic Biol Med 1996; 21: 631–9.
17. Rochette L, Ghibu S, Muresan A, Vergely C. α-Lipoic acid: Molecular mechanisms and therapeutic potential in diabetes. Can J Physiol Pharmacol 2015; 93: 1021–7.
18. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med 2004; 21 (2): 114–21.
19. Ziegler D, Reljanovic M, Mehnert H et al. α-Lipoic acid in the treatment of diabetic polyneuropathy in Germany: Current evidence from clinical trials. Exp Clin Endocrinol Diabetes 1999; 107: 421–30.
20. Al'-Zamil' M.Kh, Brezhneva E.V. Primenenie preparatov al'fa-lipoevoi kisloty v lechenii diabeticheskoi neiropatii. Zhurn. nevrologii i psikhiatrii im. C.C.Korsakova. 2008; 2: 28–30. [in Russian]
21. Ametov A.S., Mamedova I.N. Klinicheskaia farmakologicheskaia terapiia. 2003; 12 (2): 74–80. [in Russian]
22. Shcheplev P.A., Kuznetskii Yu.Ya. Opyt primeneniia preparata Berlition v korrektsii erektil'noi disfunktsii u bol'nykh sakharnym diabetom 2 tipa. Andrologiia i genital'naia khirurgiia. 2004; 3: 40–2. [in Russian]
Авторы
О.В.Воробьева*
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*ovvorobeva@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
*ovvorobeva@mail.ru
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*ovvorobeva@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
*ovvorobeva@mail.ru
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