medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-289medsovet-9310Research ArticleЗАБОЛЕВАНИЯ ПЕРИФЕРИЙНОЙ НЕРВНОЙ СИСТЕМЫPERIPHERAL NERVOUS SYSTEM DISEASESКомплексный подход к патогенетически ориентированной фармакотерапии у пациентов с сахарным диабетом с диабетической дистальной полинейропатиейAn integrated approach to pathogenetic-oriented pharmacotherapy of patients with diabetes mellitus and diabetic distal polyneuropathyhttps://orcid.org/0000-0002-9574-105XВорохобинаН. В.VorokhobinaN. V.

Ворохобина Наталья Владимировна - д.м.н., профессор, заведующая кафедрой эндокринологии имени академика В.Г. Баранова.

191015, Санкт-Петербург, ул. Кирочная, д. 41

Natalia V. Vorokhobina - Dr. Sci. (Med.), Professor, Head of the Department of Endocrinology named after Academician V.G. Baranov.

41, Kirochnaya St., St Petersburg, 191015

natvorokh@mail.ruhttps://orcid.org/0000-0001-7826-7184БарановВ. Л.BaranovV. L.

Баранов Виталий Леонидович - д.м.н., профессор, профессор кафедры эндокринологии имени академика В.Г. Баранова.

191015, Санкт-Петербург, ул. Кирочная, д. 41

Vitalii L. Baranov - Dr. Sci. (Med.), Professor, Professor of the Department of Endocrinology named after Academician V.G. Baranov.

41, Kirochnaya St., St Petersburg, 191015

bvl60@yandex.ruhttps://orcid.org/0000-0002-2812-6911КалугинаВ. В.KaluginaV. V.

Калугина Валентина Викторовна - к.м.н., ассистент кафедры эндокринологии имени академика В.Г. Баранова.

191015, Санкт-Петербург, ул. Кирочная, д. 41

Valentina V. Kalugina - Cand. Sci. (Med.), Assistant of the Department of Endocrinology named after Academician V.G. Baranov.

41, Kirochnaya St., St Petersburg, 191015

kaluginavav@gmail.comhttps://orcid.org/0000-0001-7765-2048ШороховаП. Б.ShorokhovaP. B.

Шорохова Полина Борисовна - к.м.н., врач-эндокринолог.

188540, Ленинградская обл., Сосновый Бор, ул. Космонавтов, д. 3

Polina B. Shorokhova - Cand. Sci. (Med.), Endocrinologist.

3, Kosmonavtov St., Sosnovy Bor, Leningrad Region, 188540

poliamina@gmail.comhttps://orcid.org/0009-0000-0907-8638ГришаеваВ. А.GrishaevaV. A.

Гришаева Валерия Андреевна - аспирант кафедры эндокринологии имени академика В.Г. Баранова.

191015, Санкт-Петербург, ул. Кирочная, д. 41

Valeriia A. Grishaeva - Postgraduate Student of the Department of Endocrinology named after Academician V.G. Baranov.

41, Kirochnaya St., St Petersburg, 191015

valeriagrishaeva1313@gmail.comСеверо-Западный государственный медицинский университет имени И.И. МечниковаРоссияNorth-Western State Medical University named after I.I. MechnikovRussian FederationЦентральная медико-санитарная часть №38 Федерального медико-биологического агентства РоссииРоссияCentral Medical and Sanitary Unit No. 38Russian Federation20250808202501292100Copyright © Ворохобина Н.В., Баранов В.Л., Калугина В.В., Шорохова П.Б., Гришаева В.А., 20252025Ворохобина Н.В., Баранов В.Л., Калугина В.В., Шорохова П.Б., Гришаева В.А.Vorokhobina N.V., Baranov V.L., Kalugina V.V., Shorokhova P.B., Grishaeva V.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9310

Сахарный диабет (СД) остается глобальной медико-социальной проблемой ввиду широкого распространения, наличия тяжелых осложнений, высокой инвалидизации и смертности населения. Одним из самых часто встречающихся хронических осложнений СД является диабетическая дистальная нейропатия (ДДН), основными факторами риска развития которой признаются хроническая гипергликемия, артериальная гипертензия, ожирение, курение, возраст и генетическая предрасположенность больного. Результатом сложного взаимодействия метаболических процессов, иммунной системы и генетической предрасположенности служат выраженные морфологические изменения в виде демиелинизации и утолщения аксонов, уменьшения количества шванновских клеток, а также нарушения строения перехватов Ранвье. Сенсорные и моторные нарушения проявляются снижением всех видов чувствительности, ослаблением сухожильных рефлексов, мышечной гипотрофией. Бессимптомное течение наблюдается у половины больных с ДДН. До сих пор не существует идеальных методов ранней диагностики и терапии ДДН. Дискуссионные вопросы лечения ДДН в основном касаются использования витаминов группы В и препаратов альфа-липоевой (тиоктовой) кислоты. Некоторые исследования показали эффективность препаратов тиоктовой кислоты в лечении больных с ДДН, обусловленную ее противовоспалительными, антиоксидантными свойствами, а также благоприятным влиянием на углеводный обмен. Витамины группы В длительное время применяются в качестве дополнительной терапии у пациентов с ДДН. Опыт лечения ДДН показывает, что наилучший результат достигается при использовании комбинации альфа-липоевой кислоты и витаминов В1, В6, В12, что обусловлено их синергическим действием. В обзорной статье рассматриваются вопросы применения комплексной патогенетически обоснованной терапии ДДН у больных СД.

Diabetes mellitus remains a global medical and social problem due to its prevalence, presence of severe complications, and high disability and mortality rates among the population. One of the most common chronic complications of diabetes mellitus is the diabetic distal neuropathy, the main risk factors for the development of which are chronic hyperglycemia, arterial hypertension, obesity, smoking, age, and genetic predisposition of the patient. Diabetic distal neuropathy stems from a complex interaction of metabolic processes, immune system, and genetic predisposition, which result in morphological changes in the form of demyelination and thickening of axons, a decrease in the number of Schwann cells, as well as disruption of the structure of the Ranvier nodes. Sensory and motor disorders are manifested by a decrease in all types of sensitivity, weakening of reflexes. Asymptomatic course is observed in 50% of patients with diabetic distal neuropathy. Ideal methods for early diagnosis and therapy of patients with diabetic distal neuropathy do not exist. Controversial issues of diabetic distal neuropathy treatment mainly concern the use of В vitamins and alpha-lipoic acid preparations. Some studies of the alpha-lipoic acid have determined its anti-inflammatory, antioxidant properties, as well as its possible effect on carbohydrate metabolism in patients with diabetic distal neuropathy. B vitamins have long been used as an additional therapy for patients with diabetic distal neuropathy. Clinical experience in treating patients with diabetic distal neuropathy shows that the best result is achieved by using a combination of alpha-lipoic acid and B1, B6, B12 vitamins which is due to their synergistic effect. This review examines the issues of complex pathogenetic therapy of diabetic distal neuropathy in patients with diabetes mellitus.

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