medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-23-86-92medsovet-7295Research ArticleНЕВРОЛОГИЯNEUROLOGYБолевая диабетическая полиневропатия: современные подходы к диагностике и лечениюPainful diabetic polyneuropathy: modern approaches to diagnosis and treatmenthttps://orcid.org/0000-0002-7384-6715АхмеджановаЛ. Т.AkhmedzhanovaL. T.

Ахмеджанова Луиза Талгатовна – кандидат медицинских наук, доцент кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Россолимо, д. 11, корп. 1

Louiza T. Akhmedzhanova - Cand. Sci. (Med.), Associate Professor of the Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).

11, Bldg. 1, Rossolimo St., Moscow, 119991

luiziana78@mail.ruhttps://orcid.org/0000-0002-5397-9422МандраЕ. В.MandraE. V.

Мандра Екатерина Владимировна - аспирант кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Россолимо, д. 11, корп. 1

Ekaterina V. Mandra - Postgraduate Student, Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).

11, Bldg. 1, Rossolimo St., Moscow, 119991

emandra97@mail.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation2022180120230238692Copyright © Ахмеджанова Л.Т., Мандра Е.В., 20232023Ахмеджанова Л.Т., Мандра Е.В.Akhmedzhanova L.T., Mandra E.V.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/7295

Сахарный диабет (СД) – одно из наиболее распространенных хронических заболеваний, заболеваемость которым неуклонно растет. В современном мире примерно 1 из 11 взрослых людей страдает СД. Диабетическая полиневропатия (ДПН) является частым осложнением СД и приводит к снижению качества и продолжительности жизни пациентов, повышает риск инвалидизации. Особенно негативно на качество жизни влияет болевая форма ДПН. К ней относят как острые (невропатия Элленберга и острая инсулин-индуцированная невропатия), так и хронические формы. В статье обсуждаются современные представления о патогенезе болевой ДПН, а также факторы риска, клинические симптомы заболевания и диагностические методы (электронейромиографическое исследование, количественное сенсорное тестирование, исследование судомоторной функции, биопсия кожи, конфокальная биопсия роговицы). У большинства пациентов болевая форма ДПН сопровождается автономными нарушениями. Лечение болевой ДПН представляет собой непростую задачу, включающую коррекцию факторов риска (уровень гликемии, образ жизни пациентов), а также патогенетическую и симптоматическую терапию. В качестве симптоматической терапии используются адъювантные анальгетики, а именно препараты из группы антиконвульсантов (габапентин, прегабалин) и антидепрессантов (дулоксетин). Применение альфа-липоевой кислоты лежит в основе патогенетической терапии. Как универсальный антиоксидант альфа-липоевая кислота является абсолютно безопасным препаратом с доказанным эффектом в лечении болевой ДПН и может быть рекомендована к применению в клинической практике.

Diabetes mellitus is one of the most common chronic diseases, the incidence of which is steadily increasing. Approximately 1 in 11 adults in the world today has diabetes. Diabetic polyneuropathy is a common complication of diabetes mellitus and leads to a decrease in the quality and life expectancy of patients, increases the risk of disability. The pain form of diabetic polyneuropathy has a particularly negative effect on the quality of life. It includes both acute (Ellenberg’s neuropathy and acute insulin-induced neuropathy) and chronic forms. The article discusses modern ideas about the pathogenesis of pain diabetic polyneuropathy, as well as risk factors, clinical symptoms and diagnostic methods (electroneuromyography, quantitative sensory testing, sudomotor function, skin biopsy, confocal biopsy of the cornea) of the disease. In most patients, the pain form of diabetic polyneuropathy is accompanied by autonomic disorders. Treatment of painful diabetic polyneuropathy is a difficult task, including the correction of risk factors (glycemia level, patient lifestyle), as well as pathogenetic and symptomatic therapy. As symptomatic therapy, adjuvant analgesics are used, namely drugs from the group of anticonvulsants (gabapentin, pregabalin) and antidepressants (duloxetine). The use of alpha-lipoic acid is the basis of pathogenetic therapy. As a universal antioxidant, alpha-lipoic acid is an absolutely safe drug with a proven effect in the treatment of painful diabetic polyneuropathy and can be recommended for use in clinical practice.

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