medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-1-52-56medsovet-2898Research ArticleЗаболевания периферической нервной системыPERIPHERAL NERVOUS SYSTEM DISEASESКардиальная автономная невропатия у больных сахарным диабетомCardiac autonomic neuropathy in diabetic patientsБеляевА. А.BelyaevA. A.

младший научный сотрудник отделения неотложной сосудистой хирургии Государственного бюджетного учреждения здравоохранения города Москвы «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения города Москвы»

junior researcher of the Department of Emergency Vascular Surgery of the State Budget Institution of Public Health of Moscow «Research Institute of Urgent Care named after N.V. Sklifosovsky of the Moscow Department of Healthcare»

КотоваО. В.KotovaO. V.

к.м.н., врач-невролог, вице-президент международного общества «Стресс под контролем»

Candidate of medical sciences, neurologist, vice-president of the international society «Stress under control»

ol_kotova@mail.ruАкарачковаЕ. С.AkarachkovaE. S.

д.м.н., врач-невролог, президент международного общества «Стресс под контролем»

Dr. of Sci. (Med), neurologist, president of the international society «Stress under control»

Государственное бюджетное учреждение здравоохранения города Москвы «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения города Москвы»РоссияState Budgetary Healthcare Institution of the City of Moscow «Research Institute of Emergency Medical Care named after N.V. Sklifosovsky of the Department of Healthcare of Moscow»Russian FederationМеждународное общество «Стресс под контролем»РоссияInternational Society «Stress under Control»Russian Federation201905032019015256Copyright © Беляев А.А., Котова О.В., Акарачкова Е.С., 20192019Беляев А.А., Котова О.В., Акарачкова Е.С.Belyaev A.A., Kotova O.V., Akarachkova E.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2898

Кардиальная автономная невропатия (КАН) является распространенным и недостаточно диагностируемым осложнением сахарного диабета (СД). Обычно это связано с тем, что заболевание протекает бессимптомно до самых поздних стадий. Воздействие КАН на пациентов с СД может быть губительным, потому что КАН связана с повышенной смертностью, сердечнососудистыми заболеваниями, хроническим заболеванием почек. Распространенность КАН: 17–66% у пациентов с СД 1-го типа и 31–73% у пациентов с СД 2-го типа. Ключевыми моментами в патогенезе невропатий при СД, и в частности КАН, являются гипергликемия, аутоиммунная реакция, генетические факторы, обструктивное апноэ во сне, воспаление. Рассмотрены клинические проявления КАН и факторы риска развития КАН у пациентов с СД. Ранняя диагностика КАН имеет жизненно важное значение для успеха терапии, поскольку есть предположение, что денервация сердечно-сосудистой системы может быть обратимой, если диагностируется вскоре после ее начала. В лечении КАН используют антиоксидантную, вазоактивную и витаминотерапию. Сделан акцент на применении инъекционной формы Нейромультивита.

Cardiac autonomic neuropathy (CAN) is a common and insufficiently diagnosed complication of diabetes mellitus. This is usually due to the fact that the disease runs asymptomatically until the very late stages. The impact of CAN on patients with diabetes can be devastating, because CAN is associated with increased mortality, cardiovascular disease, chronic kidney disease. CAN prevalence: 17-66% in patients with type 1 diabetes and 31–73% in patients with type 2 diabetes. Hyperglycemia, autoimmune reaction, genetic factors, obstructive sleep apnea, and inflammation are the key points in the pathogenesis of neuropathies in diabetes, in particular, CAN. Clinical manifestations of CAN and risk factors of CAN development in patients with diabetes are considered. Early diagnosis of CAN is of vital importance for the success of therapy, as there is an assumption that denervation of cardiovascular system may be reversible if diagnosed soon after its beginning. Antioxidant, vasoactive and vitamin therapy is used in the treatment of CAN. Emphasis is placed on the use of the injection form of Neuromultivitis.

кардиальная автономная невропатияэпидемиологияфакторы рискаклиника КАНлечение КАНвитамины группы ВНейромультивитcardiac autonomous neuropathyepidemiologyrisk factorsCAN clinicCAN treatmentB vitaminsNeuromultivitisReferencesFisher V.L., Tahrani A.A. Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives. Diabetes Metab Syndr Obes. 2017 Oct 6;10:419-434. doi: 10.2147/ DMSO.S129797. eCollection 2017.Fisher V.L., Tahrani A.A. Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives. Diabetes Metab Syndr Obes. 2017 Oct 6;10:419-434. doi: 10.2147/ DMSO.S129797. eCollection 2017.Domingueti C.P., Dusse L.M., Carvalho M.G., de Sousa L.P., Gomes K.B., Fernandes A.P. Diabetes mellitus: the linkage between oxidative stress, inflammation, hypercoagulability and vascular complications. J Diabetes Complications. 2016;30(4):738–745.Domingueti C.P., Dusse L.M., Carvalho M.G., de Sousa L.P., Gomes K.B., Fernandes A.P. Diabetes mellitus: the linkage between oxidative stress, inflammation, hypercoagulability and vascular complications. J Diabetes Complications. 2016;30(4):738–745.Balcıoğlu A.S., Müderrisoğlu H. Diabetes and cardiac autonomic neuropathy: clinical manifestations, cardiovascular consequences, diagnosis and treatment. World J Diabetes. 2015;6(1):80–91.Balcıoğlu A.S., Müderrisoğlu H. Diabetes and cardiac autonomic neuropathy: clinical manifestations, cardiovascular consequences, diagnosis and treatment. World J Diabetes. 2015;6(1):80–91.Spallone V., Ziegler D., Freeman R., et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011;27(7):639–653.Spallone V., Ziegler D., Freeman R., et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011;27(7):639–653.Dimitropoulos G., Tahrani A.A., Stevens M.J. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes. 2014;5(1):17–39.Dimitropoulos G., Tahrani A.A., Stevens M.J. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes. 2014;5(1):17–39.Giacco F., Brownlee M. Oxidative stress and diabetic complications. Circ Res. 2010;107(9):1058–1070.Giacco F., Brownlee M. Oxidative stress and diabetic complications. Circ Res. 2010;107(9):1058–1070.Pop-Busui R., Low P.A., Waberski B.H., et al. Effects of prior intensive insulin therapy on cardiac autonomic nervous system function in type 1 diabetes mellitus: the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study (DCCT/EDIC). Circulation. 2009;119(22):2886–2893.Pop-Busui R., Low P.A., Waberski B.H., et al. Effects of prior intensive insulin therapy on cardiac autonomic nervous system function in type 1 diabetes mellitus: the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study (DCCT/EDIC). Circulation. 2009;119(22):2886–2893.Pop-Busui R., Braffett B.H., Zinman B., et al. Cardiovascular autonomic neuropathy and cardiovascular outcomes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Diabetes Care. 2017;40(1):94–100.Pop-Busui R., Braffett B.H., Zinman B., et al. Cardiovascular autonomic neuropathy and cardiovascular outcomes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Diabetes Care. 2017;40(1):94–100.Pop-Busui R. Cardiac autonomic neuropathy in diabetes: a clinical perspective. Diabetes Care. 2010;33(2):434–441.Pop-Busui R. Cardiac autonomic neuropathy in diabetes: a clinical perspective. Diabetes Care. 2010;33(2):434–441.Dimova R., Tankova T., Guergueltcheva V., et al. Risk factors for autonomic and somatic nerve dysfunction in different stages of glucose tolerance. J Diabetes Complications. 2017;31(3):537–543.Dimova R., Tankova T., Guergueltcheva V., et al. Risk factors for autonomic and somatic nerve dysfunction in different stages of glucose tolerance. J Diabetes Complications. 2017;31(3):537–543.Low P.A., Benrud-Larson L.M., Sletten D.M., et al. Autonomic symptoms and diabetic neuropathy: a population-based study. Diabetes Care. 2004;27(12):2942–2947.Low P.A., Benrud-Larson L.M., Sletten D.M., et al. Autonomic symptoms and diabetic neuropathy: a population-based study. Diabetes Care. 2004;27(12):2942–2947.Ziegler D. Diabetic cardiovascular autonomic neuropathy: prognosis, diagnosis and treatment. Diabetes Metab Rev. 1994;10(4):339–383.Ziegler D. Diabetic cardiovascular autonomic neuropathy: prognosis, diagnosis and treatment. Diabetes Metab Rev. 1994;10(4):339–383.Boulton A.J., Vinik A.I., Arezzo J.C., et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956–962.Boulton A.J., Vinik A.I., Arezzo J.C., et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956–962.Witte D.R., Tesfaye S., Chaturvedi N., et al. Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus. Diabetologia. 2005;48(1):164–171.Witte D.R., Tesfaye S., Chaturvedi N., et al. Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus. Diabetologia. 2005;48(1):164–171.Chung J.O., Park S.Y., Cho D.H., Chung D.J., Chung M.Y. Anemia, bilirubin, and cardiovascular autonomic neuropathy in patients with type 2 diabetes. Medicine (Baltimore). 2017;96(15):e6586.Chung J.O., Park S.Y., Cho D.H., Chung D.J., Chung M.Y. Anemia, bilirubin, and cardiovascular autonomic neuropathy in patients with type 2 diabetes. Medicine (Baltimore). 2017;96(15):e6586.Valensi P., Pariès J., Attali J.R. Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications – the French multicenter study. Metabolism. 2003;52(7):815–820.Valensi P., Pariès J., Attali J.R. Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications – the French multicenter study. Metabolism. 2003;52(7):815–820.Maser R.E., Lenhard M.J. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab. 2005;90(10):5896–5903.Maser R.E., Lenhard M.J. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab. 2005;90(10):5896–5903.Kempler P., Tesfaye S., Chaturvedi N., et al. Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM complications study. Diabet Med. 2002;19(11):900–909.Kempler P., Tesfaye S., Chaturvedi N., et al. Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM complications study. Diabet Med. 2002;19(11):900–909.Ko S.H., Park S.A., Cho J.H., et al. Progression of cardiovascular autonomic dysfunction in patients with type 2 diabetes: a 7-year followup study. Diabetes Care. 2008;31(9):1832–1836.Ko S.H., Park S.A., Cho J.H., et al. Progression of cardiovascular autonomic dysfunction in patients with type 2 diabetes: a 7-year followup study. Diabetes Care. 2008;31(9):1832–1836.Huang C.C., Lee J.J., Lin T.K., et al. Diabetic retinopathy is strongly predictive of cardiovascular autonomic neuropathy in type 2 diabetes. J Diabetes Res. 2016;2016:6090749.Huang C.C., Lee J.J., Lin T.K., et al. Diabetic retinopathy is strongly predictive of cardiovascular autonomic neuropathy in type 2 diabetes. J Diabetes Res. 2016;2016:6090749.Tannus L.R., Drummond K.R., Clemente E.L., da Matta M.F., Gomes M.B. Predictors of cardiovascular autonomic neuropathy in patients with type 1 diabetes. Front Endocrinol (Lausanne). 2014;5:191.Tannus L.R., Drummond K.R., Clemente E.L., da Matta M.F., Gomes M.B. Predictors of cardiovascular autonomic neuropathy in patients with type 1 diabetes. Front Endocrinol (Lausanne). 2014;5:191.Charles M., Fleischer J., Witte D.R., et al. Impact of early detection and treatment of diabetes on the 6-year prevalence of cardiac autonomic neuropathy in people with screen-detected diabetes: ADDITION-Denmark, a cluster-randomised study. Diabetologia. 2013;56(1):101– 108.Charles M., Fleischer J., Witte D.R., et al. Impact of early detection and treatment of diabetes on the 6-year prevalence of cardiac autonomic neuropathy in people with screen-detected diabetes: ADDITION-Denmark, a cluster-randomised study. Diabetologia. 2013;56(1):101– 108.Vinik A.I., Freeman R., Erbas T. Diabetic autonomic neuropathy. Semin Neurol. 2003;23(4):365–372.Vinik A.I., Freeman R., Erbas T. Diabetic autonomic neuropathy. Semin Neurol. 2003;23(4):365–372.Pop-Busui R. What do we know and we do not know about cardiovascular autonomic neuropathy in diabetes. J Cardiovasc Transl Res. 2012;5(4):463–478.Pop-Busui R. What do we know and we do not know about cardiovascular autonomic neuropathy in diabetes. J Cardiovasc Transl Res. 2012;5(4):463–478.Hillis G., Woodward M., Rodgers A., et al. Resting heart rate and the risk of death and cardiovascular complications in patients with type 2 diabetes mellitus. Diabetologia. 2012;55(5):1283–1290.Hillis G., Woodward M., Rodgers A., et al. Resting heart rate and the risk of death and cardiovascular complications in patients with type 2 diabetes mellitus. Diabetologia. 2012;55(5):1283–1290.Vinik A.I., Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115(3):387–397.Vinik A.I., Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115(3):387–397.Kuehl M., Stevens M.J. Cardiovascular autonomic neuropathies as complications of diabetes mellitus. Nat Rev Endocrinol. 2012;8(7):405– 416.Kuehl M., Stevens M.J. Cardiovascular autonomic neuropathies as complications of diabetes mellitus. Nat Rev Endocrinol. 2012;8(7):405– 416.Ninkovic V.M., Ninkovic S.M., Miloradovic V., et al. Prevalence and risk factors for prolonged QT interval and QT dispersion in patients with type 2 diabetes. Acta Diabetol. 2016;53(5):737– 744.Ninkovic V.M., Ninkovic S.M., Miloradovic V., et al. Prevalence and risk factors for prolonged QT interval and QT dispersion in patients with type 2 diabetes. Acta Diabetol. 2016;53(5):737– 744.Edwards J.L., Vincent A.M., Cheng H.T., Feldman E.L. Diabetic neuropathy: mechanisms to management. Pharmacol Ther. 2008;120(1):1–34.Edwards J.L., Vincent A.M., Cheng H.T., Feldman E.L. Diabetic neuropathy: mechanisms to management. Pharmacol Ther. 2008;120(1):1–34.Gibbons C., Centi J., Vernino S., Freeman R. Autoimmune autonomic ganglionopathy with reversible cognitive impairment. Arch Neurol. 2012;69(4):461–466.Gibbons C., Centi J., Vernino S., Freeman R. Autoimmune autonomic ganglionopathy with reversible cognitive impairment. Arch Neurol. 2012;69(4):461–466.Politi C., Ciccacci C., D’Amato C., Novelli G., Borgiani P., Spallone V. Recent advances in exploring the genetic susceptibility to diabetic neuropathy. Diabetes Res Clin Pract. 2016;120:198–208.Politi C., Ciccacci C., D’Amato C., Novelli G., Borgiani P., Spallone V. Recent advances in exploring the genetic susceptibility to diabetic neuropathy. Diabetes Res Clin Pract. 2016;120:198–208.Tahrani A.A., Ali A., Raymond N.T., et al. Obstructive sleep apnea and diabetic neuropathy: a novel association in patients with type 2 diabetes. Am J Respir Crit Care Med. 2012;186(5):434–441.Tahrani A.A., Ali A., Raymond N.T., et al. Obstructive sleep apnea and diabetic neuropathy: a novel association in patients with type 2 diabetes. Am J Respir Crit Care Med. 2012;186(5):434–441.Vinik A.I., Erbas T., Casellini C.M. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig. 2013;4(1):4–18.Vinik A.I., Erbas T., Casellini C.M. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig. 2013;4(1):4–18.Ziegler D., Buchholz S., Sohr C., Nourooz-Zadeh J., Roden M. Oxidative stress predicts progression of peripheral and cardiac autonomic nerve dysfunction over 6 years in diabeticZiegler D., Buchholz S., Sohr C., Nourooz-Zadeh J., Roden M. Oxidative stress predicts progression of peripheral and cardiac autonomic nerve dysfunction over 6 years in diabeticpatients. Acta Diabetol. 2015;52(1):65–72.patients. Acta Diabetol. 2015;52(1):65–72.Jaiswal M., Fingerlin T.E., Urbina E.M., et al. Impact of glycemic control on heart rate variability in youth with type 1 diabetes: the SEARCH CVD study. Diabetes Technol Ther. 2013;15(12):977–983.Jaiswal M., Fingerlin T.E., Urbina E.M., et al. Impact of glycemic control on heart rate variability in youth with type 1 diabetes: the SEARCH CVD study. Diabetes Technol Ther. 2013;15(12):977–983.Shah M.S., Brownlee M. Molecular and cellular mechanisms of cardiovascular disorders in diabetes. Circ Res. 2016;118(11):1808–1829.Shah M.S., Brownlee M. Molecular and cellular mechanisms of cardiovascular disorders in diabetes. Circ Res. 2016;118(11):1808–1829.Котова О.В. Диабетическая автономная полиневропатия. Фарматека. 2012;6:40-44.Kotova O.V. Diabetic autonomous polyneuropathy. Pharmacy [Farmateka]. 2012;6:40-44Thornalley P., Babaei-Jadidi R., Al Ali H. et al. High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease. Diabetologia. 2007;50(10):2164–2170.Thornalley P., Babaei-Jadidi R., Al Ali H. et al. High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease. Diabetologia. 2007;50(10):2164–2170.Cameron N., Gibson T., Nangle M. Inhibitors of advanced glycation end product formation and neurovascular dysfunction in experimental diabetes. Ann N Y Acad Sci. 2005;1043:784–92.Cameron N., Gibson T., Nangle M. Inhibitors of advanced glycation end product formation and neurovascular dysfunction in experimental diabetes. Ann N Y Acad Sci. 2005;1043:784–92.Строков И.А., Ахмеджанова Л.Т., Солоха О.А. Витамины группы В в лечении неврологических заболеваний. РМЖ. 2009;11:776.Strokov I.A., Akhmedzhanova L.T., Soloha O.A. Group B vitamins in the treatment of neurological diseases. RMJ. 2009;11:776Куцемелов И.Б., Беркут О.А., Кушнарева В.В., Постникова А.С. Алгоритмы и клинические рекомендации по использованию препарата Нейромультивит в неврологической практике. РМЖ. Медицинское обозрение. 2014;31:2186.Kutsemelov I.B., Berkut O.A., Kushnareva V.V., Postnikova A.S. Algorithms and clinical recommendations on the use of Neuromultivitis in neurological practice. RMJ. Medical review [RMJ. Medicinskoe obozrenie]. 2014;31:2186Shipton M.J., Thachil J. Vitamin B12 deficiency – A 21st century perspective. Clin Med (Lond). 2015 Apr;15(2):145-50. doi: 10.7861/clinmedicine.15-2-145.Shipton M.J., Thachil J. Vitamin B12 deficiency – A 21st century perspective. Clin Med (Lond). 2015 Apr;15(2):145-50. doi: 10.7861/clinmedicine.15-2-145.Wang H., Li L., Qin L.L., Song Y., Vidal-Alaball J., Liu T.H. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev. 2018 Mar 15;3.Wang H., Li L., Qin L.L., Song Y., Vidal-Alaball J., Liu T.H. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev. 2018 Mar 15;3.Howorka K., Pumprla J., Haber P., Koller-Strametz J., Mondrzyk J., Schabmann A. Effects of physical training on heart rate variability in diabetic patients with various degrees of cardiovascular autonomic neuropathy. Cardiovasc Res. 1997;34(1):206–214.Howorka K., Pumprla J., Haber P., Koller-Strametz J., Mondrzyk J., Schabmann A. Effects of physical training on heart rate variability in diabetic patients with various degrees of cardiovascular autonomic neuropathy. Cardiovasc Res. 1997;34(1):206–214.Котова О.В. Диабетическая нейропатия. Применение нейротропных витаминов. Поликлиника. 2015;1(2):36-39.Kotova O.V. Diabetic neuropathy. Application of neurotropic vitamins. Polyclinic [Poliklinika]. 2015;1(2):36-39

The authors declare that there are no conflicts of interest present.