Milgamma hauv kev kho mob ntshav qab zib neuropathy

R.A. MANUSHAROVA, MD, xibfwb, D.I. CHERKEZOV

Chav Department of Endocrinology thiab Diabetology nrog chav kawm endocrine phais

GOU DPO RMA PO Ministry of Social Health, Moscow, Russia

Hauv cov neeg mob nrog mob ntshav qab zib kev mob plawv yog cov muaj ntau dua li cov neeg tsis muaj ntshav qab zib. Txawm li cas los xij, tswj kom ruaj khov piam thaj thiab kev tiv thaiv / kev kho thaum ntxov pab txo kev tuag thiab txhim kho lub neej kom zoo cov neeg mob ntshav qab zibCov. Nrog rau kev nce ntxiv hauv cov ntshav qab zib, qhov tshwm sim ntawm microvascular ntau dua ntxiv. Nws tuaj yeem xav tias nrog qhov nce zuj zus ntawm cov ntshav qab zib mellitus, uas tau pom tam sim no, lub luag haujlwm ntawm microvascular cov teeb meem tseem yuav nce ntxiv yav tom ntej. Zaus ntawm kev tshwm sim ntawm cov teeb meem microvascular li tshuaj mob hlwbnws txawv heev nyob ntawm txoj kev kuaj mob. Yog li, tus nqi ntawm neuropathy thaum coj mus rau hauv tus account kev soj ntsuam cov tsos mob tsuas yog 25%, thiab thaum ua qhov kev tshawb fawb electromyographic, nws pom nyob rau yuav luag txhua tus neeg mob ntshav qab zib mellitus.

Mob neuropathy mob ntshav qab zib txo qhov muaj lub neej zoo ntawm cov neeg mob thiab yog qhov kev pheej hmoo rau kev txhim kho mob ko taw, mob caj pas. Yog li ntawv, kev kuaj mob raws sijhawm thiab kev kho mob ntshav qab zib polyneuropathy.

Cov tib neeg txoj hlab ntsha nruab nrab muaj lub hauv nruab nrab, ntu ntu ntawm tus kheej thiab lub zog ntawm tus kheej. Lub hauv nruab nrab cov hlab ntsha muaj lub hlwb thiab tus txha caj qaum. Lub peripheral lub paj hlwb yog tsim los ntawm cov hlab ntsha cov hlab ntsha uas mus rau sab sauv thiab sab hauv qab, pob tw, taub hau. Ntawm cov ntshav qab zib mellitus, feem ntau kev puas tsuaj rau peripheral lub paj hlwb yuav siv qhov chaw, thiab yog li ntawd qhov kev cuam tshuam no yog hu ua peripheral polyneuropathy. Feem ntau, nrog kev mob ntshav qab zib polyneuropathy, cov leeg ntshaus siab yog cuam tshuam. Cov neeg mob tau txhawj xeeb txog kev ua kom yuag, loog, txias ntawm ko taw lossis qhov hnov ntawm nqaij tawv, mob hauv nqua. Tau ntau xyoo, cov xwm txheej no tau sau tseg feem ntau thaum so, cuam tshuam nrog kev pw tsaug zog hmo ntuj, thiab tom qab ntawd xav tias tus cwj pwm tsis tu ncua thiab mob siab rau.

Thaum pib ntawm qhov tshwm sim ntawm cov kev tsis txaus ntseeg no, feem ntau nws tuaj yeem pom qhov txo qis ntawm qhov tsis haum (mob, nruj, qhov kub, kev co) ntawm hom "thom khwm" thiab "hnab looj tes", ua rau lub zog tsis zoo ntawm cov thim rov qab, thiab lub cev muaj zog. Qhov mob yog mob hnyav, mob, ua pa. Feem ntau mob nrog ua ke nrog kev nyuaj siab, ua kom tsaug zog thiab tsis qab los noj mov. Cov kev mob siab qis no nrog rau lub cev tawm ntawm lub cev, hauv kev sib piv ntawm qhov mob nrog kev puas tsuaj rau cov hlab ntsha peripheral.

Kev nkag siab txawv txav maj mam nthuav tawm los ntawm qhov ceg luv rau qhov sib thooj, tom qab ntawd txhais tes kuj tseem koom nrog hauv txoj kev ua. Thaum peripheral qab haus huv muaj kev cuam tshuam rau cov neeg mob ntshav qab zib mellitus, cov thauj khoom thauj axon feem ntau raug kev txom nyem, uas yog nqa los ntawm axoplasmic tam sim no nqa ntau cov khoom siv roj ntsha uas tsim nyog rau kev ua haujlwm ntawm cov leeg thiab cov leeg nqaij hauv qhov kev taw qhia los ntawm lub cev neuron mus rau cov leeg thiab lwm tus rov ua dua. Axonopathies zoo li qeeb nrog kev hloov zuj zus ntawm cov txheej txheem pathological. Kev kho dua ntawm txoj haujlwm ntawm peripheral qab haus huv nrog axonopathies ntawm ntau yam keeb kwm tshwm sim maj mam thiab ib nrab, raws li ib feem ntawm cov axons tas mus li tuag.

Cov teeb meem txaus ntshai ntawm DPN yog qhov mob ntawm neuropathic mob rau ntawm txhais ceg, qhov laj thawj tseem ceeb rau kev tsim cov uas yog qhov ploj ntawm qhov mob rhiab thiab microtrauma ntawm daim tawv nqaij.

Kev tsis sib txig sib xyaw ntawm cov hloov pauv thiab txuas ntxiv ntawm qhov qis qis tshaj qhov txo qis kev ua haujlwm ntawm "me" leeg ntawm ko taw, uas ua rau kev hloov pauv ntawm lub hauv paus taw ntawm lub taw thiab kev txhim kho ntawm deformation. Hauv qhov no, thaj tsam ntawm qhov nce ntawm kev nce siab tshwm sim hauv qee thaj chaw ntawm plantar nto. Qhov tso siab tsis tu ncua ntawm cov chaw no yog nrog tus txheej txheem mob ntawm cov nqaij mos thiab tsim kom muaj mob rau ko taw. Tawm tsam cov keeb kwm yav dhau los ntawm kev poob qis hauv qhov mob rhiab thiab ib qho kev nyiam los txhim kho osteoporosis, nrog rau cov ntshav nce ntxiv, uas ua rau cov pob txha resorption nyob rau hauv cov ntshav qab zib mellitus, microtrauma tuaj yeem ua rau pob txha thiab pob txha puas (sib koom tes puas, ua kom puas thiab tawg ntawm pob txha). Ko taw yog deformed, gait pauv hloov. Kev ua txhaum ntawm cov leeg ua haujlwm ntawm cov leeg ua haujlwm ua rau ntxiv kev tsim ntawm ulcerative tsis xws luag.

Lub sij hawm ntev kev kho mob ntshav qab zib neuropathy suav nrog cov kab mob pathogenetic thiab cov tsos mob. Cov tshuaj siv tau zoo tshaj plaws nrog ob qho pathogenetic thiab cov tsos mob tshwm sim suav nrog cov vitamins B - thiamine thiab pyridoxine - hauv cov koob tshuaj ntau, uas txhim kho cov txheej txheem ntawm kev ua cov axon impulses.

Cov vitamins ntawm pab pawg B nyob rau hauv koob tshuaj muaj ntau lub cev metabolic thiab soj ntsuam, thiab yog li ntawd lawv tau ib txwm siv rau kev kho mob ntshav qab zib polyneuropathy thiab neuropathies degenerative ntawm qhov sib txawv. Thiamine (vitamin B1) yog cov coenzyme ntawm dehydrogenase ua rau ntawm Krebs lub cev tswj kev ua pentose phosphate, yog li tswj cov txheej txheem ntawm kev siv cov kua nplaum.

Hauv cov ntsiab lus siab, thiamine muaj peev xwm txo cov txheej txheem ntawm pathobiochemical glycation ntawm cov protein, uas yog qhov tseem ceeb rau cov neeg mob ntshav qab zib mellitus. Thiamine muaj cov nyhuv neurotropic los ntawm kev koom nrog kev tsim ntawm txoj hlab hlwb, thauj cov khoom thauj axonal, hauv cov txheej txheem ntawm kev tsim dua tshiab ntawm cov leeg nqaij, hloov kho ntawm neuromuscular kis hauv n-cholinergic receptors.

Benfotiamine

Ib qho tshwj xeeb lipophilic tshuaj nrog thiamin zoo li kev ua haujlwm yog qhov muaj txiaj ntsig zoo thiab muaj kev tiv thaiv zoo rau cov tshuaj uas yuav luag 100% bioavailability. Dej-soluble thiamine nyob rau hauv lub zog ntau ntau yog nqus tau los ntawm nquag sodium-thauj thauj. Thaum tseem ceeb ntau nyob rau hauv txoj hnyuv mus txog, qhov tshuab no yog depleted, thiab muaj txiaj ntsig zoo passive diffusion tau qhib. Qhov nqus dej ntau tshaj plaws ntawm thiamine tsis yog ntau dua 10%. Lub kinetics ntawm benfotiamine muaj qhov sib txawv tseem ceeb. Thaum nws yog nqus rau hauv txoj hnyuv plab, tsis muaj qhov tshwm sim zoo. Lub cev kev noj qab haus huv ntawm cov tshuaj yog 8-10 zaug siab dua li ntawm thiamine, lub sijhawm nce mus txog qhov siab tshaj plaws yog 2 zaug qis dua, qhov nruab nrab concentration ntawm benfotiamine hauv cov ntshav tau khaws cia ntev dua, uas ua rau kom muaj kev sib txuam ntau dua ntawm cov tshuaj hauv hlwb.

Cov tshuaj muaj kuab lom tsawg. Kev kawm txog kev siv tshuaj lom ntawm benfotiamine hauv koob tshuaj 100 mg / kg lub cev qhov hnyav (hauv cov nas tsuag) tau pom zoo zoo rau cov tshuaj no thiab qhov tsis muaj qhov sib txawv tseem ceeb piv nrog kev tswj hwm. Thaum siv tshuaj nyob rau hauv nruab nrab kho koob tshuaj, tsis muaj kev phiv. Kev taw qhia rau kev siv cov tshuaj benfotiamine hauv tshuaj muaj pes tsawg leeg ntawm cov tshuaj Milgamma compositum yog polyneuropathies vim muaj ntshav qab zib mellitus thiab qhov tsis txaus ntawm cov vitamin B1.

Pyridoxine (Vitamin B6)

Daim ntawv ua haujlwm physiologically dhia - pyridoxalphosphate, muaj coenzyme thiab metabolic nyhuv. Ua lub coenzyme, pyridoxal phosphate ua lub luag haujlwm tseem ceeb hauv cov metabolism ntawm tus naj npawb ntawm cov amino acids, tshwj xeeb tshaj yog tryptophan, sulfur-uas muaj cov amino acids thiab hydroxy amino acids, thiab koom nrog phospholation ntawm glycogen, uas yog qhov tseem ceeb heev rau cov neeg mob ntshav qab zib mellitus. Pyridoxalphosphate koom nrog kev sib xyaw ua ke ntawm cov neeg kho kom haum xeeb - catecholamines, histamine, aminobutyric acid, uas ua rau kev ua kom zoo ntawm lub paj hlwb.

Pyridoxine kuj tseem nce qhov chaw tshwj xeeb ntawm magnesium nyob rau hauv lub cell, uas yog qhov tseem ceeb ntawm cov khoom noj hauv lub cev ua haujlwm hauv cov txheej txheem lub zog thiab cov kev ua haujlwm hauv lub paj hlwb, muaj qhov sib cais, thiab koom tes hauv cov txheej txheem hematopoiesis. Qhov kev nqus ntawm pyridoxine nyob rau hauv lub plab zom mov tsis muaj qhov ua rau tsis txaus, thiab vim li ntawd nws cov kev xav hauv cov ntshav yog nyob ntawm cov ntsiab lus hauv cov hnyuv. Pyridoxalphosphate yog nrawm nrawm ntawm lub plab zom mov, ua rau sab hauv ob lub raum. Nkag tau los ntawm qhov chaw tso cov nyom thiab tso rau hauv niam cov kua mis.

Coenzyme Vitamin B6

Nws muaj cov nyhuv hauv lub cev kev zom zaub mov, txo qis kev sib xyaw ntawm cov roj cholesterol thiab lipids, nce glycogen hauv lub siab, txhim kho nws cov khoom hauv detoxification, koom tes hauv cov metabolism ntawm histamine. Txhim cov txheej txheem kev zom zaub mov hauv cov tawv nqaij thiab cov qog ua kua.

Pyridoxalphosphate feem ntau muaj kev tiv thaiv zoo. Kev ua xua cuam tshuam, nce acidity ntawm lub plab ua kua tuaj yeem tau.

Hauv kev kho mob ntshav qab zib polyneuropathy, ib qho tshuaj zoo tshaj plaws yog Milgamma compositum, uas suav nrog 100 mg ntawm benfotiamine thiab 100 mg ntawm pyridoxine. Cov tshuaj muaj nyob rau hauv daim ntawv ntawm dragees, uas muab kev nplij siab ntxiv thaum noj thiab qhov tsis cuam tshuam ntawm cov tshuaj. Vim nws cov roj solubility, benfotiamine muaj 8-10-ntau dua qhov kev nyab xeeb dua li piv rau cov dej-soluble thiamine ntsev. Nrog rau kev tswj hwm ntawm qhov ncauj, qib ntawm benfotiamine nyob rau hauv lub cerebrospinal kua nce mus txog xws li qhov tseem ceeb uas tuaj yeem ua tiav nkaus xwb nrog kev tswj hwm kev tswj hwm ntawm cov dej-soluble ntsev ntawm thiamine. Benfotiamine induces kev ua ntawm transketolase detoxifying enzyme, uas ua rau cov kev txwv tsis pub cuam tshuam los ntawm hypergikemia ntawm metabolic mechanisms, xws li hexosamine txoj hauv kev. Milgamma compositum yog noj ntawm qhov ncauj ntawm 150-900 mg ib hnub, ob qho tib si li monotherapy thiab hauv kev sib xyaw nrog lwm cov tshuaj.

Ntxiv nrog rau cov tshuaj tshwj xeeb rau DPN, ib qho kev daws teeb meem rau kev txhaj tshuaj ntawm Milgamma yog siv, uas muaj cov tshuaj B ntawm cov vitamins thiab lub tshuaj loog hauv zos:

- Thiamine hydrochloride - 100 mg.

- Pyridoxine hydrochloride - 100 mg.

- Cyanocobalamin hydrochloride - 1000 mg.

- Lidocaine - 20 mg.

Cov tshuaj muaj cov nyhuv analgesic, txhim kho cov ntshav ncig thiab txhawb txoj kev tsim dua tshiab ntawm cov hlab ntshav hlwb. Cov qib B ntau cov vitamins nyob hauv kev npaj, raws li qhia saum toj no, muaj txiaj ntsig zoo hauv kev muaj mob tsis zoo thiab cuam tshuam ntawm cov kab mob ntawm cov hlab ntsha thiab lub cev muaj zog. Hauv kev txhaj tshuaj siab, cov nyhuv analgesic tau pom zoo zoo, kev ua haujlwm ntawm cov leeg hlwb thiab cov txheej txheem ntawm hematopoiesis yog ib txwm ua. Nws yog ib qho tseem ceeb kom nco ntsoov tias lub xub ntiag ntawm lidocaine thiab lub ntim me me ntawm cov tshuaj txhaj ua rau cov kev txhaj tshuaj tsis haum, uas ua rau tus neeg mob ua raws li kev kho mob.

Milgamma thiab Milgamma compositum npaj rau cov kab mob ntawm cov hlab hlwb ntawm ntau yam hauv paus:

- Neuropathy (ntshav qab zib, haus dej cawv, thiab lwm yam),

- Neuritis thiab polyneuritis, suav nrog retrobulbar neuritis,

- Peripheral paresis (suav nrog lub ntsej muag lub ntsej muag),

- Neuralgia, incl. trigeminal hlab ntsha thiab intercostal qab haus huv,

Tshuaj tsis tuaj yeem noj nrog cov ntawv hnyav thiab mob hnyav ntawm kev ua kom lub plawv dhia zoo, hauv lub sijhawm tsis muaj tshuaj tiv thaiv thiab nrog lub cev tsis haum tshuaj.

Kev kho mob ntshav qab zib neuropathy suav nrog cov chaw hauv qab no:

- Kev them nyiaj ntawm ntshav qab zib mellitus (kev siv tshuaj kho ntshav qab zib kom tsawg).

- Txoj kev kho cov kab mob ua rau cov hlab ntsha puas lawm (Milgamma npaj rau kev txhaj tshuaj thiab Milgamma compositum nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj rau kev tswj hwm qhov ncauj lossis a-lipoic acid npaj + Milgamma compositum).

- Kev kho qhov mob ntawm kev hnov mob.

Sachse G. thiab Reiners K. (2008) pom zoo kom kho qhov muaj txiaj ntsig ntawm tus mob ntshav qab zib neuropathy raws li nram no:

Thib peb theem

Kev sib xyaw ua ke (thioctic acid + benfotiamine):

- Thiogamma - tso dej nrog 600 mg ib hnub twg

- Milgamma compositum - 1 ntsiav tshuaj 3 zaug ib hnub

- Ob qhov tshuaj rau 4-6 lub lis piam.

Ntau cov kev tshawb fawb txawv teb chaws thiab hauv tsev paub meej txog cov hauj lwm zoo thiab kev nyab xeeb ntawm Milgamma thiab Milgamma compositum hauv kev kho mob ntshav qab zib neuropathy.

Hauv peb txoj haujlwm, peb tau siv thawj txoj kev kho mob hauv 20 tus neeg mob ntshav qab zib neuropathy (Milgamma 10 txhaj tshuaj, tom qab ntawd Milgamma compositum rau 6 lub lis piam) thiab tau sau tseg txog qhov zoo ntawm daim duab kho mob ntawm DPN, uas tau ua ke nrog txoj hauv kev txhim kho electrophysiological tsis ua haujlwm, uas qhia tau tias rov kho dua ntawm cov haujlwm axon. Raws li cov ntawv nyeem, cov txiaj ntsig ntawm Milgamma compositum tseem tau sau tseg hauv kev mob plawv neuropathy hauv cov neeg mob ntshav qab zib mellitus.

Peb tau pom 20 tus neeg mob ntshav qab zib hom 2, lub hnub nyoog nruab nrab ntawm cov neeg mob yog 58 xyoo, lub sijhawm mob ntshav qab zib yog 9 xyoo, thiab lub sijhawm ntawm neuropathy yog 3 xyoos.

Txhua tus neeg mob uas peb tau pom muaj tsos mob rau tus mob ntshav qab zib ua rau lub hlwb hnoos qeev nrog qhov mob. Hauv 7 tus neeg mob, cov tsos mob tshwm sim, thiab hauv cov neeg mob seem, cov tsos mob rau tus mob ntshav qab zib tau mob nyhav. Thawj qhov xwm txheej, kev kho mob tau pib nrog kev txhaj tshuaj ntawm Milgamma 2 ml txhua hnub intramuscularly (10 txhaj tshuaj), thiab tom qab ntawd hloov mus rau kev tswj hwm ntawm qhov ncauj ntawm Milgamma compositum 1 ntsiav tshuaj 3 zaug hauv ib hnub rau tsawg kawg 4-6 lub lis piam. Hauv cov neeg mob uas muaj cov tsos mob me ntsis ntawm DPN, kev kho mob tau nqa nrog Milgamma compositum 1 ntsiav tshuaj 3 zaug hauv ib hnub rau 4-6 lub lis piam. Txoj kev kho no tsis yog tsuas yog yooj yim thiab tsis ua lub nra hnyav rau tus neeg mob thiab nws tsev neeg, tab sis kuj tseem pheej yig dua, vim nws tsis tas yuav tsum tau pw hauv tsev kho mob, uas nws txo tus nqi kho. Txhawm rau tiv thaiv kom rov tshwm sim ntawm DPN, kev rov ua dua ntawm kev kho mob tau ua 6-12 lub hlis tom qab thawj zaug tiv thaiv keeb kwm ntawm cov nyiaj them siab tshaj plaws rau kev cuam tshuam ntawm metabolic.

Raws li kev kho mob, qhov txo qis ntawm qhov mob rhiab thiab qhov ua tau zoo ntawm tag nrho lwm cov tsos mob tau ua tiav. mob ntshav qab zib polyneuropathy nyob rau hauv feem coob (hauv 17) cov neeg mob. Qhov nruab nrab ntawm qhov mob txhua hnub txo los ntawm 60-70%, thiab nws tau muab tawm tias cov nyhuv ntawm kev siv Milgamma thiab Milgamma compositum tau tsim kho sai heev - twb tau 2 lub lis piam tom qab pib kho. Thaum noj cov tshuaj cim ua ke (kev txhaj tshuaj thiab tshuaj hauv qhov ncauj), cov tsos mob hauv qab no poob qis: hlawv, tua thiab plooj mob. Hauv pawg ntawm cov neeg mob uas kev mob hmo ntuj tau sau tseg, ib qho kev txo qis hauv lawv qhov kev siv tau sau tseg. Kev mob hmo ntuj feem ntau ua rau lub neej qis dua qub rau cov neeg mob lub neej, yog li ntawd, tom qab kev kho mob, cov neeg mob muaj qhov txhim kho lub neej muaj txiaj ntsig zoo li kev hloov pauv thaum nruab hnub thiab tshwj xeeb kev mob thaum hmo ntuj. Cov nyhuv ntawm cov tshuaj Milgamma compositum tau nce thoob plaws hauv chav kawm ntawm kev kho mob, uas tau siv sijhawm ntev li 4-6 lub lis piam.

Txoj kev tshawb no pom tias Milgamma muaj kev thev taus zoo thiab kev nyab xeeb. Cov kev mob tshwm sim tau pom thaum pib siv yeeb tshuaj thiab feem ntau yog hauv txoj kev hais ntawm xeev siab, kiv taub hau. Cov teebmeem no tau mob sib khuav lossis me hauv qhov xwm txheej thiab tended tsis muaj zog lossis ploj tag nrho tom qab 10 hnub tom qab noj cov tshuaj.

Yog li, polyneuropathy nyob rau hauv cov ntshav qab zib mellitus yog qhov nyuaj thiab feem ntau yog vim muaj kev cuam tshuam hauv cov hlab ntsha peripheral. Kev nce qib hauv kev kawm txog pathogenesis qhib kev tshiab rau kev tshawb nrhiav cov tshuaj uas cuam tshuam ncaj qha pathophysiological cov txheej txheem ntawm DPN, uas suav nrog Milgamma thiab Milgamma compositum, nrog cov kev cuam tshuam ua rau kev txhim kho cov ntshav, txhim kho kev tsim kho ntawm cov hlab nqaij, ua kom muaj kev nrawm nrawm thiab muaj cov nyhuv analgesic. Cov.Cov tshuaj occupies ib qho chaw tseem ceeb hauv txoj kev kho mob ntshav qab zib mob neuropathy.