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Диабетическая полиневропатия - Справочник поликлинического врача №4 (2017)
Диабетическая полиневропатия
Ганькина О.А., Левин О.С. Диабетическая полиневропатия. Справочник поликлинического врача. 2017; 4: 70–77.
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Аннотация
В обзорной статье рассмотрены современные представления о распространенности, клинической картине, подходах к диагностике и лечению одного из наиболее частых неврологических осложнений сахарного диабета – диабетической полиневропатии, как соматические, так и вегетативные ее проявления. Развитие невропатии имеет высокую распространенность среди больных диабетом, а клинически выраженные ее формы отражают тяжелое течение сахарного диабета и служат неблагоприятным прогностическим признаком, сопряженным с увеличением смертности примерно в 5 раз. В то же время своевременное выявление и адекватная коррекция ее проявлений могут существенно улучшать качество жизни больных. Рассмотрены возможности патогенетической терапии диабетической полиневропатии, связанные с применением бенфотиамина и α-липоевой кислоты, а также симптоматической терапии ее отдельных проявлений.
Ключевые слова: сахарный диабет, полиневропатия, бенфотиамин, α-липоевая кислота.
Key words: diabetes mellitus, polyneuropathy, benfotiamine, α-lipoic acid.
Ключевые слова: сахарный диабет, полиневропатия, бенфотиамин, α-липоевая кислота.
________________________________________________
Key words: diabetes mellitus, polyneuropathy, benfotiamine, α-lipoic acid.
Полный текст
Список литературы
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22. Shaw JE, Zimmet PZ, Gries FA, Ziegler D. Epidemiology of diabetic neuropathy. In: Gries FA, Cameron NE, Low PA (eds). Textbook of Diabetic Neuropathy. New York: Thieme, 2003; p. 64–82.
23. Stracke H, Gaus W, Achenbach U et al. Benfotiamine in Diabetic Polyneuropathy (BENDIP): Results of a randomised, double-blind, placebo-controlled clinical study. Exp Clin Endocrinol Diabetes 2008; 116: 600 – 5.
24. Tesfaye S, Stevens LK, Stephenson JM et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia 1996; 39: 1377–84.
25. Trence DL. Peripheral neuropathy in diabetes: is it diabetic neuropathy? Clin Diabetes 2002; 20: 103–4.
26. Vinik AI, Maser RE, Mitchell BD et al. Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 53–81.
27. Vinik AI, Mehrabyan A. Diabetic neuropathies. Med Clin North Am 2004; 88: 947–99.
28. Ziegler D. Treatment of diabetic neuropathy and neuropathic pain. Diabetes Care 2008; 31: 255–61.
29. Ziegler D, Hanefeld M, Ruhnau RJ et al. The ALADIN III Study group. Treatment of symptomatic diabetic peripherial neuropathy with antioxidant alpha-lipoic acid. Diabetes Care 1999; 22: 1296–1301.
30. 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: 2365–70.
31. Ziegler D. Thioctic acid for patients with symptomatic diabetic neuropathy: a critical review. Treat Endocrinol 2004; 3 (3): 173–89.
32. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysi. Diabet Med 2004; 21 (2): 114–21.
2. Levin O.S. Polinevropatiia. M.: MIA, 2006. [in Russian]
3. Strokov I.A., Barinov A.N. Klinika, patogenez i lechenie bolevogo sindroma pri diabeticheskoi polinevropatii. Nevrol. zhurn. 2001; 6: 47–54. [in Russian]
4. Shtul'man D.R., Levin O.S. Nevrologiia: spravochnik prakticheskogo vracha. M.: Medpress-inform, 2008. [in Russian]
5. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009; 32 (Suppl. 1): S62–S67.
6. Ametov AS, Barinov A, Dyck PJ et al. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid. Diabetes Care 2003; 26: 770–6.
7. Androne L, Gavan NA, Veresiu IA, Orasan R. In vivo effect of lipoic acid on lipid peroxidation in patients with diabetic neuropathy. In Vivo 2000; 14: 327–30.
8. Boulton AJ, Vinik AI, Arezzo JC et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 2005; 28 (4): 956–62.
9. Boulton A, Tesfaye S (eds). Diabetic neuropathy. Oxford, 2009; p.98.
10. Dyck PJ, Karnes JL, O’Brien PC et al. The Rochester Diabetic Neuropathy study: reassessment of tests and criteria for diagnosis and staged severity. Neurology 1992; 42: 1164-70.
11. Dyck PJ, Thomas PK (eds). Diabetic neuropathy. 2nd ed. Philadelphia: WB Saunders, 1999.
12. Dyck PJB. Diabetic Radiculoplexus Neuropathies. In. Neurological therapeutics: principles and practice. J.H.Noseworthy (ed). Martin Dunitz, 2003; p. 2007–10.
13. Dyck PJ, Karnes JL, O’Brien PC et al. The Rochester Diabetic Neuropathy Study: reassessment of tests and criteria for diagnosis and staged severity. Neurology 1992; 42: 1164–70.
14. Gries FA, Cameron NE, Low PA (eds). Textbook of Diabetic Neuropathy. Stuttgart: Thieme, 2003.
15. Han D, Handelman G, Marcocci L et al. Lipoic acid increases de novo synthesis of cellular glutathione by improving cystine utilization. Biofactors 1997; 6 (3): 321–38.
16. Heitzer T, Finckh B, Albers S et al. Benefficial effects of alpha-lipoic acid and ascorbic acid on endothelium-dependent, nitric oxide-mediated vasodilation in diabetic patients: relation to parameters of oxidative stress. Free Radic Biol Med 2001; 31: 53–61.
17. Kishi Y, Schmelzer JD, Yao JK et al. Alpha-lipoic acid: effect on glucose uptake, sorbitol pathway, and energy metabolism in experimental diabetic neuropathy. Diabetes 1999; 48: 2045–51.
18. Kramer H, Rolke R, Hecht M et al. Follow-up of advanced diabetic neuropathy. J Neurol 2005: 315–20.
19. Low PA, Benrud-Larsen LM, Sletten DM et al. Autonomic symptoms and diabetic neuropathy: a population-based study. Diabetes Care 2004; 27: 2942–7.
20. Reljanovic M, Reichel G, Rett K et al. The ALADIN II Study Group: Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two-year mylticenter randomized double blind placebo contorolled trial (ALADIN II). Free Radic Res 1999; 31: 171–9.
21. Said G, Baudoin D, Toyooka K. Sensory loss, pains, motor deficit and axonal regeneration in length-dependent diabetic polyneuropathy. J Neurol 2008; 255: 1693–702.
22. Shaw JE, Zimmet PZ, Gries FA, Ziegler D. Epidemiology of diabetic neuropathy. In: Gries FA, Cameron NE, Low PA (eds). Textbook of Diabetic Neuropathy. New York: Thieme, 2003; p. 64–82.
23. Stracke H, Gaus W, Achenbach U et al. Benfotiamine in Diabetic Polyneuropathy (BENDIP): Results of a randomised, double-blind, placebo-controlled clinical study. Exp Clin Endocrinol Diabetes 2008; 116: 600 – 5.
24. Tesfaye S, Stevens LK, Stephenson JM et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia 1996; 39: 1377–84.
25. Trence DL. Peripheral neuropathy in diabetes: is it diabetic neuropathy? Clin Diabetes 2002; 20: 103–4.
26. Vinik AI, Maser RE, Mitchell BD et al. Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 53–81.
27. Vinik AI, Mehrabyan A. Diabetic neuropathies. Med Clin North Am 2004; 88: 947–99.
28. Ziegler D. Treatment of diabetic neuropathy and neuropathic pain. Diabetes Care 2008; 31: 255–61.
29. Ziegler D, Hanefeld M, Ruhnau RJ et al. The ALADIN III Study group. Treatment of symptomatic diabetic peripherial neuropathy with antioxidant alpha-lipoic acid. Diabetes Care 1999; 22: 1296–1301.
30. 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: 2365–70.
31. Ziegler D. Thioctic acid for patients with symptomatic diabetic neuropathy: a critical review. Treat Endocrinol 2004; 3 (3): 173–89.
32. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysi. Diabet Med 2004; 21 (2): 114–21.
2. Левин О.С. Полиневропатия. М.: МИА, 2006. / Levin O.S. Polinevropatiia. M.: MIA, 2006. [in Russian]
3. Строков И.А., Баринов А.Н. Клиника, патогенез и лечение болевого синдрома при диабетической полиневропатии. Неврол. журн. 2001; 6: 47–54. / Strokov I.A., Barinov A.N. Klinika, patogenez i lechenie bolevogo sindroma pri diabeticheskoi polinevropatii. Nevrol. zhurn. 2001; 6: 47–54. [in Russian]
4. Штульман Д.Р., Левин О.С. Неврология: справочник практического врача. М.: Медпресс-информ, 2008. / Shtul'man D.R., Levin O.S. Nevrologiia: spravochnik prakticheskogo vracha. M.: Medpress-inform, 2008. [in Russian]
5. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009; 32 (Suppl. 1): S62–S67.
6. Ametov AS, Barinov A, Dyck PJ et al. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid. Diabetes Care 2003; 26: 770–6.
7. Androne L, Gavan NA, Veresiu IA, Orasan R. In vivo effect of lipoic acid on lipid peroxidation in patients with diabetic neuropathy. In Vivo 2000; 14: 327–30.
8. Boulton AJ, Vinik AI, Arezzo JC et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 2005; 28 (4): 956–62.
9. Boulton A, Tesfaye S (eds). Diabetic neuropathy. Oxford, 2009; p.98.
10. Dyck PJ, Karnes JL, O’Brien PC et al. The Rochester Diabetic Neuropathy study: reassessment of tests and criteria for diagnosis and staged severity. Neurology 1992; 42: 1164-70.
11. Dyck PJ, Thomas PK (eds). Diabetic neuropathy. 2nd ed. Philadelphia: WB Saunders, 1999.
12. Dyck PJB. Diabetic Radiculoplexus Neuropathies. In. Neurological therapeutics: principles and practice. J.H.Noseworthy (ed). Martin Dunitz, 2003; p. 2007–10.
13. Dyck PJ, Karnes JL, O’Brien PC et al. The Rochester Diabetic Neuropathy Study: reassessment of tests and criteria for diagnosis and staged severity. Neurology 1992; 42: 1164–70.
14. Gries FA, Cameron NE, Low PA (eds). Textbook of Diabetic Neuropathy. Stuttgart: Thieme, 2003.
15. Han D, Handelman G, Marcocci L et al. Lipoic acid increases de novo synthesis of cellular glutathione by improving cystine utilization. Biofactors 1997; 6 (3): 321–38.
16. Heitzer T, Finckh B, Albers S et al. Benefficial effects of alpha-lipoic acid and ascorbic acid on endothelium-dependent, nitric oxide-mediated vasodilation in diabetic patients: relation to parameters of oxidative stress. Free Radic Biol Med 2001; 31: 53–61.
17. Kishi Y, Schmelzer JD, Yao JK et al. Alpha-lipoic acid: effect on glucose uptake, sorbitol pathway, and energy metabolism in experimental diabetic neuropathy. Diabetes 1999; 48: 2045–51.
18. Kramer H, Rolke R, Hecht M et al. Follow-up of advanced diabetic neuropathy. J Neurol 2005: 315–20.
19. Low PA, Benrud-Larsen LM, Sletten DM et al. Autonomic symptoms and diabetic neuropathy: a population-based study. Diabetes Care 2004; 27: 2942–7.
20. Reljanovic M, Reichel G, Rett K et al. The ALADIN II Study Group: Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two-year mylticenter randomized double blind placebo contorolled trial (ALADIN II). Free Radic Res 1999; 31: 171–9.
21. Said G, Baudoin D, Toyooka K. Sensory loss, pains, motor deficit and axonal regeneration in length-dependent diabetic polyneuropathy. J Neurol 2008; 255: 1693–702.
22. Shaw JE, Zimmet PZ, Gries FA, Ziegler D. Epidemiology of diabetic neuropathy. In: Gries FA, Cameron NE, Low PA (eds). Textbook of Diabetic Neuropathy. New York: Thieme, 2003; p. 64–82.
23. Stracke H, Gaus W, Achenbach U et al. Benfotiamine in Diabetic Polyneuropathy (BENDIP): Results of a randomised, double-blind, placebo-controlled clinical study. Exp Clin Endocrinol Diabetes 2008; 116: 600 – 5.
24. Tesfaye S, Stevens LK, Stephenson JM et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia 1996; 39: 1377–84.
25. Trence DL. Peripheral neuropathy in diabetes: is it diabetic neuropathy? Clin Diabetes 2002; 20: 103–4.
26. Vinik AI, Maser RE, Mitchell BD et al. Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 53–81.
27. Vinik AI, Mehrabyan A. Diabetic neuropathies. Med Clin North Am 2004; 88: 947–99.
28. Ziegler D. Treatment of diabetic neuropathy and neuropathic pain. Diabetes Care 2008; 31: 255–61.
29. Ziegler D, Hanefeld M, Ruhnau RJ et al. The ALADIN III Study group. Treatment of symptomatic diabetic peripherial neuropathy with antioxidant alpha-lipoic acid. Diabetes Care 1999; 22: 1296–1301.
30. 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: 2365–70.
31. Ziegler D. Thioctic acid for patients with symptomatic diabetic neuropathy: a critical review. Treat Endocrinol 2004; 3 (3): 173–89.
32. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysi. Diabet Med 2004; 21 (2): 114–21.
________________________________________________
2. Levin O.S. Polinevropatiia. M.: MIA, 2006. [in Russian]
3. Strokov I.A., Barinov A.N. Klinika, patogenez i lechenie bolevogo sindroma pri diabeticheskoi polinevropatii. Nevrol. zhurn. 2001; 6: 47–54. [in Russian]
4. Shtul'man D.R., Levin O.S. Nevrologiia: spravochnik prakticheskogo vracha. M.: Medpress-inform, 2008. [in Russian]
5. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009; 32 (Suppl. 1): S62–S67.
6. Ametov AS, Barinov A, Dyck PJ et al. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid. Diabetes Care 2003; 26: 770–6.
7. Androne L, Gavan NA, Veresiu IA, Orasan R. In vivo effect of lipoic acid on lipid peroxidation in patients with diabetic neuropathy. In Vivo 2000; 14: 327–30.
8. Boulton AJ, Vinik AI, Arezzo JC et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 2005; 28 (4): 956–62.
9. Boulton A, Tesfaye S (eds). Diabetic neuropathy. Oxford, 2009; p.98.
10. Dyck PJ, Karnes JL, O’Brien PC et al. The Rochester Diabetic Neuropathy study: reassessment of tests and criteria for diagnosis and staged severity. Neurology 1992; 42: 1164-70.
11. Dyck PJ, Thomas PK (eds). Diabetic neuropathy. 2nd ed. Philadelphia: WB Saunders, 1999.
12. Dyck PJB. Diabetic Radiculoplexus Neuropathies. In. Neurological therapeutics: principles and practice. J.H.Noseworthy (ed). Martin Dunitz, 2003; p. 2007–10.
13. Dyck PJ, Karnes JL, O’Brien PC et al. The Rochester Diabetic Neuropathy Study: reassessment of tests and criteria for diagnosis and staged severity. Neurology 1992; 42: 1164–70.
14. Gries FA, Cameron NE, Low PA (eds). Textbook of Diabetic Neuropathy. Stuttgart: Thieme, 2003.
15. Han D, Handelman G, Marcocci L et al. Lipoic acid increases de novo synthesis of cellular glutathione by improving cystine utilization. Biofactors 1997; 6 (3): 321–38.
16. Heitzer T, Finckh B, Albers S et al. Benefficial effects of alpha-lipoic acid and ascorbic acid on endothelium-dependent, nitric oxide-mediated vasodilation in diabetic patients: relation to parameters of oxidative stress. Free Radic Biol Med 2001; 31: 53–61.
17. Kishi Y, Schmelzer JD, Yao JK et al. Alpha-lipoic acid: effect on glucose uptake, sorbitol pathway, and energy metabolism in experimental diabetic neuropathy. Diabetes 1999; 48: 2045–51.
18. Kramer H, Rolke R, Hecht M et al. Follow-up of advanced diabetic neuropathy. J Neurol 2005: 315–20.
19. Low PA, Benrud-Larsen LM, Sletten DM et al. Autonomic symptoms and diabetic neuropathy: a population-based study. Diabetes Care 2004; 27: 2942–7.
20. Reljanovic M, Reichel G, Rett K et al. The ALADIN II Study Group: Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two-year mylticenter randomized double blind placebo contorolled trial (ALADIN II). Free Radic Res 1999; 31: 171–9.
21. Said G, Baudoin D, Toyooka K. Sensory loss, pains, motor deficit and axonal regeneration in length-dependent diabetic polyneuropathy. J Neurol 2008; 255: 1693–702.
22. Shaw JE, Zimmet PZ, Gries FA, Ziegler D. Epidemiology of diabetic neuropathy. In: Gries FA, Cameron NE, Low PA (eds). Textbook of Diabetic Neuropathy. New York: Thieme, 2003; p. 64–82.
23. Stracke H, Gaus W, Achenbach U et al. Benfotiamine in Diabetic Polyneuropathy (BENDIP): Results of a randomised, double-blind, placebo-controlled clinical study. Exp Clin Endocrinol Diabetes 2008; 116: 600 – 5.
24. Tesfaye S, Stevens LK, Stephenson JM et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia 1996; 39: 1377–84.
25. Trence DL. Peripheral neuropathy in diabetes: is it diabetic neuropathy? Clin Diabetes 2002; 20: 103–4.
26. Vinik AI, Maser RE, Mitchell BD et al. Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 53–81.
27. Vinik AI, Mehrabyan A. Diabetic neuropathies. Med Clin North Am 2004; 88: 947–99.
28. Ziegler D. Treatment of diabetic neuropathy and neuropathic pain. Diabetes Care 2008; 31: 255–61.
29. Ziegler D, Hanefeld M, Ruhnau RJ et al. The ALADIN III Study group. Treatment of symptomatic diabetic peripherial neuropathy with antioxidant alpha-lipoic acid. Diabetes Care 1999; 22: 1296–1301.
30. 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: 2365–70.
31. Ziegler D. Thioctic acid for patients with symptomatic diabetic neuropathy: a critical review. Treat Endocrinol 2004; 3 (3): 173–89.
32. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysi. Diabet Med 2004; 21 (2): 114–21.
Авторы
О.А.Ганькина, О.С.Левин*
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*oslevin@mail.ru
Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*oslevin@mail.ru
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*oslevin@mail.ru
________________________________________________
Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*oslevin@mail.ru
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