Издательский дом "Заславский"

Международный эндокринологический журнал Том 20, №7, 2024

Вітамін В12 і діабетичні нейропатії

Авторы: Сергієнко В.О., Маркевич М.-Ю., Сегін В.Б., Сергієнко О.О.
Львівський національний медичний університет імені Данила Галицького, м. Львів, Україна
Рубрики: Эндокринология
Разделы: Справочник специалиста

Резюме

Вітамін B12 (ціанокобаламін, кобаламін) є необхідним кофактором двох важливих біохімічних шляхів: метаболізму метилмалонової кислоти та синтезу метіоніну з гомоцистеїну. Дефіцит кобаламіну, крім гематологічних аномалій (мегалобластної анемії або навіть панцитопенії), може викликати неврологічні симптоми, схожі на діабетичну нейропатію (ДН). Основні молекулярні механізми розвитку ДН все ще залишаються не з’ясованими. Більшість досліджень виявили внесок хронічного запалення низької інтенсивності (ХЗНІ) і оксидантного стресу (ОС) в розвиток ДН. Імуногістохімічні дослідження біоптатів нервів литкових м’язів, отриманих у хворих на цукровий діабет і ДН, вказують на активацію шляхів ХЗНІ, зумовлену підвищеним вмістом кінцевих продуктів неферментативного глікування, що призводить до посилення ОС. Подібні результати виявлені у пацієнтів з дефіцитом вітаміну В12. Отже, клінічні зміни у пацієнтів з ДН можуть бути спричинені клітинним дефіцитом кобаламіну. In vitro та in vivo продемонстровано, що вітамін B12 виявляє внутрішню антиоксидантну активність. Таким чином, кобаламін, незалежно від його класичної функції кофактора, може діяти як внутрішньоклітинний, зокрема як внутрішньомітохондріальний, антиоксидант. Це може слугувати обґрунтуванням для використання вітаміну B12 в лікуванні ДН, навіть на ранніх субклінічних стадіях. Метою цього огляду було обговорити роль вітаміну В12 у профілактиці та лікуванні ДН, а також проаналізувати нові тенденції та напрямки майбутніх досліджень. Пошук проводився в Scopus, Science Direct (від Elsevier) і PubMed, включно з базами даних Medline. Використані ключові слова «вітамін В12», «кобаламін», «цукровий діабет», «нейропатія», «кардіальна автономна нейропатія». Для виявлення результатів дослідження, які не вдалося знайти під час онлайн-пошуку, використовувався ручний пошук бібліографії публікацій.

Ключевые слова

вітамін В12; цукровий діабет; діабетична периферична нейропатія; кардіальна автономна нейропатія; огляд літератури

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