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Диагностика и лечение ранних стадий диабетической полинейропатии

https://doi.org/10.21518/2079-701X-2020-7-56-65

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Аннотация

Диабетическая полинейропатия является самым ранним и наиболее частым осложнением сахарного диабета. Диабетическая полинейропатия может развиваться на ранних стадиях нарушения углеводного обмена, более того, дистальная полинейропатия может развиваться и у пациентов с метаболическим синдромом, не имеющих нарушений углеводного обмена. Гипергликемия является важнейшим, но не единственным фактором риска развития и прогрессии диабетической полинейропатии. Поражение периферической нервной системы при преддиабете и на начальных этапах сахарного диабета преимущественно затрагивает тонкие нервные волокна, что обуславливает достаточно частое развитие нарушений со стороны вегетативной нервной системы. Так, уже на момент диагностики сахарного диабета 1-го и 2-го типов кардиальная автономная нейропатия диагностируется у 5–7,7%. Скрининг диабетической полинейропатии рекомендован не только при сахарном диабете 1-го типа длительностью 5 лет и более и сахарном диабете 2-го типа с момента диагноза, но и среди симптомных пациентов с преддиабетом. Для ранней диагностики диабетической полинейропатии могут использоваться как рутинные тесты оценки периферической чувствительности, так и специализированные методики (симпатические кожные реакции, биопсия кожи, конфокальная корнеальная микроскопия, количественные сенсорные тесты) и валидизированные опросники (шкала Юта для диагностики ранних проявлений нейропатии), акцентированные на оценке функции тонких нервных волокон. Для диагностики ранней диабетической полинейропатии могут быть использованы и неэлектрофизиологические исследования: соноэластография периферических нервов, оптическая когерентная томография, МРТ-нейрография, спиральная позитронно-эмиссионная КТ с 123 йод-метайодобензилгуанидином. Ранняя диагностика диабетической полинейропатии крайне важна, т. к. изменение образа жизни, расширение физической активности способно замедлить развитие данного осложнения. Соотношение выраженности оксидативного стресса и активности антиоксидантной защиты рассматривается как потенциальный механизм раннего поражения периферической нервной системы при гипергликемии и как возможная цель терапевтического воздействия. В обзоре обсуждаются вопросы эпидемиологии, диагностики и потенциальные терапевтические стратегии ранней диабетической полинейропатии.

Об авторах

В. Н. Храмилин
Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
Россия

 

117997, Россия, Москва, ул. Островитянова, д. 1



А. Н. Завьялов
Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
Россия

 

117997, Россия, Москва, ул. Островитянова, д. 1



И. Ю. Демидова
Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
Россия

 

117997, Россия, Москва, ул. Островитянова, д. 1



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Для цитирования:


Храмилин В.Н., Завьялов А.Н., Демидова И.Ю. Диагностика и лечение ранних стадий диабетической полинейропатии. Медицинский Совет. 2020;(7):56-65. https://doi.org/10.21518/2079-701X-2020-7-56-65

For citation:


Khramilin V.N., Zavyalov A.N., Demidova I.Yu. Diagnosis and treatment of the early stages of diabetic polyneuropathy. Meditsinskiy sovet = Medical Council. 2020;(7):56-65. (In Russ.) https://doi.org/10.21518/2079-701X-2020-7-56-65

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