Диабетическая полиневропатия (ДПН) – частое неврологическое осложнение сахарного диабета. Наиболее распространенной клинической формой ДПН является дистальная симметричная, преимущественно сенсорная, полиневропатия (ДСПН), нередко сопровождающаяся болевым синдромом. Цель работы – оценить эффективность применения ипидакрина (Ипигрикса) в рамках комплексной терапии ДСПН. Динамика клинических и нейрофизиологических проявлений ДПН в виде появления ранее отсутствовавших сухожильных рефлексов, уменьшения зоны и выраженности сенсорных нарушений, интенсивности невропатической боли, увеличения амплитуды моторных и сенсорных ответов в ответ на стимуляцию периферических нервов свидетельствует об активации процессов реиннервации на фоне терапии с использованием ипидакрина. Оценивая положительный эффект в отношении восстановления структуры и функции периферических нервов, хорошую переносимость и безопасность ипидакрина (Ипигрикса), возможно рекомендовать применение препарата у пациентов с ДСПН.
Diabetic polyneuropathy (DPN) is a common neurological complication of diabetes mellitus. The most common DPN type is distal symmetric, predominantly sensory, polyneuropathy (DSPN), often accompanied by pain syndrome. This article is aimed to evaluate of ipidacrine (Ipigrix) efficacy in complex DSPN therapy. The dynamics of clinical and neurophysiological manifestations of DPN in the form of the appearance of previously absent tendon reflexes, a decrease in the area and severity of sensory disturbances, the intensity of neuropathic pain, an increase in the amplitude of motor and sensory responses in response to stimulation of peripheral nerves indicates the activation of reinnervation processes against the background of therapy using ipidacrine. Assessing the positive effect on the restoration of the structure and function of peripheral nerves, good tolerability
and safety of ipidacrine (Ipigrix), it is possible to recommend the drug in patients with DSPN.
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(in Russian)]. DOI:10.24411/2226-0757-2018-12019
________________________________________________
1. IDF Diabetes Atlas, 9th edition. Brussels: International Diabetes Federation, 2019. Available at: https://www.diabetesatlas.org/en. Accessed: 13.02.2022.
2. Neeland IJ, Patel KV. Diabetes: Key Markers of Injury and Prognosis. In: Biomarkers in Cardiovascular Disease. Ed. V Nambi. Netherlands: Elsevier, 2019; p. 41-51.
DOI:10.1016/B978-0-323-54835-9.00004-1
3. Hicks CW, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diabetes Rep. 2019;19(10):86. DOI:10.1007/s11892-019-1212-8
4. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44 (Suppl. 1):S15-33. DOI:10.2337/dc21-S002
5. Maslova OV, Suntsov YuI. Epidemiology of diabetes mellitus and microvascular complications. Diabetes mellitus. 2011;3:6-11 (in Russian).
6. Tesfaye S, Boulton AJ, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285-93. DOI:10.2337/dc10-1303
7. Gordon SA, Singleton JR. Diabetic neuropathy. Continuum (Minneap Minn). 2012;18(1):60-84. DOI:10.1212/01.CON.0000411568.34085.3e
8. 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. DOI:10.1212/wnl.43.4.817
9. Zinovyeva OE, Ostroumova TM, Koniashova MV, Gorbachev NA. Evaluation and treatment of peripheral nervous system dysfunction in patients with prediabetes. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(5):116-22 (in Russian).
10. Singleton JR, Smith AG, Russell J, Feldman EL. Polyneuropathy with Impaired Glucose Tolerance: Implications for Diagnosis and Therapy. Curr Treat Options Neurol. 2005;7(1):33-42. DOI:10.1007/s11940-005-0004-4
11. Ndip A, Ebah L, Mbako A. Neuropathic diabetic foot ulcers - evidence-to- practice. Int J Gen Med. 2012;5:129-34. DOI:10.2147/IJGM.S10328
12. Feldman EL, Stevens MJ, Thomas PK, et al. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994;17(11):1281-9. DOI:10.2337/diacare.17.11.1281
13. Herman WH, Pop-Busui R, Braffett BH, et al. Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. Diabet Med. 2012;29(7):937-44.
DOI:10.1111/j.1464-5491.2012.03644.x
14. Ziegler D, Papanas N, Zhivov A, et al. Early detection of nerve fiber loss by corneal confocal microscopy and skin biopsy in recently diagnosed type 2 diabetes. Diabetes. 2014;63(7):2454-63. DOI:10.2337/db13-1819
15. Tesfaye S, Vileikyte L, Rayman G, et al. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes Metab Res Rev. 2011;27(7):629-38. DOI:10.1002/dmrr.1225
16. Figueroa-Romero C, Sadidi M, Feldman EL. Mechanisms of disease: the oxidative stress theory of diabetic neuropathy. Rev Endocr Metab Disord. 2008;9(4):301-14. DOI:10.1007/s11154-008-9104-2
17. Yan LJ. Redox imbalance stress in diabetes mellitus: Role of the polyol pathway. Animal Model Exp Med. 2018;1(1):7-13. DOI:10.1002/ame2.12001
18. Park S, Kang HJ, Jeon JH, et al. Recent advances in the pathogenesis of microvascular complications in diabetes. Arch Pharm Res. 2019;42(3):252-62.
DOI:10.1007/s12272-019-01130-3
19. Nowotny K, Jung T, Höhn A, et al. Advanced glycation end products and oxidative stress in type 2 diabetes mellitus. Biomolecules. 2015;5(1):194-222. DOI:10.3390/biom5010194
20. Sugimoto K, Yasujima M, Yagihashi S. Role of advanced glycation end products in diabetic neuropathy. Curr Pharm Des. 2008;14(10):953-61. DOI:10.2174/138161208784139774
21. Kennedy JM, Zochodne DW. Impaired peripheral nerve regeneration in diabetes mellitus. J Peripher Nerv Syst. 2005;10(2):144-57. DOI:10.1111/j.1085-9489.2005.0010205.x
22. Sango K, Mizukami H, Horie H, Yagihashi S. Impaired Axonal Regeneration in Diabetes. Perspective on the Underlying Mechanism from In Vivo and In Vitro Experimental Studies. Front Endocrinol (Lausanne). 2017;8:12. DOI:10.3389/fendo.2017.00012
23. Leinninger GM, Vincent AM, Feldman EL. The role of growth factors in diabetic peripheral neuropathy. J Peripher Nerv Syst. 2004;9(1):26-53. DOI:10.1111/j.1085-9489.2004.09105.x
24. The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med. 1995;122(8):561-8. DOI:10.7326/0003-4819-122-8-199504150-00001
25. Ametov AS, Soluianova TN. Preimushchestva benfotiamina v lechenii diabeticheskoi polineiropatii. Effektivnaia farmakoterapiia v endokrinologii. 2008;1:1-4 (in Russian).
26. Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006;29(11):2365-70. DOI:10.2337/dc06-1216
27. Kukushkin ML, Karpova MN, Kuznetsova LV, Klishina NYu. Analgesic effect ipidacrine. Russian journal of pain. 2019;17(3):29-33 (in Russian). DOI:10.25731/RASP.2019.03.29
28. Strokov IA, Zinov'eva OE, Barinov AN, Akhmedzhanova LT. Neiromidin v lechenii diabeticheskoi polinevropatii. Nevrologicheskii zhurnal. 2007;12(6):52-5 (in Russian).
29. Magomedova AM, Merkulov YA, Biglova AN, et al. An outpatient with hand numbness: old prejudices, new strategies of differential diagnosis and treatment. Zhurnal Nevrologii i Psikhiatrii im. SS Korsakova. 2019;119(3):16-23 (in Russian). DOI:10.17116/jnevro201911903116
30. Zhivolupov SA, Samartsev IN. Neuroplasticity: pathophysiological patterns and perspectives of therapeutic modulation. Zhurnal Nevrologii i Psikhiatrii Im. SS Korsakova. 2009;109(4):78-85 (in Russian).
31. Katunina EA, Avanesova OV, Pestovskaia OR, et al. Primenenie ingibitorov atsetilkholinesterazy pri lechenii zabolevanii perifericheskoi nervnoi sistemy. Farmateka. 2009;15:51-7 (in Russian).
32. Rachin AP, Sharov MN, Rachin SA, Prokof'eva IuS. Nabliudatel'noe issledovanie po otsenke effektivnosti primeneniia preparata Ipigriks pri diabeticheskoi polinevropatii (issledovanie NIRVANA). Nervnye bolezni. 2018;2:26-30
(in Russian). DOI:10.24411/2226-0757-2018-12019
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*egorovpd@vk.com
________________________________________________
Olga E. Zinovyeva, Pavel D. Egorov*, Anna I. Penkina, Samir S. Guseinov
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*egorovpd@vk.com