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Коморбідний ендокринологічний пацієнт
Коморбідний ендокринологічний пацієнт

Международный эндокринологический журнал Том 20, №8, 2024

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Порушення циркадних ритмів варіабельності ритму серця при діабетичній кардіальній автономній нейропатії: механізми та наслідки

Порушення циркадних ритмів варіабельності ритму серця при діабетичній кардіальній автономній нейропатії: механізми та наслідки

Авторы: V.A. Serhiyenko (1), M.I. Dolynay (2), V.B. Sehin (1), Y.V. Lazur (3), A.A. Serhiyenko (1)
(1) - Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
(2) - Mukachevo State University, Mukachevo, Ukraine
(3) - Uzhhorod National University, Uzhorod, Ukraine

Рубрики: Эндокринология

Разделы: Справочник специалиста

Версия для печати


Резюме

Порушення варіабельності ритму серця (ВРС) може збільшити ризик серцево-судинних захворювань протягом наступних шести років від 4 до 100 %. Повідомляється, що хронобіологічна оцінка ВРС та своєчасна оптимізація лікування дозволяють зменшити ризик інсульту або серцевої смерті. Фізіологічна серцево-судинна діяльність знаходиться під контролем вегетативної нервової системи. Пошкодження вегетативних нервів викликає порушення контролю частоти серцевих скорочень і судинної динаміки, особливо при кардіальній автономній нейропатії (КАН). Вегетативний дисбаланс у регуляції серцево-судинної функції симпатичною (СНС) та парасимпатичною нервовою системою (ПСНС) призводить до метаболічних порушень і значної захворюваності й смертності серед осіб із цукровим діабетом (ЦД). У них виявляють порушення циркадних ритмів. Існує тісний зв’язок між змінами нейроендокринної архітектури сну, коливаннями біологічного годинника, метаболізмом глюкози, вегетативною функцією та добовими профілями артеріального тиску й частоти серцевих скорочень. Метаболічний синдром, артеріальна гіпертензія, інфаркт міокарда та ЦД характеризуються підвищеною активністю СНС і зниженою — ПСНС. Однак у хворих на ЦД 2-го типу спостерігається зниження активності як ПСНС, так і СНС. Це можна пояснити тим, що ЦД 2-го типу є метаболічним захворюванням, яке спричиняє КАН, вражаючи симпатичні й парасимпатичні волокна. Метою цього огляду було обговорення сучасного стану проблеми взаємозв’язку ЦД і порушень циркадного ритму, ВРС. Особливу увагу приділено факторам ризику діабетичної КАН; механізмам збільшення смертності, пов’язаної з КАН; патогенезу діабетичної КАН; можливим патогенетичним шляхам, що пов’язують КАН та прогресування атеросклерозу; генетичним, епігенетичним особливостям і КАН; ЦД та циркадним ритмам ВРС; діабетичній КАН і порушенням циркадного ритму ВРС. Пошук проводився в Scopus, Science Direct (від Elsevier) і PubMed, включно з базами даних MEDLINE. Використані ключові слова «цукровий діабет», «кардіальна автономна нейропатія», «циркадні ритми», «варіабельність ритму серця». Для виявлення результатів досліджень, які не вдалося знайти під час онлайн-пошуку, використовувався ручний пошук бібліографії публікацій.

Abnormalities in heart rate variability (HRV) may increase the risk of cardiovascular disease over the next six years from 4 to 10 %. It is reported that the probability of stroke or cardiac death can be immediately reduced by chronobiologically assessing HRV and optimizing timed treatment efficacy. Physiological cardiovascular activities are under the control of the cardiac autonomic nervous system. Damage to the autonomic nerves results in dysfunction in heart rate control and vascular dynamics, particularly in cardiac autonomic neuropathy (CAN). Autonomic imbalance in the sympathetic (SNS) and parasympathetic nervous systems (PSNS) regulation of cardiovascular function contributes to metabolic abnormalities and significant morbidity and mortality for individuals with diabetes mellitus (DM). Misalignment of circadian rhythms has been evidenced in patients with DM, and there is a close relationship between alterations in neuroendocrine sleep architecture, circadian clock oscillations, glucose metabolism, autonomic function, and diurnal profiles of blood pressure and heart rate. Metabolic syndrome, hypertension, myocardial infarction, and DM are characterized by increased SNS activity and decreased PSNS activity. However, type 2 DM patients had a decrease in both PSNS and SNS activity. It can be explained by type 2 DM, which is a metabolic disease responsible for CAN that affects both sympathetic and parasympathetic fibers. The purpose of this review was to discuss the current state of the problem of the relationship between DM and circadian rhythm disorders, HRV. Particular attention is paid to the risk factors of diabetic CAN; insights into the mechanisms of excess mortality associated with CAN; the pathogenesis of diabetic CAN; possible pathogenic pathways binding CAN and atherosclerosis progression; genetic and epigenetic factors and CAN; DM and circadian rhythms of HRV; diabetic CAN and circadian rhythm disorders. The search was conducted in Scopus, Science Direct (from Else­vier), and PubMed, including MEDLINE databases. The keywords used were diabetes mellitus, cardiac autonomic neuropathy, circadian rhythms, heart rate variability. A manual search of the bibliography of publications was used to identify study results that could not be found during the online search.


Ключевые слова

цукровий діабет; кардіальна автономна нейропатія; циркадні ритми; варіабельність ритму серця; огляд літератури

diabetes mellitus; cardiac autonomic neuropathy; circadian rhythms; heart rate variability; review

doi: http://dx.doi.org/10.22141/2224-0721.20.8.2024.1461

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