medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-243medsovet-7647Research ArticleЗАБОЛЕВАНИЯ ПЕРИФЕРИЙНОЙ НЕРВНОЙ СИСТЕМЫPERIPHERAL NERVOUS SYSTEM DISEASESТрудный пациент с полиневропатией: хроническая воспалительная демиелинизирующая полиневропатия, ассоциированная с сахарным диабетом 1-го типаDifficult patient with polyneuropathy: CIDP associated with type 1 diabetes mellitushttps://orcid.org/0000-0002-7384-6715АхмеджановаЛ. Т.AkhmedzhanovL. T.

Ахмеджанова Луиза Талгатовна, к.м.н., доцент кафедры нервных болезней и нейрохирургии

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

Louiza T. Akhmedzhanova, Cand. Sci. (Med.), Associate Professor of the Department of Nervous Diseases and Neurosurgery

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

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

Ekaterina V. Mandra, Postgraduate Student, Department of Nervous Diseases and Neurosurgery

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

emandra97@mail.ruhttps://orcid.org/0000-0001-5904-0697ЯнакаеваТ. А.YanakaevaT. A.

Янакаева Татьяна Александровна, к.м.н., врач-невролог

119991, Москва, ул. Россолимо, д. 11, стр. 4, 5

Tatyana A. Yanakaeva, Cand. Sci. (Med.), Neurologist

11, Bldg. 4, 5, Rossolimo St., Moscow, 119991

СолохаО. А.SolokhaO. A.

Солоха Оксана Александровна, к.м.н., ассистент кафедры нервных болезней и нейрохирургии

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

Oksana A. Solokha, Cand. Sci. (Med.), Assistant of the Department of Nervous Diseases and Neurosurgery

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

soloxa71@mail.ruИнститут клинической медицины имени Н.В. Склифосовского Первого Московского государственного медицинского университета имени И.М. Сеченова (Сеченовского Университета)РоссияSklifosovsky Institute of Clinical Medicine of Sechenov First Moscow State Medical University (Sechenov University)Russian FederationУниверситетская клиническая больница №3 Первого Московского государственного медицинского университета имени И.М. Сеченова (Сеченовского Университета)РоссияUniversity Clinical Hospital No. 3 of Sechenov First Moscow State Medical University (Sechenov University)Russian Federation202324072023010106–114Copyright © Ахмеджанова Л.Т., Мандра Е.В., Янакаева Т.А., Солоха О.А., 20232023Ахмеджанова Л.Т., Мандра Е.В., Янакаева Т.А., Солоха О.А.Akhmedzhanov L.T., Mandra E.V., Yanakaeva T.A., Solokha O.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7647

Полиневропатии представляют собой гетерогенную группу заболеваний, которые могут быть вызваны как первичным, так и вторичным поражением периферических нервов на фоне различных соматических болезней. Наиболее частой причиной хронической полиневропатии является дистальная симметричная диабетическая полиневропатия. В клинической практике важно помнить о дизиммуных полиневропатиях, таких как синдром Гийена – Барре, хроническая воспалительная демиелинизирующая полиневропатия и парапротеинемические полиневропатии, которые приводят к выраженным двигательным нарушениям и инвалидизации пациентов. Выявление причины полиневропатии требует настоящего искусства, включающ его в себя знание клинической, электрофизиологической картины и вариантов течения заболевания, а также широкого спектра состояний, приводящих к их развитию. Своевременная диагностика полиневропатий и раннее назначение этиологической и патогенетической терапии уменьшают риски развития необратимых изменений в периферических нервах, вызванных аксональной дегенерацией. В лечении полиневропатий различного генеза особое место занимают витамины группы В, которые обладают нейротропным эффектом. Цианокобаламин является патогенетической терапией у пациентов с сахарным диабетом (СД), которые длительно принимают метформин и у которых развилась полиневропатия на фоне дефицита витамина В12. У одного пациента возможно сочетание нескольких вариантов полиневропатий. Представлен клинический случай пациентки с СД 1-го типа, у которой на фоне дистальной симметричной безболевой диабетической полиневропатии после перенесенной инфекции COVID-1 9 развилась дизиммунная хроническая воспалительная демиелинизирующая полиневропатия (ХВДП), ассоциированная с СД. Особенностью развития ХВДП было острое начало заболевания. Обсуждаются варианты клинической картины, электронейромиографические критерии, а также особенности лечения, эффективность терапии и прогноз ХВДП у пациентов с СД.

Polyneuropathies are a heterogeneous group of diseases that can be caused both by a primary lesion of peripheral nerves, and secondarily, against the background of various somatic diseases. The most common cause of chronic polyneuropathy is distal symmetrical diabetic polyneuropathy. In clinical practice, it is important to be aware of dysimmune polyneuropathy, such as Guillain Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and paraproteinemic polyneuropathy, which lead to severe motor impairment and disability in patients. Identification of the cause of polyneuropathy requires real art, which includes knowledge of the clinical, electrophysiological picture and variants of the course of the disease, as well as a wide range of conditions leading to their development. Timely diagnosis of polyneuropathies and early assignment of etiological and pathogenetic therapy reduce the risk of developing irreversible changes in peripheral nerves caused by axonal degeneration. In the treatment of polyneuropathy of various origins, a special place is occupied by B vitamins, which have a neurotropic effect. Cyanocobalamin is a pathogenetic therapy in patients with diabetes who take metformin for a long time and who developed polyneuropathy due to vitamin B12 deficiency. In one patient, a combination of several variants of polyneuropathies is possible. The article presents a clinical case of a patient with type 1 diabetes mellitus (DM) who developed dysimmune chronic inflammatory demyelinating polyneuropathy (CIDP) associated with DM on the background of distal symmetrical painless diabetic polyneuropathy after a COVID- 19 infection. A feature of the development of CIDP was the acute onset of the disease. Variants of the clinical picture, ENMG criteria, as well as features of treatment, the effectiveness of therapy and the prognosis of CIDP in patients with DM are discussed.

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