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Коморбидный пациент в практике невролога. Возможности лечения
Коморбидный пациент в практике невролога. Возможности лечения
Чуканова А.С., Чуканова Е.И. Коморбидный пациент в практике невролога. Возможности лечения. Справочник поликлинического врача. 2018; 4: 41-46
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Аннотация
В статье представлены вопросы коморбидности – сочетания у одного пациента двух или более хронических заболеваний. Рассмотрены патофизиологические механизмы формирования хронической цереброваскулярной недостаточности и диабетической полиневропатии как одного из частых вариантов коморбидности. Показаны возможности лечения препаратами, снижающими полипрагмазию при ведении данных пациентов.
Ключевые слова: хроническая цереброваскулярная недостаточность, диабетическая полиневропатия, факторы риска, коморбидность, полифармакотерапия, микроангиопатии, эндотелиальная дисфункция, оксидативный стресс, антитромботическая терапия, дипиридамол, тиоктовая кислота.
Key words: chronic cerebrovascular insufficiency, diabetic polyneuropathy, risk factors, comorbidity, polypharmacotherapy, microangiopathy, endothelial dysfunction, oxidative stress, antithrombotic therapy, dipyridamole, thioctic acid.
Ключевые слова: хроническая цереброваскулярная недостаточность, диабетическая полиневропатия, факторы риска, коморбидность, полифармакотерапия, микроангиопатии, эндотелиальная дисфункция, оксидативный стресс, антитромботическая терапия, дипиридамол, тиоктовая кислота.
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Key words: chronic cerebrovascular insufficiency, diabetic polyneuropathy, risk factors, comorbidity, polypharmacotherapy, microangiopathy, endothelial dysfunction, oxidative stress, antithrombotic therapy, dipyridamole, thioctic acid.
Полный текст
Список литературы
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14. Чуканова Е.И. Отдельные механизмы патогенеза формирования недостаточности мозгового кровообращения. Фарматека (кардиология/неврология). 2014; 13 (286): 14–20. / Chukanova E.I. Otdel'nye mehanizmy patogeneza formirovanija nedostatochnosti mozgovogo krovoobrashhenija. Farmateka (kardiologija/nevrologija). 2014; 13 (286): 14–20. [in Russian]
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25. Balakumar P, Nyo YH, Renushia R et al. Classical and pleiotropic actions of dipyridamole: Not enough light to illuminate the dark tunnel? Pharmacol Res 2014; 87: 144–50.
26. Воробьева О.В. Плейотропные эффекты дипиридамола: клинические перспективы. Эффективная фармакотерапия. Неврология. 2016; 3 (25): 15–8. / Vorob'eva O.V. Plejotropnye jeffekty dipiridamola: klinicheskie perspektivy. Jeffektivnaja farmakoterapija. Nevrologija. 2016; 3 (25): 15–8. [in Russian]
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28. Gurer H, Ozgunes H, Oztezcan S et al. Antioxidant role of alpha-lipoic acid in lead toxicity. Free Radic Biol Med 1999; 27 (1–2): 75–81.
29. 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.
30. Biewenga GP, Haenen GR, Bast A. The pharmacology of the antioxidant lipoic acid. Gen Pharmacol 1997; 29: 315–31.
31. Javed S, Petropoulos IN, Alam U, Malik RA. Treatment of painful diabetic neuropathy. Ther Adv Chronic Dis 2015: 6 (1): 15–28. DOI: 10.1177/2040622314552071
32. Nagamatsu M, Nickander KK, Schmelzer JD et al. Lipoic acid improves nerve blood ow, reduces oxidative stress and improves distal nerve conduction in experimental diabetic neuropathy. Diabetes Care 1995; 18: 1160–7.
33. Ruhnau KJ, Meissner HP, Finn JR et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med 1999; 16: 1040–3.
34. Ziegler D, Hanefeld M, Ruhnau KJ et al., the ALADIN Study Group. Treatment of symptomatic diabetic peripheral neuropathy with the antioxidant alpha-lipoic acid. A 3-week multicentre randomised controlle trial (ALADIN study). Diabetologia 1995; 38: 1425–33.
35. Reljanovic M, Reichel G, Rett K et al. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized doubleblind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res 1999; 31 (3): 171–9.
36. Andreassen CS, Jakobsen J, Andersen H. Muscle Weakness – A Progressive Late Complication in Diabetic Distal Symmetric Polyneuropathy. Diabetes 2006; 55: 806–12.
37. Ametov A, Barinov A, O’Brien P et al., the SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: The SYDNEY Trial. Diabetes Care 2003; 26: 770–6.
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2. Levin O.S. Discirkuljatornaja jencefalopatija. Metodicheskoe posobie. M., 2010. [in Russian]
3. Dzau V, Braunwald E. Resolved and unresolved issues in the prevention and treatment of coronary artery disease: a workshop consensus statement. Am Heart J 1991; 121: 1244–63.
4. Beljalov F.I. Lechenie vnutrennih boleznej v uslovijah komorbidnosti. Irkutsk: RIO IGMAPO, 2013. [in Russian]
5. Zhuravlev Ju.I., Thorikova V.N. Sovremennye problemy izmerenija polimorbidnosti. Nauch. vedomosti BelGU. 2013; 11 (22): 214–9. [in Russian]
6. Payne R et al. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol 2014; 70 (5): 575–81.
7. Bushardt RL et al. Polypharmacy: misleading, but manageable. Clin Intervent Aging 2008; 3 (2): 383–9.
8. Gnjidic D. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 2012; 65 (9): 989–95.
9. Zinman B, Wanner C, Lachin JM et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373 (22): 2117–28.
10. Komorbidnaja patologija v klinicheskoj praktike. Klinicheskie rekomendacii. Rabochaja gruppa pod rukovodstvom R.G.Oganova. Kardiovask. terapija i profilaktika. 2017; 16 (6). [in Russian]
11. Levin O.S. Polinevropatija. M.: MIA, 2011. [in Russian]
12. Kramer H, Rolke R, Hecht M. Follow-up of advanced diabetic neuropathy. J Neurol 2005; p. 315–20.
13. Vinik AI, Mehrabyan A. Diabetic neuropathies. Med Clin North Am 2004; 88: 947–99.
14. Chukanova E.I. Otdel'nye mehanizmy patogeneza formirovanija nedostatochnosti mozgovogo krovoobrashhenija. Farmateka (kardiologija/nevrologija). 2014; 13 (286): 14–20. [in Russian]
15. Gusev E.I., Skvorcova V.I. Ishemija golovnogo mozga. M.: Medicina, 2001; s. 328. [in Russian]
16. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25 (5): 457–507.
17. Hasday JD, Sitrin RG. Dipyridamole stimulates urokinase production and suppresses procoagulant activity of rabbit alveolar macrophages: a possible mechanism of antithrombotic action. Blood 1987; 69 (2): 660–7.
18. Ariesen MJ, Algra A, Kappelle LJ. Antiplatelet drugs in the secondary prevention after stroke: differential efficacy in large versus small vessel disease? A subgroup analysis from ESPS-2. Stroke 2006; 37: 1: 134–8.
19. ESPS Group. European Stroke Prevention Study. Stroke 1990; 21: 1122–30.
20. Aktas B, Utz A, Hoenig-Liedl P. 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 (3): 764–9.
21. Chakrabarti S, Freedman JE. Dipyridamole, cerebrovascular disease, and the vasculature. Vascul Pharmacol 2008; 48 (4–6): 143–9.
22. Kusmic C, Petersen C, Picano E et al. Antioxidant effect of oral dipyridamole during cerebral hypoperfusion with human carotid endarterectomy. J Cardiovasc Pharmacol 2000; 36 (2): 141–5.
23. Nelson CW, Wei EP, Povlishock JT et al. Oxygen radicals in cerebral ischemia. Am J Physiol 1992; 263 (5; Pt. 2): H1356–1362.
24. 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 (1–2): 333–8.
25. Balakumar P, Nyo YH, Renushia R et al. Classical and pleiotropic actions of dipyridamole: Not enough light to illuminate the dark tunnel? Pharmacol Res 2014; 87: 144–50.
26. Vorob'eva O.V. Plejotropnye jeffekty dipiridamola: klinicheskie perspektivy. Jeffektivnaja farmakoterapija. Nevrologija. 2016; 3 (25): 15–8. [in Russian]
27. Arivazhagan P, Juliet P, Panneerselvam C. Effect of DL alpha-lipoic acid on the status of lipid peroxidation and antioxidants in aged rats. Pharmacol Res 2000; 41 (3): 299–303.
28. Gurer H, Ozgunes H, Oztezcan S et al. Antioxidant role of alpha-lipoic acid in lead toxicity. Free Radic Biol Med 1999; 27 (1–2): 75–81.
29. 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.
30. Biewenga GP, Haenen GR, Bast A. The pharmacology of the antioxidant lipoic acid. Gen Pharmacol 1997; 29: 315–31.
31. Javed S, Petropoulos IN, Alam U, Malik RA. Treatment of painful diabetic neuropathy. Ther Adv Chronic Dis 2015: 6 (1): 15–28. DOI: 10.1177/2040622314552071
32. Nagamatsu M, Nickander KK, Schmelzer JD et al. Lipoic acid improves nerve blood ow, reduces oxidative stress and improves distal nerve conduction in experimental diabetic neuropathy. Diabetes Care 1995; 18: 1160–7.
33. Ruhnau KJ, Meissner HP, Finn JR et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med 1999; 16: 1040–3.
34. Ziegler D, Hanefeld M, Ruhnau KJ et al., the ALADIN Study Group. Treatment of symptomatic diabetic peripheral neuropathy with the antioxidant alpha-lipoic acid. A 3-week multicentre randomised controlle trial (ALADIN study). Diabetologia 1995; 38: 1425–33.
35. Reljanovic M, Reichel G, Rett K et al. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized doubleblind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res 1999; 31 (3): 171–9.
36. Andreassen CS, Jakobsen J, Andersen H. Muscle Weakness – A Progressive Late Complication in Diabetic Distal Symmetric Polyneuropathy. Diabetes 2006; 55: 806–12.
37. Ametov A, Barinov A, O’Brien P et al., the SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: The SYDNEY Trial. Diabetes Care 2003; 26: 770–6.
38. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabetic Medicine 2004; 21: 114–21.
39. Barancevich E.R., Posohina O.V. Podhody k terapii nevrologicheskih projavlenij saharnogo diabeta. Zhurn. nevrologii i psihiatrii. 2010; 110: 4: 63–6. [in Russian]
40. Chukanova E.I. Jeffektivnost' tioktacida pri lechenii bol'nyh s discirkuljatornoj jencefalopatiej. Zhurn. nevrologii i psihiatrii im. S.S.Korsakova. 2001; 101 (11): 31–5. [in Russian]
41. Chukanova E.I. Farmakojekonomicheskij analiz vlijanija tioktacida i solkoserila na risk razvitija insul'ta i progressirovanie DJe. V sb.: Mezhdunarodnyj forum nevrologov. Erevan, 2004; s. 195–9. [in Russian]
2. Левин О.С. Дисциркуляторная энцефалопатия. Методическое пособие. М., 2010. / Levin O.S. Discirkuljatornaja jencefalopatija. Metodicheskoe posobie. M., 2010. [in Russian]
3. Dzau V, Braunwald E. Resolved and unresolved issues in the prevention and treatment of coronary artery disease: a workshop consensus statement. Am Heart J 1991; 121: 1244–63.
4. Белялов Ф.И. Лечение внутренних болезней в условиях коморбидности. Иркутск: РИО ИГМАПО, 2013. / Beljalov F.I. Lechenie vnutrennih boleznej v uslovijah komorbidnosti. Irkutsk: RIO IGMAPO, 2013. [in Russian]
5. Журавлев Ю.И., Тхорикова В.Н. Современные проблемы измерения полиморбидности. Науч. ведомости БелГУ. 2013; 11 (22): 214–9. / Zhuravlev Ju.I., Thorikova V.N. Sovremennye problemy izmerenija polimorbidnosti. Nauch. vedomosti BelGU. 2013; 11 (22): 214–9. [in Russian]
6. Payne R et al. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol 2014; 70 (5): 575–81.
7. Bushardt RL et al. Polypharmacy: misleading, but manageable. Clin Intervent Aging 2008; 3 (2): 383–9.
8. Gnjidic D. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 2012; 65 (9): 989–95.
9. Zinman B, Wanner C, Lachin JM et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373 (22): 2117–28.
10. Коморбидная патология в клинической практике. Клинические рекомендации. Рабочая группа под руководством Р.Г.Оганова. Кардиоваск. терапия и профилактика. 2017; 16 (6). / Komorbidnaja patologija v klinicheskoj praktike. Klinicheskie rekomendacii. Rabochaja gruppa pod rukovodstvom R.G.Oganova. Kardiovask. terapija i profilaktika. 2017; 16 (6). [in Russian]
11. Левин О.С. Полиневропатия. М.: МИА, 2011. / Levin O.S. Polinevropatija. M.: MIA, 2011. [in Russian]
12. Kramer H, Rolke R, Hecht M. Follow-up of advanced diabetic neuropathy. J Neurol 2005; p. 315–20.
13. Vinik AI, Mehrabyan A. Diabetic neuropathies. Med Clin North Am 2004; 88: 947–99.
14. Чуканова Е.И. Отдельные механизмы патогенеза формирования недостаточности мозгового кровообращения. Фарматека (кардиология/неврология). 2014; 13 (286): 14–20. / Chukanova E.I. Otdel'nye mehanizmy patogeneza formirovanija nedostatochnosti mozgovogo krovoobrashhenija. Farmateka (kardiologija/nevrologija). 2014; 13 (286): 14–20. [in Russian]
15. Гусев Е.И., Скворцова В.И. Ишемия головного мозга. М.: Медицина, 2001; с. 328. / Gusev E.I., Skvorcova V.I. Ishemija golovnogo mozga. M.: Medicina, 2001; s. 328. [in Russian]
16. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25 (5): 457–507.
17. Hasday JD, Sitrin RG. Dipyridamole stimulates urokinase production and suppresses procoagulant activity of rabbit alveolar macrophages: a possible mechanism of antithrombotic action. Blood 1987; 69 (2): 660–7.
18. Ariesen MJ, Algra A, Kappelle LJ. Antiplatelet drugs in the secondary prevention after stroke: differential efficacy in large versus small vessel disease? A subgroup analysis from ESPS-2. Stroke 2006; 37: 1: 134–8.
19. ESPS Group. European Stroke Prevention Study. Stroke 1990; 21: 1122–30.
20. Aktas B, Utz A, Hoenig-Liedl P. 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 (3): 764–9.
21. Chakrabarti S, Freedman JE. Dipyridamole, cerebrovascular disease, and the vasculature. Vascul Pharmacol 2008; 48 (4–6): 143–9.
22. Kusmic C, Petersen C, Picano E et al. Antioxidant effect of oral dipyridamole during cerebral hypoperfusion with human carotid endarterectomy. J Cardiovasc Pharmacol 2000; 36 (2): 141–5.
23. Nelson CW, Wei EP, Povlishock JT et al. Oxygen radicals in cerebral ischemia. Am J Physiol 1992; 263 (5; Pt. 2): H1356–1362.
24. 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 (1–2): 333–8.
25. Balakumar P, Nyo YH, Renushia R et al. Classical and pleiotropic actions of dipyridamole: Not enough light to illuminate the dark tunnel? Pharmacol Res 2014; 87: 144–50.
26. Воробьева О.В. Плейотропные эффекты дипиридамола: клинические перспективы. Эффективная фармакотерапия. Неврология. 2016; 3 (25): 15–8. / Vorob'eva O.V. Plejotropnye jeffekty dipiridamola: klinicheskie perspektivy. Jeffektivnaja farmakoterapija. Nevrologija. 2016; 3 (25): 15–8. [in Russian]
27. Arivazhagan P, Juliet P, Panneerselvam C. Effect of DL alpha-lipoic acid on the status of lipid peroxidation and antioxidants in aged rats. Pharmacol Res 2000; 41 (3): 299–303.
28. Gurer H, Ozgunes H, Oztezcan S et al. Antioxidant role of alpha-lipoic acid in lead toxicity. Free Radic Biol Med 1999; 27 (1–2): 75–81.
29. 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.
30. Biewenga GP, Haenen GR, Bast A. The pharmacology of the antioxidant lipoic acid. Gen Pharmacol 1997; 29: 315–31.
31. Javed S, Petropoulos IN, Alam U, Malik RA. Treatment of painful diabetic neuropathy. Ther Adv Chronic Dis 2015: 6 (1): 15–28. DOI: 10.1177/2040622314552071
32. Nagamatsu M, Nickander KK, Schmelzer JD et al. Lipoic acid improves nerve blood ow, reduces oxidative stress and improves distal nerve conduction in experimental diabetic neuropathy. Diabetes Care 1995; 18: 1160–7.
33. Ruhnau KJ, Meissner HP, Finn JR et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med 1999; 16: 1040–3.
34. Ziegler D, Hanefeld M, Ruhnau KJ et al., the ALADIN Study Group. Treatment of symptomatic diabetic peripheral neuropathy with the antioxidant alpha-lipoic acid. A 3-week multicentre randomised controlle trial (ALADIN study). Diabetologia 1995; 38: 1425–33.
35. Reljanovic M, Reichel G, Rett K et al. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized doubleblind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res 1999; 31 (3): 171–9.
36. Andreassen CS, Jakobsen J, Andersen H. Muscle Weakness – A Progressive Late Complication in Diabetic Distal Symmetric Polyneuropathy. Diabetes 2006; 55: 806–12.
37. Ametov A, Barinov A, O’Brien P et al., the SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: The SYDNEY Trial. Diabetes Care 2003; 26: 770–6.
38. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabetic Medicine 2004; 21: 114–21.
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29. 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.
30. Biewenga GP, Haenen GR, Bast A. The pharmacology of the antioxidant lipoic acid. Gen Pharmacol 1997; 29: 315–31.
31. Javed S, Petropoulos IN, Alam U, Malik RA. Treatment of painful diabetic neuropathy. Ther Adv Chronic Dis 2015: 6 (1): 15–28. DOI: 10.1177/2040622314552071
32. Nagamatsu M, Nickander KK, Schmelzer JD et al. Lipoic acid improves nerve blood ow, reduces oxidative stress and improves distal nerve conduction in experimental diabetic neuropathy. Diabetes Care 1995; 18: 1160–7.
33. Ruhnau KJ, Meissner HP, Finn JR et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med 1999; 16: 1040–3.
34. Ziegler D, Hanefeld M, Ruhnau KJ et al., the ALADIN Study Group. Treatment of symptomatic diabetic peripheral neuropathy with the antioxidant alpha-lipoic acid. A 3-week multicentre randomised controlle trial (ALADIN study). Diabetologia 1995; 38: 1425–33.
35. Reljanovic M, Reichel G, Rett K et al. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized doubleblind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res 1999; 31 (3): 171–9.
36. Andreassen CS, Jakobsen J, Andersen H. Muscle Weakness – A Progressive Late Complication in Diabetic Distal Symmetric Polyneuropathy. Diabetes 2006; 55: 806–12.
37. Ametov A, Barinov A, O’Brien P et al., the SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: The SYDNEY Trial. Diabetes Care 2003; 26: 770–6.
38. Ziegler D, Nowak H, Kempler P et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabetic Medicine 2004; 21: 114–21.
39. Barancevich E.R., Posohina O.V. Podhody k terapii nevrologicheskih projavlenij saharnogo diabeta. Zhurn. nevrologii i psihiatrii. 2010; 110: 4: 63–6. [in Russian]
40. Chukanova E.I. Jeffektivnost' tioktacida pri lechenii bol'nyh s discirkuljatornoj jencefalopatiej. Zhurn. nevrologii i psihiatrii im. S.S.Korsakova. 2001; 101 (11): 31–5. [in Russian]
41. Chukanova E.I. Farmakojekonomicheskij analiz vlijanija tioktacida i solkoserila na risk razvitija insul'ta i progressirovanie DJe. V sb.: Mezhdunarodnyj forum nevrologov. Erevan, 2004; s. 195–9. [in Russian]
Авторы
А.С.Чуканова*, Е.И.Чуканова
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*chukanova.anna@gmail.com
N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*chukanova.anna@gmail.com
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*chukanova.anna@gmail.com
________________________________________________
N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*chukanova.anna@gmail.com
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