nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2020-6-96-103nnp-1477Research ArticleREVIEWSОБЗОРЫEarly diagnosis and treatment of diabetic and alcoholic polyneuropathy in outpatient practiceРанняя диагностика и лечение диабетической и алкогольной полиневропатии в амбулаторной практикеГоловачеваВ. А.GolovachevaV. A.

Вероника Александровна Головачева

Кафедра нервных болезней и нейрохирургии

119021, Москва, ул. Россолимо, 11, стр. 1

Veronika Aleksandrovna Golovacheva

Department of Nervous System Diseases and Neurosurgery

11, Rossolimo St., Build. 1, Moscow 119021

xoxo.veronicka@gmail.comИнститута клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияN.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of RussiaRussian Federation20201212202012696103Copyright © Golovacheva V.A., 20202020Головачева В.А.Golovacheva V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/1477

Diabetes mellitus (DM) and chronic alcoholism (CA) are diseases that damage many organs and systems of the body and, in particular, lead to peripheral neuropathies. The pathogenesis of peripheral neuropathies caused by diabetes mellitus (DM) and CA is complex and diverse. Different types of peripheral neuropathies develop according to the leading pathogenetic mechanism. The most common type of peripheral neuropathy in DM is diabetic distal symmetric polyneuropathy (DSPN) and that in CA is alcoholic polyneuropathy (APN). The principles of diagnosis and treatment of DSPN and APN are considered. Treatment of DSPN and APN is complex, which is aimed at treating the underlying disease and includes non-drug and drug treatments. The mainstay of DSPN treatment is achievement of the optimal blood glucose level, maintenance of a healthy lifestyle (diet, daily activity), and correction of cardiovascular comorbidities (if any) with symptomatic pharmacotherapy for neuropathic pain (if any) with antidepressants or anticonvulsants. Antioxidants, such as B group vitamins (B1, B6 and B12) and alpha-lipoic acid (ALA), are widely used to treat DSPN in clinical practice. APN treatment involves cessation of alcohol consumption, physical and mental rehabilitation, and intake of B group vitamins (B1, B2, B6 and B12). The use of ALA in DSPN and APN is discussed.

Сахарный диабет (СД) и хронический алкоголизм (ХА) – это заболевания, которые повреждают множество органов и систем организма и, в частности, приводят к периферическим невропатиям. Патогенез периферических невропатий, обусловленных СД и ХА, сложен и многообразен. В зависимости от ведущего патогенетического механизма развиваются различные формы периферических невропатий. Самая распространенная форма периферической невропатии при СД – это диабетическая дистальная симметричная полиневропатия (ДСПН), а при ХА – алкогольная полиневропатия (АПН). Рассмотрены принципы диагностики и лечения ДСПН и АПН. Лечение ДСПН и АПН комплексное, направлено на терапию основного заболевания и включает нелекарственные и лекарственные методы. Основы лечения ДСПН – это достижение оптимального уровня гликемии, поддержание здорового образа жизни (диета, повседневная активность), коррекция сочетанных сердечно-сосудистых заболеваний (при их наличии), симптоматическая фармакотерапия невропатической боли (при ее наличии) с помощью антидепрессантов или антиконвульсантов. При ДСПН в клинической практике широко назначаются препараты с антиоксидантной активностью – витамины группы В (В1, В6, В12) и альфа-липоевая кислота (АЛК). Лечение АПН состоит из прекращения злоупотребления алкоголем, физической и психической реабилитации, приема препаратов группы В (В1, В2, В6 и В12). Обсуждаются вопросы применения АЛК при ДСПН и АПН. 

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