Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya30655Editorial articleПередовая статьяClinical and metabolic risk factors for cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitusКлинико-метаболические факторы риска сердечно-сосудистой формы автономной нейропатии у больных сахарным диабетом 2-го типаBondar'Irina Arkad'evnaБондарьИрина Аркадьевна

д-р мед. наук, проф., зав. каф. эндокринологии; ГОУ ВПО Новосибирский государственный медицинский университет

Shabel'nikovaOlesya Yur'evnaШабельниковаОлеся Юрьевна

кафедра эндокринологии на базе ОГУЗ Государственной Новосибирской областной клинической больницыканд. мед. наук, врач-эндокринолог, рук. областного диабетического центра; ОГУЗ Государственная Новосибирская областная клиническая больница

odc@oblmed.nsk.ruBondarI AShabelnikovaO YuГОУ ВПО Новосибирский государственный медицинский университетОГУЗ Государственная Новосибирская областная клиническая больница151020108210NO10 (2010)ТОМ 82, №10 (2010)151909042020Copyright ©; 2010, Consilium MedicumCopyright ©; 2010, ООО "Консилиум Медикум"2010Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/30655

Aim: to study clinical and metabolic risk factors for cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus (T2DM). Subjects and methods. One hundred and fifty-seven patients were examined. According to the results of ECG tests and cardiointervalography, the patients were divided into 2 groups: 1) 45 patients without cardiovascular autonomic neuropathy; 2) 112 patients with this condition. Results. The T2DM patients with cardiovascular autonomic neuropathy significantly differed from those without autonomic disorders in DM duration, insulin level, insulin resistance indices (HOMA-IR, FIRI), atherogenicity coefficient, and high-density lipoprotein levels. The glycated hemoglobin level of more than 9% affected the values of autonomic ECG tests. Conclusion. In patients with T2DM, the development of cardiovascular autonomic neuropathy is affected by not only the duration of DM and the decompensation of carbohydrate metabolism, but also by hyperinsulinemia and insulin resistance, the low level of high-density lipoproteins, and the high coefficient of atherogenicity.

diabetes mellituscardiovascular autonomic neuropathyrisk factorsinsulin resistanceсахарный диабетсердечно-сосудистая автономная нейропатияфакторы рискаинсулинорезистентностьДедов И. И., Шестакова М. В. Сахарный диабет. М.: Универсум Паблишинг; 2003.Maser R. E., Mitchell В. D., Vinik A. I. et al. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabet. Care 2003; 26 (6): 1895-1901.Ткачева О. Н., Зорина С. А., Хайбулина Э. Т. и др. Диабетическая автономная нейропатия: распространенность, патогенез, лечение. Рус. мед. журн. 2005; 20 (13): 1329- 1333.Vinik A. I., Maser R. E., Mitchell В. D. et al. Diabetic autonomic neuropathy. Diabet. Care 2003; 26: 1553-1579.Vinik A. I., Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007; 115: 387-397.Дедов И. И., Александров А. А. Диабетическое сердце: основные закономерности. Сердце 2004; 13 (1): 5-8.Ramachandran A., Snehalatha C. Epidemiology of heart disease in type 2 diabetes. Medicographia 2007; 29 (3): 207-212.Freeman R., Weir G., Kahn R., King L. The peripheral nervous system and diabetes. Jn: Joslin's diabetes mellitus. Philadelphia: Lippincott, 2002.Ziegler D., Zentai C., Perz S. et al. Selective contribution of diabetes and other cardiovascular risk factors to cardiac autonomic dysfunction in the general population. Exp. Clin. Endocrinol. 2006; 114: 153-159.Балаболкин М. И. Лечение сахарного диабета и его осложнений. М.: Медицина; 2005.Kempler P. Neuropathies. Pathomechanism, clinical presentation, diagnosis, therapy. Berlin: Springer; 2002.Вейн А. М. Вегетативные расстройства. Клиника, диагностика, лечение. М.: Мед. информ. агентство; 2003.Veves A., King G. L. Can VEGF reverse diabetic neuropathy in human subjects? J. Clin. Invest. 2001; 107: 1215-1218.Верткин А. Л., Ткачева О. Н., Подпругина Н. Г. и др. Диабетическая автономная нейропатия: диагностика и метаболическая терапия. Клин. фармакол. и тер. 2004; 13 (4): 39-43.Бондарь И. А., Демин А. А., Королева Е. А. Диабетическая автономная нейропатия. Новосибирск; 2006.Witte D. R., Tesfaye S., Chaturvedi N. et al. Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus. Diabetologia 2005; 48 (1): 164-171.Valensi P., Paries J., Attali J. R. French Group for Research and Study of Diabetic Neuropathy: Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications - the French multicenter study. Metabolism 2003; 52: 815-820.Pirart J. Diabetes Mellitus and degenerative complications: A prospective study of 4400 patients observed between 1947- 1973. Diabet. Care 1978; 1: 168-188.Reichard P., Jensen-Urstad K., Ericsson M. et al. Autonomic neuropathy - a complication less pronounced in patients with type 1 diabetes mellitus who have lower blood glucose levels. Diabet. Med. 2000; 17: 860-866.Ko S., Park S., Cho J. et al. Progression of cardiovascular autonomic dysfunction in patients with type 2 diabetes. Diabet. Care 2008; 31: 1832-1836.Wu J., Yang Y., Lin T. Epidemiological evidence of altered cardiac autonomic function in subjects with impaired glucose tolerance but not isolated impaired fasting glucose. J. Clin. Endocrinol. 2007; 92 (10): 3885-3889.Frontoni S., Bracaglia D., Baroni A. et al. Autonomic dysfunction in glucose-tolerant but insulin-resistant offspring of type 2 diabetic patients. Hypertension 2003; 41: 1223.Magnan C., Cruciani C., Clement L. et al. Glucose-induced insulin hypersecretion in lipid-infused healthy subjects is associated with a decrease in plasma norepinephrine concentration and urinary excretion. J. Clin. Endocrinol. 2001; 86: 4901- 4907.Reaven G. M., Lithell H., Landsberg L. Mechanism of disease: hypertension and associated metabolic abnormalities - the role of insulin resistance in the sympathoadrenal system. N. Engl. J. Med. 1996; 334: 374-381.Haffner S., Lehto S., Ronnemaa Т. et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N. Engl. J. Med 1998; 339: 229-234.Morino K., Petersen K. F., Dufour S. et al. Reduced mitochondrial density and increased IRS-1 serine phosphorylation in muscle of insulin-resistant offspring of type 2 diabetic parents. J. Clin. Invest. 2005; 115: 3587-3593.Ucgun N. I., Yildirim Z., Kilic N. et al. The importance of serum lipids in exudative diabetic macular edema in type 2 diabetic patients. Ann. N. Y. Acad. Sci. 2007; 100: 213-217.Chapman M. J. Fibrates in 2003: therapeutic action in atherogenic dyslipidaemia and future perspectives. Atherosclerosis 2003; 171: 1-13.Kontush A., Chapman M. J. Anti-atherogenic small, dense HDL - guardian of the arterial wall? Nat. Clin. Pract. Cardiovasc. Med. 2006; 3: 144-153.