medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-12-256-265medsovet-6356Research ArticleЭНДОКРИНОЛОГИЯENDOCRINOLOGYДифференциальный диагноз полинейропатий при сахарном диабетеDifferential diagnosis of polyneuropathies in diabetes mellitushttps://orcid.org/0000-0002-5161-7743ХрамилинВ. Н.KhramilinV. N.

к.м.н., доцент кафедры эндокринологии и диабетологии факультета дополнительного  профессионального образования, 

117997, Москва, ул. Островитянова, д. 1

Cand. Sci. (Med.), Associate Professor of the Department of Endocrinology and Diabetology of the Facultyof  Additional vocational education,

1, Ostrovityanov St., Moscow, 117997

Khramilin_RGMU@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202118092021012256265Copyright © Храмилин В.Н., 20212021Храмилин В.Н.Khramilin V.N.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/6356

Диабетическая полинейропатия (ДПН) гетерогенна по клиническому течению и паттерну поражения периферической нервной системы. В зависимости от первичного поражения толстых или тонких нервных волокон возможны различные начало, течение и клинические проявления полинейропатии. У пациентов с сахарным диабетом высока частота сочетанного поражения периферической нервной системы. При верификации диагноза ДПН необходимо проводить дифференциальный диагноз с целым рядом заболеваний: паранеопластические, метаболические нейропатии, нейропатии при васкулитах, токсические, аутоиммунные, воспалительные и наследственные нейропатии. Сахарный диабет не всегда является единственной причиной развития полинейропатии, до 50% всех случаев поражения периферической нервной системы при сахарном диабете имеют дополнительные причины. Диагноз ДПН является диагнозом исключения. Развитие полинейропатии у  пациентов с  длительностью сахарного диабета 1-го типа менее 5 лет, отсутствие нефропатии и/или ретинопатии, асимметрия в симптомах и признаках, преобладание моторной симптоматики, начало с поражения верхних конечностей, быстрая прогрессия симптоматики и неврологического дефицита должны аргументировать врача к дифференциально-диагностическому поиску. Также следует учитывать особенности пациента (пожилой возраст, вегетарианство, хроническое употребление алкоголя), медикаментозные и токсические воздействия в анамнезе (прием метформина ≥ 3 лет и ≥ 2 г/сут; цитостатики, химиотерапия, тяжелые металлы), семейный анамнез нейропатии. Лечебная тактика должна быть индивидуализирована и учитывать полиэтиологичность полинейропатии. Цель настоящего обзора – обсуждение наиболее частых причин поражения периферической нервной системы при сахарном диабете и особенностей дифференциальной диагностики с диабетической полинейропатией. 

Diabetic polyneuropathy (DPN) is heterogeneous in its clinical course and clinical manifestations. Depending on the primary lesion of large or small nerve fibers, different onset, course and clinical manifestations of polyneuropathy are possible. In patients with diabetes, the incidence of associated lesions of the peripheral nervous system is high. When verifying the diagnosis of DPN, it is necessary to carry out a differential diagnosis with a number of diseases: paraneoplastic neuropathies, metabolic neuropathies, neuropathies in vasculitis, toxic neuropathies, autoimmune neuropathies, inflammatory neuropathies and hereditary neuropathies. Diabetes is not the only cause of polyneuropathy. Up to 50% of all cases of polyneuropathies in diabetes have additional causes. Diagnosis of diabetic polyneuropathy - diagnosis of exclusion. The development of polyneuropathy in patients with a duration of type 1 diabetes less than 5 years, the absence of nephropathy and / or retinopathy, asymmetry in symptoms and signs, the predominance of motor symptoms, beginning with upper limb lesions, rapid progression should justify the doctor for differential diagnostic search. You should also take into account the characteristics of the patient (old age, vegetarianism and alcohol use), medical and toxic effects (taking metformin> 3 years and> 2 g / day; cytostatics, chemotherapy, heavy metals), family history of neuropathy. Therapeutic tactics should be individualized and take into account the polyneuropathy polyetiology. The purpose of this review is to discuss the most common reasons peripheral neuropathy in diabetes mellitus. The differential diagnosis of the diabetic polyneuropathy is the focus of this article. 

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