Астения у здоровых людей и при различных патологических состояниях в клинических примерах

Воробьева О.В., Евдокимова А.А., Романова А.А. Астения у здоровых людей и при различных патологических состояниях в клинических примерах. Consilium Medicum. 2025;27(11):711–717. DOI: 10.26442/20751753.2025.11.203497

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Vorobeva OV, Evdokimova AA, Romanova AA. Asthenia in healthy individuals and patients with various conditions: clinical cases. Consilium Medicum. 2025;27(11):711–717. DOI: 10.26442/20751753.2025.11.203497

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Аннотация

Астения имеет широкий спектр потенциальных биологических, психологических, социальных причин, и прямую причинно-следственную связь не всегда можно точно установить. Цель работы − иллюстрация клиническими примерами различных категорий астении и обобщение опыта использования препарата Стимол^® (цитруллина малат). Представлено 3 клинических случая, демонстрирующих: 1) патологическую усталость, связанную с социальными факторами; 2) мультикаузальную астению, связанную с лекарственной терапией у пациента с гипертонической болезнью и церебральной микроангиопатией; 3) поствирусную (SARS-CoV-2) астению с трансформацией в синдром хронической усталости. Несмотря на разные стимулы, запускающие патологический процесс, в конечном итоге наблюдается универсальная реакция организма в виде гомеостатического истощения, что позволяет рассматривать эргогенные препараты как важное звено терапии астении любого генеза. Всем пациентам успешно проведена комплексная терапия, включающая 10–12-дневный курс цитруллина малата (Стимол^®) в дозе 3 г/сут. Таким образом, эргогенные препараты можно считать важным звеном терапии астении любого генеза. Стимол^® демонстрирует высокую эффективность в качестве удобного и безопасного корректора энергетического дефицита, характерного для пациентов с астенией.

Ключевые слова: астения, патологическая усталость, синдром хронической усталости, цитруллина малат, Стимол

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Asthenia has a wide range of potential biological, psychological, and social causes, and a direct causal relationship cannot always be accurately established. The paper aims to present clinical cases of various categories of asthenia and to summarize experience with Stimol^® (citrulline malate). Three clinical cases were presented, demonstrating 1) fatigue associated with social factors; 2) multicausal asthenia associated with drug therapy in a patient with hypertension and cerebral microangiopathy; 3) post-viral (SARS-CoV-2) asthenia with transformation into chronic fatigue syndrome. Despite the different stimuli that trigger the pathological process, a universal body reaction of homeostatic exhaustion is ultimately observed, suggesting that ergogenic drugs can be an important part of the therapy of any asthenia. All patients successfully received complex therapy, including a 10–12-day course of citrulline malate (Stimol^®) at a dose of 3 g/day. Thus, ergogenic drugs can be considered an important part of the therapy of any asthenia. Stimol^® demonstrates high effectiveness as a convenient and safe agent for correcting energy deficiency in patients with asthenia.

Keywords: asthenia, fatigue, chronic fatigue syndrome, citrulline malate, Stimol

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________________________________________________

1. Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet. 1999;354(9182):936-9. DOI:10.1016/S0140-6736(98)08320-2
2. Strebkova R. Cancer-related Fatigue in Patients with Oncological Diseases: Causes, Prevalence, Guidelines for Assessment and Management. Folia Med (Plovdiv). 2020;62(4):679-89. DOI:10.3897/folmed.62.e50517
3. Kutlubaev MA, Akhmetova AI. Poststroke asthenic disorder. Ann Clin Exper Neurol. 2023;17(4):64-71 (in Russian). DOI:10.54101/ACEN.2023.4.8
4. Swaen GMH, van Amelsvoort LGPM, Bültmann U, Kant IJ. Fatigue as a risk factor for being injured in an occupational accident: results from the Maastricht Cohort Study. Occup Environ Med. 2003;60 (Suppl. 1):i88-92. DOI:10.1136/oem.60.suppl_1.i88
5. De Vries, Michielsen H, Van Heck GL, Drent M. Measuring fatigue in sarcoidosis: the Fatigue Assessment Scale (FAS). Br J Health Psychol. 2004;9(Pt 3):279-91. DOI:10.1348/1359107041557048
6. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81. DOI:10.1249/00005768-198205000-00012
7. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Arch Neurol. 1989;46(10):1121-4. DOI:10.1001/archneur.1989.00520460115022
8. Fisk JD, Ritvo PG, Ross L, et al. Measuring the Functional Impact of Fatigue: Initial Validation of the Fatigue Impact Scale. Clin Infect Dis. 1994;8(Suppl. 1):S79-83. DOI:10.1093/clinids/18.Supplement_1.S79
9. Vorobeva OV, Rusaya VV. Pharmacotherapy of anxiety disorders in patients with chronic cerebral ischemia. Zhurnal nevrologii i psikhiatrii im. C.C. Korsakova. 2016;116(12-2):49-55 (in Russian). DOI:10.17116/jnevro201611612249-54
10. Van Eijsden HM, van de Port IG, Visser-Meily JM, Kwakkel G. Poststroke fatigue: who is at risk for an increase in fatigue? Stroke Res Treat. 2012;2012:863978. DOI:10.1155/2012/863978
11. Committee on the diagnostic criteria for myalgic encephalomyelitis/Chronic Fatigue Syndrome; Board on the Health of Select Populations, Institute of Medicine. Beyond myalgic encephalomyelitis/Chronic Fatigue Syndrome: redefining an illness. Washington (DC): National Academies Press (US), 2015. DOI:10.17226/19012
12. Strobera LB, Brucec JM, Arnettd PA, et al. A new look at an old test: Normative data of the symbol digit modalities test – Oral version. Mult Scler Relat Disord. 2020;43:102154. DOI:10.1016/j.msard.2020.102154
13. Vollbracht C, Kraft K. Feasibility of vitamin C in the treatment of post viral fatigue with focus on long COVID, based on a systematic review of IV vitamin C on fatigue. Nutrients. 2021;13(4):1154. DOI:10.3390/nu13041154
14. Fukuda S, Nojima J, Motoki Y, et al. A potential biomarker for fatigue: oxidative stress and anti-oxidative activity. Biol Psychol. 2016;118:88-93. DOI:10.1016/j.biopsycho.2016.05.005
15. Nyawose S, Naidoo R, Naumovski N, McKune AJ. The Effects of Consuming Amino Acids L-Arginine, L-Citrulline (and Their Combination) as a Beverage or Powder, on Athletic and Physical Performance: A Systematic Review. Beverages. 2022;8(3):48. DOI:10.3390/beverages8030048
16. Takeda K, Machida M, Kohara A, et al. Effects of citrulline supplementation on fatigue and exercise performance in mice. J Nutr Sci Vitaminol (Tokyo). 2011;57(3):246-50. DOI:10.3177/jnsv.57.246
17. Martinez-Sanchez A, Ramos-Campo DJ, Fernandez-Lobato B, et al. Biochemical, physiological, and performance response of a functional watermelon juice enriched in L-citrulline during a half-marathon race. Food Nutr Res. 2017;61(1):1330098. DOI:10.1080/16546628.2017.1330098
18. Gonzalez AM, Trexler ET. Effects of Citrulline Supplementation on Exercise Performance in Humans: A Review of the Current Literature. J Strength Cond Res. 2020;34(5):1480-95. DOI:10.1519/JSC.0000000000003426
19. Wax B, Kavazis AN, Weldon K, Sperlak J. Effects of supplemental citrulline malate ingestion during repeated bouts of lower-body exercise in advanced weightlifters. J Strength Cond Res. 2015;29(3):786-92. DOI:10.1519/JSC.0000000000000670
20. Chappell AJ, Allwood DM, Simper TN. Citrulline malate fails to improve German volume training performance in healthy young men and women. J Diet Suppl. 2020;17(3):249-60. DOI:10.1080/19390211.2018.1513433
21. Gonzalez AM, Spitz RW, Ghigiarelli JJ, et al. Acute effect of citrulline malate supplementation on upper-body resistance exercise performance in recreationally resistance-trained men. J Strength Cond Res. 2018;32(11):3088-94. DOI:10.1519/JSC.0000000000002373
22. Trexler ET, Persky AM, Ryan ED, et al. Acute effects of citrulline supplementation on high-intensity strength and power performance: A systematic review and meta-analysis. Sports Med. 2019;49(5):707-18. DOI:10.1007/s40279-019-01091-z
23. Perez-Guisado J, Jakeman PM. Citrulline malate enhances athletic anaerobic performance and relieves muscle soreness. J Strength Cond Res. 2010;24(5):1215-22. DOI:10.1519/JSC.0b013e3181cb28e0
24. Varvik FT, Bjornsen T, Gonzalez AM. Acute Effect of Citrulline Malate on Repetition Performance During Strength Training: A Systematic Review and Meta-Analysis. Int J Sport Nutr Exerc Metab. 2021;31(4):350-8. DOI:10.1123/ijsnem.2020-0295
25. Dubnitskaya EB. Stimol pri astenicheskikh sostoianiyakh v spetsializirovannoi i obshchemeditsinskoi praktike (obzor literatury). Psychiatry and Psychopharmacotherapy. 2010;12(4):12-4 (in Russian). EDN:NDGHFP
26. Gromova OA, Zakharova IN, Torshin IY, et al. About pathophysiological therapy of asthenia in children by citrulline malate drugs. Meditsinskiy Sovet. 2017;(19):142-8 (in Russian). DOI:10.21518/2079-701X-2017-19-142-148
27. Oknin VIu, Fedotova AV, Vein AM. Use of citrulline malate (stimol) in patients with autonomic dystonia associated with arterial hypotension. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 1999;99(1):30-3 (in Russian).
28. Kukes IV, Lim VG, Ivantsov KA, et al. Evaluation of the effectiveness of Stimol in the treatment of asthenic syndrome after infection with COVID-19. Pharmacology & Pharmacotherapy. 2023;3:56-66 (in Russian). DOI:10.46393/27132129_2023_3_56
29. Moinard C, Nicolis I, Neveux N, et al. Dose-ranging effects of citrulline administration on plasma amino acids and hormonal patterns in healthy subjects: The Citrudose pharmacokinetic study. Br J Nutr. 2008;99(4):855-62. DOI:10.1017/S0007114507841110

Авторы

О.В. Воробьева*, А.А. Евдокимова, А.А. Романова

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Российская Федерация
*ovvorobeva@mail.ru

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Olga V. Vorobeva*, Anastasiya A. Evdokimova, Anastasia A. Romanova

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
*ovvorobeva@mail.ru

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