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Π‘ΠΠ₯ΠΠ ΠΠ«Π ΠΠΠΠΠΠ’ β ΠΠΠΠ‘ΠΠΠΠ¨ΠΠ ΠΠ«ΠΠΠ ΠΠΠ ΠΠΠΠΠ£ Π‘ΠΠΠΠ©ΠΠ‘Π’ΠΠ£
According to the WHO and the UN definitions, diabetes mellitus is a non-infectious disease that has an epidemic spread rate, this has led to the UN 2006 resolution against diabetes mellitus. A special diabetologic service has been established in Russia which includes Federal and regional diabetes centres, endocrinologic clinics, equipped with modern diagnostic and treatment equipment for diabetes and its vascular complications handling. Planning of diabetologic service functioning is based on State diabetes mellitus register data, according to which nowadays in Russia 3 268 871Β patients have been registered. This article contains data from control-and-epidemiological studies from various regions of Russia which have shown real spread of the disease. This article also contains information about innovative technologies of treatment of diabetes mellitus and its complications, international and national foreground studies, as well as discussion of diabetologic service development perspectives.Π‘Π°Ρ
Π°ΡΠ½ΡΠΉ Π΄ΠΈΠ°Π±Π΅Ρ, ΠΏΠΎ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΠΠΠ ΠΈ ΠΠΠ, ΠΎΡΠ½ΠΎΡΡΡ ΠΊ Π½Π΅ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌ Ρ ΡΠΏΠΈΠ΄Π΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΊΠΎΡΠΎΡΡΡΡ ΡΠΎΡΡΠ° ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΠΈ, ΡΡΠΎ ΠΏΠΎΠ±ΡΠ΄ΠΈΠ»ΠΎ ΠΠΠ Π² 2006 Π³ΠΎΠ΄Ρ ΠΏΡΠΈΠ½ΡΡΡ ΡΠ΅Π·ΠΎΠ»ΡΡΠΈΡ ΠΏΠΎ Π±ΠΎΡΡΠ±Π΅ Ρ ΡΠ°Ρ
Π°ΡΠ½ΡΠΌ Π΄ΠΈΠ°Π±Π΅ΡΠΎΠΌ. Π Π ΠΎΡΡΠΈΠΈ ΡΠΎΠ·Π΄Π°Π½Π° ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΡΠ΅Ρ Π΄ΠΈΠ°Π±Π΅ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠ»ΡΠΆΠ±Π°, Π²ΠΊΠ»ΡΡΠ°ΡΡΠ°Ρ Π€Π΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΠΉ ΠΈ ΡΠ΅Π³ΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠ΅ ΡΠ΅Π½ΡΡΡ Π΄ΠΈΠ°Π±Π΅ΡΠ°, ΡΠ½Π΄ΠΎΠΊΡΠΈΠ½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π΄ΠΈΡΠΏΠ°Π½ΡΠ΅ΡΡ, ΠΎΡΠ½Π°ΡΠ΅Π½Π½ΡΠ΅ ΡΠΎΠ²ΡΠ΅-ΠΌΠ΅Π½Π½ΡΠΌ ΠΎΠ±ΠΎΡΡΠ΄ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π΄Π»Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ°Ρ
Π°ΡΠ½ΠΎΠ³ΠΎ Π΄ΠΈΠ°Π±Π΅ΡΠ° ΠΈ Π΅Π³ΠΎ ΡΠΎΡΡΠ΄ΠΈΡΡΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ. ΠΠ»Π°Π½ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Π΄ΠΈΠ°Π±Π΅ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ»ΡΠΆΠ±Ρ ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΎ Π½Π° Π΄Π°Π½Π½ΡΡ
ΠΠΎΡΡΠ΄Π°ΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΡΠ΅Π³ΠΈΡΡΡΠ° Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΠ°Ρ
Π°ΡΠ½ΡΠΌ Π΄ΠΈΠ°Π±Π΅ΡΠΎΠΌ, ΡΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΊΠΎΡΠΎΡΡΠΌ Π² Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ Π² Π ΠΎΡΡΠΈΠΈ ΠΏΠΎ ΠΎΠ±ΡΠ°ΡΠ°Π΅ΠΌΠΎΡΡΠΈ Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½Ρ 3 268 871 Π±ΠΎΠ»ΡΠ½ΠΎΠΉ. ΠΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ Π΄Π°Π½Π½ΡΠ΅ ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΠΎ-ΡΠΏΠΈΠ΄Π΅ΠΌΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ Π² ΡΠ΅Π³ΠΈΠΎΠ½Π°Ρ
Π ΠΎΡΡΠΈΠΈ, ΠΏΠΎΠΊΠ°Π·Π°Π²ΡΠΈΡ
ΡΠ΅Π°Π»ΡΠ½ΡΡ ΡΠΈΡΠ»Π΅Π½Π½ΠΎΡΡΡ Π±ΠΎΠ»ΡΠ½ΡΡ
Π΄ΠΈΠ°Π±Π΅ΡΠΎΠΌ. Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ ΠΈΠ½Π½ΠΎΠ²Π°ΡΠΈΠΎΠ½Π½ΡΠ΅ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΈ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΡΠ°Ρ
Π°ΡΠ½ΠΎΠ³ΠΎ Π΄ΠΈΠ°Π±Π΅ΡΠ° ΠΈ Π΅Π³ΠΎ ΠΎΡΠ»ΠΎΠΆ-Π½Π΅Π½ΠΈΠΉ, ΠΏΡΠΈΠΎΡΠΈΡΠ΅ΡΠ½ΡΠ΅ Π½Π°ΡΡΠ½ΡΠ΅ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠΈ Π² ΠΌΠΈΡΠ΅ ΠΈ Π ΠΎΡΡΠΈΠΈ, ΠΎΠ±ΡΡΠΆΠ΄Π°ΡΡΡΡ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Ρ ΡΠ°Π·Π²ΠΈΡΠΈΡ Π΄ΠΈΠ°Π±Π΅ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ»ΡΠΆΠ±Ρ
ΠΠΠΠΠΠΠΠΠ§ΠΠ‘ΠΠΠ― ΠΠΠ’ΠΠ ΠΠΠΠΠΠΠ‘Π’Π¬, ΠΠΠΠΠΠ£ΠΠ―Π ΠΠΠ― ΠΠΠΠΠ’ΠΠΠ Π ΠΠΠΠ£ΠΠΠΠΠΠΠ― ΠΠ£Π’ΠΠΠΠΠ£ΠΠΠΠΠ Π‘ΠΠ₯ΠΠ ΠΠΠΠ ΠΠΠΠΠΠ’Π
Article is devoted to the review of literature data, and also the analysis of results of own researches concerning genetics, molecular genetics and immunological violations at various forms of the autoimmune diabetes (DM) including classical T1DM, LADA type and an autoimmune polyglandular syndrome of 1 type (APS1). In case of T1DM more than 80% of patients are carriers of one or two strongest predisposing haplotypes: DRB1*O4-DQA1*O3O1-DQB1*O3O2 and DRB1*O3-DQA1*O5O1- DQB1*O201 designated as DQ2 and DQ8. HLA genes can model a clinical features of disease. In Russian population, the children with diabetes manifestation up to 5-year age has significantly often high risk genotypes (DQ2/DQ8) and significantly less the low risk genotypes in comparison with children, who had manifestation of T1DM in 10 years and later. The long-term16-years family studies showed the maximum frequency of T1DM in high risk group, constantly accruing in process of increase in term of supervision, and in groups of an average and low risk lower and invariable. The highest risk of T1DM manifestation, reaching 90% at 10 years of supervision is defined by existence of HLA high risk genotypes and many antibodies, revealed from early age. LADA β the hybrid form of autoimmune DM having signs of T1DM and T2DM in the basis. The development of autoimmune process against Ξ²-cells can be caused by only gene mutation (APS1). The part of T1DM cases which doesn't have the contributing HLA genes and autoimmune markers in process of studying of the importance of various genes and their biological value can be attributed to new, yet unknown forms of DM.Β Π‘ΡΠ°ΡΡΡ ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π° ΠΎΠ±Π·ΠΎΡΡ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ½ΡΡ
Π΄Π°Π½Π½ΡΡ
, Π° ΡΠ°ΠΊΠΆΠ΅ Π°Π½Π°Π»ΠΈΠ·Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΡΠΎΠ±ΡΡΠ²Π΅Π½Π½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΊΠ°ΡΠ°ΡΡΠΈΡ
ΡΡ Π³Π΅Π½Π΅ΡΠΈΠΊΠΈ, ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎΠΉ Π³Π΅Π½Π΅ΡΠΈΠΊΠΈ ΠΈ ΠΈΠΌΠΌΡΠ½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ ΠΏΡΠΈ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΡΠΎΡΠΌΠ°Ρ
Π°ΡΡΠΎΠΈΠΌΠΌΡΠ½Π½ΠΎΠ³ΠΎ ΡΠ°Ρ
Π°ΡΠ½ΠΎΠ³ΠΎ Π΄ΠΈΠ°Π±Π΅ΡΠ° (Π‘Π), Π²ΠΊΠ»ΡΡΠ°Ρ ΠΊΠ»Π°ΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π‘Π 1-Π³ΠΎ ΡΠΈΠΏΠ° (Π‘Π1), LADA ΠΈ Π°ΡΡΠΎΠΈΠΌΠΌΡΠ½Π½ΡΠΉ ΠΏΠΎΠ»ΠΈΠ³Π»Π°Π½Π΄ΡΠ»ΡΡΠ½ΡΠΉ ΡΠΈΠ½Π΄ΡΠΎΠΌ 1-Π³ΠΎ ΡΠΈΠΏΠ° (ΠΠΠ‘1). ΠΡΠΈ Π‘Π1 Π±ΠΎΠ»Π΅Π΅ 80% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ²Π»ΡΡΡΡΡ Π½ΠΎΡΠΈΡΠ΅Π»ΡΠΌΠΈ ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΈΠ»ΠΈ Π΄Π²ΡΡ
Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠΈΠ»ΡΠ½ΠΎ ΠΏΡΠ΅Π΄ΡΠ°ΡΠΏΠΎΠ»Π°Π³Π°ΡΡΠΈΡ
ΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ Π‘Π1 Π³Π°ΠΏΠ»ΠΎΡΠΈΠΏΠΎΠ²: DRB1*O4-DQA1*O3O1-DQB1*O3O2 ΠΈ DRB1*O3DQA1*O5O1-DQB1*O201, ΠΎΠ±ΠΎΠ·Π½Π°ΡΠ°Π΅ΠΌΡΡ
ΠΊΠ°ΠΊ DQ2 ΠΈ DQ8. ΠΠ΅Π½Ρ HLA ΠΌΠΎΠ³ΡΡ ΡΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π±ΠΎΠ»Π΅Π·Π½ΠΈ. Π ΡΡΡΡΠΊΠΎΠΉ ΠΏΠΎΠΏΡΠ»ΡΡΠΈΠΈ Ρ Π΄Π΅ΡΠ΅ΠΉ, Π·Π°Π±ΠΎΠ»Π΅Π²ΡΠΈΡ
Π΄ΠΎ ΠΏΡΡΠΈΠ»Π΅ΡΠ½Π΅Π³ΠΎ Π²ΠΎΠ·ΡΠ°ΡΡΠ°, Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ ΡΠ°ΡΠ΅ Π²ΡΡΡΠ΅ΡΠ°Π»ΠΈΡΡ Π³Π΅Π½ΠΎΡΠΈΠΏΡ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° (DQ2/DQ8) ΠΈ ΡΠ΅ΠΆΠ΅ β Π³Π΅Π½ΠΎΡΠΈΠΏΡ Π½ΠΈΠ·ΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ Π΄Π΅ΡΡΠΌΠΈ Ρ Π΄Π΅Π±ΡΡΠΎΠΌ Π‘Π1 Π² Π²ΠΎΠ·ΡΠ°ΡΡΠ΅ ΡΡΠ°ΡΡΠ΅ 10 Π»Π΅Ρ. Π ΡΠ΅ΠΌΠ΅ΠΉΠ½ΡΡ
ΡΠ΅ΡΡΠ½Π°Π΄ΡΠ°ΡΠΈΠ»Π΅ΡΠ½ΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ
ΡΠ°ΡΡΠΎΡΠ°Π‘Π1 Π² Π³ΡΡΠΏΠΏΠ΅ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° Π±ΡΠ»Π° ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠΉ, Π½Π°ΡΠ°ΡΡΠ°ΡΡΠ΅ΠΉ ΠΏΠΎ ΠΌΠ΅ΡΠ΅ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΡ ΡΡΠΎΠΊΠ° Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ, Π° Π² Π³ΡΡΠΏΠΏΠ°Ρ
ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ ΠΈ Π½ΠΈΠ·ΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° β Π±ΠΎΠ»Π΅Π΅ Π½ΠΈΠ·ΠΊΠΎΠΉ ΠΈ Π½Π΅ΠΈΠ·ΠΌΠ΅Π½Π½ΠΎΠΉ. ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ Π²ΡΡΠΎΠΊΠΈΠΉ ΡΠΈΡΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ Π‘Π1, Π΄ΠΎΡΡΠΈΠ³Π°ΡΡΠΈΠΉ 90% ΠΏΡΠΈ Π΄Π΅ΡΡΡΠΈΠ»Π΅ΡΠ½Π΅ΠΌ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠΈ, ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ΅ΡΡΡ Π½Π°Π»ΠΈΡΠΈΠ΅ΠΌ HLA-Π³Π΅Π½ΠΎΡΠΈΠΏΠΎΠ² Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΈ Π½Π°Π»ΠΈΡΠΈΠ΅ΠΌ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π° Π°ΡΡΠΎΠ°Π½ΡΠΈΡΠ΅Π», Π²ΡΡΠ²Π»ΡΠ΅ΠΌΡΡ
Ρ ΡΠ°Π½Π½Π΅Π³ΠΎ Π²ΠΎΠ·ΡΠ°ΡΡΠ°. LADA β Π³ΠΈΠ±ΡΠΈΠ΄Π½Π°Ρ ΡΠΎΡΠΌΠ° Π°ΡΡΠΎΠΈΠΌΠΌΡΠ½Π½ΠΎΠ³ΠΎ Π‘Π, ΠΈΠΌΠ΅ΡΡΠ°Ρ Π² ΡΠ²ΠΎΠ΅ΠΉ ΠΎΡΠ½ΠΎΠ²Π΅ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ Π‘Π1 ΠΈ Π‘Π2. Π Π°Π·Π²ΠΈΡΠΈΠ΅ Π°ΡΡΠΎΠΈΠΌΠΌΡΠ½Π½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠ΅ΡΡΠ° ΠΏΡΠΎΡΠΈΠ² Ξ²-ΠΊΠ»Π΅ΡΠΎΠΊ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½ΠΎ ΡΠ°ΠΊΠΆΠ΅ Π΅Π΄ΠΈΠ½ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π³Π΅Π½Π½ΠΎΠΉ ΠΌΡΡΠ°ΡΠΈΠ΅ΠΉ (ΠΠΠ‘1). Π§Π°ΡΡΡ ΡΠ»ΡΡΠ°Π΅Π² Π‘Π1, Π½Π΅ ΠΈΠΌΠ΅ΡΡΠΈΡ
ΠΏΡΠ΅Π΄ΡΠ°ΡΠΏΠΎΠ»Π°Π³Π°ΡΡΠΈΡ
HLA-Π³Π΅Π½ΠΎΠ² ΠΈ Π°ΡΡΠΎΠΈΠΌΠΌΡΠ½Π½ΡΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ², ΠΏΠΎ ΠΌΠ΅ΡΠ΅ ΠΈΠ·ΡΡΠ΅Π½ΠΈΡ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΠΈ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
Π³Π΅Π½ΠΎΠ² ΠΈ ΠΈΡ
Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΎΡΠ½Π΅ΡΠ΅Π½Π° ΠΊ Π½ΠΎΠ²ΡΠΌ, ΠΏΠΎΠΊΠ° Π½Π΅ΠΈΠ·Π²Π΅ΡΡΠ½ΡΠΌ ΡΠΎΡΠΌΠ°ΠΌ Π‘Π.
ΠΠΏΠΈΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π°ΡΠΏΠ΅ΠΊΡΡ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π°
This review describes the epigenetic regulation of osteoblastogenesis and osteoclastogenesis and its future implementation in the diagnosis andΒ treatment of osteoporosis. A considerable part of the review is dedicated to the microRNAs (miRNAs). miRNAs are small regulatory factors thatΒ regulate gene expression, by post-transcriptional regulation of genes playing an important role in numerous cellular processes, including cell differentiationΒ and apoptosis. Recently, a number of studies have revealed that miRNAs participate in bone homeostasis and their role in the pathogenesisΒ of osteoporosis is practically evident. In this review, we highlight the miRNAs involved in bone remodelling and their roles in osteoporosis. miRNAsΒ are stable molecules which make them promising potential markers for bone remodeling and osteoporosis.ΠΠ±ΡΡΠΆΠ΄Π°ΡΡΡΡ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΡΠΏΠΈΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΎΠ² ΡΠ΅Π³ΡΠ»ΡΡΠΈΠΈ ΠΎΡΡΠ΅ΠΎΠ±Π»Π°ΡΡΠΎ- ΠΈ ΠΎΡΡΠ΅ΠΎΠΊΠ»Π°ΡΡΠΎΠ³Π΅Π½Π΅Π·Π° Π² ΡΠ°Π½Π½Π΅ΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π°. ΠΡΠΎΠ±ΠΎΠ΅ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ ΡΠ΄Π΅Π»Π΅Π½ΠΎ ΠΊΠ»Π°ΡΡΡ ΠΌΠ°Π»ΡΡ
Π½Π΅ΠΊΠΎΠ΄ΠΈΡΡΡΡΠΈΡ
ΡΠ΅Π³ΡΠ»ΡΡΠΎΡΠ½ΡΡ
Π ΠΠ β ΠΌΠΈΠΊΡΠΎΠ ΠΠ (ΠΌΠΊΠ ΠΠ),Β ΠΊΠΎΡΠΎΡΡΠ΅ ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΡΡΡ ΡΠΊΡΠΏΡΠ΅ΡΡΠΈΡ Π³Π΅Π½ΠΎΠ² Π½Π° ΠΏΠΎΡΡΡΡΠ°Π½ΡΠΊΡΠΈΠΏΡΠΈΠΎΠ½Π½ΠΎΠΌ ΡΡΠΎΠ²Π½Π΅, ΡΡΠ°ΡΡΠ²ΡΡ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Π²ΠΎ Π²ΡΠ΅Ρ
Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΎΡΠ΅ΡΡΠ°Ρ
Β Π² ΠΊΠ»Π΅ΡΠΊΠ΅, Π²ΠΊΠ»ΡΡΠ°Ρ ΠΊΠ»Π΅ΡΠΎΡΠ½ΡΡ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²ΠΊΡ ΠΈ Π°ΠΏΠΎΠΏΡΠΎΠ·. ΠΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΡΠΎΠ»ΠΈ ΠΌΠΊΠ ΠΠ Π² ΡΠ΅Π³ΡΠ»ΡΡΠΈΠΈ ΠΊΠΎΡΡΠ½ΠΎΠ³ΠΎ ΠΎΠ±ΠΌΠ΅Π½Π° Π½Π°ΡΠ°ΡΡ ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΒ Π½Π΅Π΄Π°Π²Π½ΠΎ, ΠΎΠ΄Π½Π°ΠΊΠΎ Π²ΡΠ΅ Π±ΠΎΠ»Π΅Π΅ ΠΎΡΠ΅Π²ΠΈΠ΄Π½ΠΎ ΠΈΡ
ΡΡΠ°ΡΡΠΈΠ΅ Π² ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π°. Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠΈΠ²Π΅Π΄Π΅Π½ ΠΏΡΠΎΡΠΈΠ»Ρ ΠΌΠΈΠΊΡΠΎΠ ΠΠ, Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ Π·Π½Π°ΡΠΈΠΌΠΎΒ Π²Π»ΠΈΡΡΡΠΈΡ
Π½Π° ΠΊΠΎΡΡΠ½ΡΠΉ ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΠ·ΠΌ. Π£ΡΡΠΎΠΉΡΠΈΠ²ΠΎΡΡΡ ΠΌΠΊΠ ΠΠ ΠΊ ΡΠ°Π·ΡΡΡΠ΅Π½ΠΈΡ Π² ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ Π΄Π°Π΅Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΒ Π½Π΅ΠΊΠΎΡΠΎΡΡΠ΅ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΡΠ΅ Π΄Π»Ρ ΠΊΠΎΡΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ ΠΌΠΊΠ ΠΠ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ
Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΠΊΠΎΡΡΠ½ΠΎΠ³ΠΎ ΡΠ΅ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΡΠΈ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π°
Π‘ΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅ ΠΌΠΈΠΎΠΊΠΈΠ½ΠΎΠ² Π² ΡΡΠ²ΠΎΡΠΎΡΠΊΠ΅ ΠΊΡΠΎΠ²ΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ½Π΄ΠΎΠ³Π΅Π½Π½ΡΠΌ Π³ΠΈΠΏΠ΅ΡΠΊΠΎΡΡΠΈΡΠΈΠ·ΠΌΠΎΠΌ ΠΈ Π°ΠΊΡΠΎΠΌΠ΅Π³Π°Π»ΠΈΠ΅ΠΉ: ΠΎΠ΄Π½ΠΎΠΌΠΎΠΌΠ΅Π½ΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Β«ΡΠ»ΡΡΠ°ΠΉβΠΊΠΎΠ½ΡΡΠΎΠ»ΡΒ»
Background:Β Myokines are produced and released by muscle cells in response to muscular contractions. Endogenous Cushing syndrome (CS) and acromegaly cause significant changes in muscle tissue leading to atrophy or hypertrophy. However, there is no data whether these endocrine abnormalities influence myokine secretion.Β Aims: To evaluate serum levels of myostatin, interleukin-6 (IL6) and irisin in patients with CS and acromegaly.Β Materials and methods: Fasting serum samples were taken and stored in aliquot at β€-20Β°C from consecutive subjects with clinically evident and biochemically confirmed active CS, acromegaly and healthy volunteers matched by age, sex and body mass index (BMI). Commercially available kits were used to assay serum myokine levels. Grip strength was measured by a dynamometer. Insulin-like growth factor-1 (IGF1) was measured by immunochemiluminescence assay (Liaison), twenty-four hours urine free cortisol (24hUFC) β by immunochemiluminescence assay (Vitros ECi), salivary free cortisol β by electrochemiluminescence assay (Cobas). One-way ANOVA was utilized to assess the difference between groups.Β Results: We enrolled 88 subjects: 30 patients suffered from CS (group 1), 28 β acromegaly (2) and 30 matched healthy controls (3) with no difference among the groups in sex, age and BMI (p=0.492, 0.062 and 0.174 respectively). Mean 24hUFC in subjects with CS and mean IGF1 in subjects with acromegaly were significantly higher as compared to other groups (p0.001). Right-hand grip strength was lower in patients with CS as compared to both patients with acromegaly and healthy subjects (p=0.04). However, among these young adults we did not find statistically significant differences in measured myokines levels: irisin β p=0.15; IL6 β p=0.34; myostatin β p=0.50. There was a significant correlation between myostatin and irisin in the whole group of people and in every separately analyzed subset of patients (p0.001), but no correlation was found between any measured myokines and 24hUFC or IGF1.Conclusions:Β Hypercortisolism or supraphysiological IGF1 levels do not significantly influence serum levels of myostatin, IL6 and irisin in young adults.Π Π΅Π·ΡΠΌΠ΅: ΠΠΈΠΎΠΊΠΈΠ½Ρ ΠΏΡΠΎΠ΄ΡΡΠΈΡΡΡΡΡΡ ΠΈ Π²ΡΡΠ²ΠΎΠ±ΠΎΠΆΠ΄Π°ΡΡΡΡ ΠΌΠΈΠΎΡΠΈΡΠ°ΠΌΠΈ Π² ΠΎΡΠ²Π΅Ρ Π½Π° ΡΠΎΠΊΡΠ°ΡΠ΅Π½ΠΈΡ ΠΌΡΡΡ. ΠΠ½Π΄ΠΎΠ³Π΅Π½Π½ΡΠΉ Π³ΠΈΠΏΠ΅ΡΠΊΠΎΡΡΠΈΡΠΈΠ·ΠΌ ΠΈ Π°ΠΊΡΠΎΠΌΠ΅Π³Π°Π»ΠΈΡ Π²ΡΠ·ΡΠ²Π°ΡΡ Π·Π½Π°ΡΠΈΠΌΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ Π² ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ, ΠΏΡΠΈΠ²ΠΎΠ΄ΡΡΠΈΠ΅ ΠΊ Π΅Π΅ Π°ΡΡΠΎΡΠΈΠΈ ΠΈΠ»ΠΈ Π³ΠΈΠΏΠ΅ΡΡΡΠΎΡΠΈΠΈ. ΠΠΌΠ΅ΡΡΠ΅ Ρ ΡΠ΅ΠΌ, Π½Π΅Ρ Π΄Π°Π½Π½ΡΡ
, Π²Π»ΠΈΡΡΡ Π»ΠΈ ΡΡΠΈ ΡΠ½Π΄ΠΎΠΊΡΠΈΠ½Π½ΡΠ΅ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ Π½Π° ΡΠ΅ΠΊΡΠ΅ΡΠΎΡΠ½ΡΡ ΡΡΠ½ΠΊΡΠΈΡ ΠΌΡΡΡ.Π¦Π΅Π»Ρ: ΠΎΡΠ΅Π½ΠΈΡΡ ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΠΎΠ΅ ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅ ΠΌΠΈΠΎΠΊΠΈΠ½ΠΎΠ² (ΠΈΠ½ΡΠ΅ΡΠ»Π΅ΠΉΠΊΠΈΠ½-6, ΠΌΠΈΠΎΡΡΠ°ΡΠΈΠ½, ΠΈΡΠΈΠ·ΠΈΠ½) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ½Π΄ΠΎΠ³Π΅Π½Π½ΡΠΌ Π³ΠΈΠΏΠ΅ΡΠΊΠΎΡΡΠΈΡΠΈΠ·ΠΌΠΎΠΌ ΠΈ Π°ΠΊΡΠΎΠΌΠ΅Π³Π°Π»ΠΈΠ΅ΠΉ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ: ΠΠ»Ρ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π²Π·ΡΡΡ ΠΎΠ±ΡΠ°Π·ΡΡ ΡΡΠ²ΠΎΡΠΎΡΠΎΠΊ ΡΠΎΡΠ°ΠΊΠΎΠ²ΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ, Π·Π°ΠΌΠΎΡΠΎΠΆΠ΅Π½Π½ΡΠ΅ ΠΏΡΠΈ T° β€-20ΒΊC, Ρ Π»ΠΈΡ Ρ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½Π½ΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΡ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΡΠ΅Π½ΠΊΠΎ-ΠΡΡΠΈΠ½Π³Π° (ΠΠΠ) ΠΈ Π°ΠΊΡΠΎΠΌΠ΅Π³Π°Π»ΠΈΠΈ ΠΈ Ρ Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π², ΠΏΠΎΠ΄ΠΎΠ±ΡΠ°Π½Π½ΡΡ
ΠΏΠΎ Π²ΠΎΠ·ΡΠ°ΡΡΡ, ΠΏΠΎΠ»Ρ ΠΈ ΠΈΠ½Π΄Π΅ΠΊΡΡ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π° (ΠΠΠ’). ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΎΠ΄Π½ΠΎΠΌΠΎΠΌΠ΅Π½ΡΠ½ΠΎ Π½Π° Π±Π°Π·Π΅ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡ Π½Π΅ΠΉΡΠΎΡΠ½Π΄ΠΎΠΊΡΠΈΠ½ΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΈ ΠΎΡΡΠ΅ΠΎΠΏΠ°ΡΠΈΠΉ Π€ΠΠΠ£ Β«ΠΠ½Π΄ΠΎΠΊΡΠΈΠ½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ Π½Π°ΡΡΠ½ΡΠΉ ΡΠ΅Π½ΡΡΒ». ΠΠ»Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΡΠΎΠ²Π½Ρ ΠΌΠΈΠΎΠΊΠΈΠ½ΠΎΠ² ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΡΒ ΠΊΠΎΠΌΠΌΠ΅ΡΡΠ΅ΡΠΊΠΈ Π΄ΠΎΡΡΡΠΏΠ½ΡΠ΅ Π½Π°Π±ΠΎΡΡ Π΄Π»Ρ ΠΈΠΌΠΌΡΠ½ΠΎΡΠ΅ΡΠΌΠ΅Π½ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π°. Π£ Π²ΡΠ΅Ρ
Π²ΠΊΠ»ΡΡΠ΅Π½Π½ΡΡ
Π»ΠΈΡ ΡΠΈΠ»Π° ΡΠΆΠ°ΡΠΈΡ ΠΊΠΈΡΡΠΈ ΠΈΠ·ΠΌΠ΅ΡΡΠ»Π°ΡΡ ΡΡΡΠ½ΡΠΌ Π΄ΠΈΠ½Π°ΠΌΠΎΠΌΠ΅ΡΡΠΎΠΌ. ΠΠ½ΡΡΠ»ΠΈΠ½ΠΎΠΏΠΎΠ΄ΠΎΠ±Π½ΡΠΉ ΡΠ°ΠΊΡΠΎΡ ΡΠΎΡΡΠ° 1 (ΠΠ€Π -1) ΠΈ ΡΠ²ΠΎΠ±ΠΎΠ΄Π½ΡΠΉ ΠΊΠΎΡΡΠΈΠ·ΠΎΠ» Π² ΡΡΡΠΎΡΠ½ΠΎΠΉ ΠΌΠΎΡΠ΅Β ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈΡΡ ΠΈΠΌΠΌΡΠ½ΠΎΡ
Π΅ΠΌΠΈΠ»ΡΠΌΠΈΠ½Π΅ΡΡΠ΅Π½ΡΠ½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ, ΡΠ²ΠΎΠ±ΠΎΠ΄Π½ΡΠΉ ΠΊΠΎΡΡΠΈΠ·ΠΎΠ» Π² ΡΠ»ΡΠ½Π΅ - ΡΠ»Π΅ΠΊΡΡΠΎΡ
Π΅ΠΌΠΈΠ»ΡΠΌΠΈΠ½Π΅ΡΡΠ΅Π½ΡΠ½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ. ΠΠ»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΠ°Π·Π»ΠΈΡΠΈΠΉ ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ ΠΎΠ΄Π½ΠΎΡΠ°ΠΊΡΠΎΡΠ½ΡΠΉ Π΄ΠΈΡΠΏΠ΅ΡΡΠΈΠΎΠ½Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ANOVA.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ: Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 88 ΡΠ΅Π»ΠΎΠ²Π΅ΠΊ [30 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΠΡΠ΅Π½ΠΊΠΎ-ΠΡΡΠΈΠ½Π³Π° (Π³ΡΡΠΏΠΏΠ° 1), 28 Ρ Π°ΠΊΡΠΎΠΌΠ΅Π³Π°Π»ΠΈΠ΅ΠΉ (Π³ΡΡΠΏΠΏΠ° 2) ΠΈ 30 ΡΡΠ»ΠΎΠ²Π½ΠΎ Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π»ΠΈΡ (Π³ΡΡΠΏΠΏΠ° 3)], Π±Π΅Π· ΡΠ°Π·Π»ΠΈΡΠΈΠΉ ΠΏΠΎ ΠΏΠΎΠ»Ρ, Π²ΠΎΠ·ΡΠ°ΡΡΡ ΠΈ ΠΠΠ’ ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ (p=0,492, 0,062 ΠΈΒ 0,174 ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ). Π‘ΡΠ΅Π΄Π½Π΅Π΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΡΠ²ΠΎΠ±ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΊΠΎΡΡΠΈΠ·ΠΎΠ»Π° Π² ΡΡΡΠΎΡΠ½ΠΎΠΉ ΠΌΠΎΡΠ΅ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ ΠΈ ΡΡΠ΅Π΄Π½ΠΈΠΉ ΡΡΠΎΠ²Π΅Π½Ρ ΠΠ Π€-1 Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π°ΠΊΡΠΎΠΌΠ΅Π³Π°Π»ΠΈΠ΅ΠΉ Π±ΡΠ»ΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ Π²ΡΡΠ΅, Π½Π΅ΠΆΠ΅Π»ΠΈ Π² Π΄ΡΡΠ³ΠΈΡ
Π³ΡΡΠΏΠΏΠ°Ρ
(p0,001). Π‘ΠΈΠ»Π° ΡΠΆΠ°ΡΠΈΡ ΠΏΡΠ°Π²ΠΎΠΉ ΠΊΠΈΡΡΠΈ Π±ΡΠ»Π° Π½ΠΈΠΆΠ΅ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ, ΡΡΡΠ°Π΄Π°ΡΡΠΈΠΌΠΈ Π°ΠΊΡΠΎΠΌΠ΅Π³Π°Π»ΠΈΠ΅ΠΉ ΠΈ ΡΠΎ Π·Π΄ΠΎΡΠΎΠ²ΡΠΌΠΈ Π»ΠΈΡΠ°ΠΌΠΈ (p=0,04). ΠΠ΄Π½Π°ΠΊΠΎ Π½Π΅ Π±ΡΠ»ΠΎ Π½Π°ΠΉΠ΄Π΅Π½ΠΎ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΡΡ
ΡΠ°Π·Π»ΠΈΡΠΈΠΉ Π² ΠΈΠ·ΠΌΠ΅ΡΠ΅Π½Π½ΡΡ
ΡΡΠΎΠ²Π½ΡΡ
ΠΌΠΈΠΎΠΊΠΈΠ½ΠΎΠ²: ΠΈΡΠΈΠ·ΠΈΠ½ - p=0,15; ΠΠ-6 - p=0,34; ΠΌΠΈΠΎΡΡΠ°ΡΠΈΠ½ - p=0,50. Π ΠΊΠ°ΠΆΠ΄ΠΎΠΉ ΠΏΠΎΠ΄Π³ΡΡΠΏΠΏΠ΅ ΠΈ Π² ΡΠ΅Π»ΠΎΠΌ ΡΡΠ΅Π΄ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠΌΠ΅Π»Π°ΡΡ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΎΠ½Π½Π°Ρ ΡΠ²ΡΠ·Ρ ΠΌΠ΅ΠΆΠ΄Ρ ΡΡΠΎΠ²Π½Π΅ΠΌ ΠΌΠΈΠΎΡΡΠ°ΡΠΈΠ½Π° ΠΈ ΠΈΡΠΈΠ·ΠΈΠ½Π° (p0,001), Π½ΠΎ Π½Π΅ ΠΠ-6. ΠΠ΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΌΠ΅ΠΆΠ΄Ρ ΡΡΠΎΠ²Π½Π΅ΠΌ ΠΌΠΈΠΎΠΊΠΈΠ½ΠΎΠ² ΠΈ ΠΊΠΎΡΡΠΈΠ·ΠΎΠ»ΠΎΠΌ Π² ΡΡΡΠΎΡΠ½ΠΎΠΉ ΠΌΠΎΡΠ΅ ΠΈΠ»ΠΈ ΠΠ Π€1 ΠΊΠ°ΠΊ Π² ΡΠ΅Π»ΠΎΠΌ, ΡΠ°ΠΊ ΠΈ Π² ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΡ
Π³ΡΡΠΏΠΏΠ°Ρ
.ΠΡΠ²ΠΎΠ΄: ΡΠ½Π΄ΠΎΠ³Π΅Π½Π½ΡΠΉ Π³ΠΈΠΏΠ΅ΡΠΊΠΎΡΡΠΈΡΠΈΠ·ΠΌ (Π±ΠΎΠ»Π΅Π·Π½Ρ ΠΡΠ΅Π½ΠΊΠΎ-ΠΡΡΠΈΠ½Π³Π°) ΠΈ ΡΡΠΏΡΠ°ΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΠΎΠ²Π΅Π½Ρ ΠΠ Π€-1 Π·Π½Π°ΡΠΈΠΌΠΎ Π½Π΅ Π²Π»ΠΈΡΡΡ Π½Π° ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΡΠ΅ ΡΡΠΎΠ²Π½ΠΈ ΠΌΠΈΠΎΡΡΠ°ΡΠΈΠ½Π°, ΠΠ-6 ΠΈ ΠΈΡΠΈΠ·ΠΈΠ½Π° Ρ ΠΌΠΎΠ»ΠΎΠ΄ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²
Standards of specialized diabetes care
Dear Colleagues! We are glad to present the 8th Edition of Standards of Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation. The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), American Diabetes Association (ADA, 2012, 2017), American Association of Clinical Endocrinologists (AACE, 2017), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014) and Russian Association of Endocrinologists (RAE, 2011, 2012, 2015). Current edition of the "Standards" also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EMPA-REG OUTCOME, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals. Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 415 million patients by the end of 2015. According to the current estimation by the International Diabetes Federation, 642 million patients will be suffering from DM by 2040. These observations resulted in the UN Resolution on Diabetes 61/225 passed on 20.12.2006, and in 2011 - UN Political Declaration, addressed to national health systems, calling for the establishment of multidisciplinary strategy in the prevention and control of non-communicable diseases, where special attention is drawn to the problem of diabetes as one of the leading causes of disability and mortality. Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4.35 million patients with DM in this country by the end of 2016 (3% of population) with 92% (4 million) - Type 2 DM, 6% (255 th) - Type 1 DM and 2% (75 th) - other types of DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) confirmed that only 50% of Type 2 DM are diagnosed. So real prevalence of patients with DM in Russia is no less than 8-9 million patients (about 6% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they don't receive any treatment ant have high risk of vascular complications. Severe consequences of the global pandemics of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral, coronary and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death. Current edition of the "Standards" emphasizes the patient-oriented approach in making decisions on therapeutic goals, such as levels of glycaemia and blood pressure. It also features updated guidelines on the management of Type 2 DM and its vascular complications, added information about bariatric surgery as a method of treatment of DM with morbide obesity. This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discussions held at national meetings and forums. These guidelines are intended for endocrinologists and diabetologists, primary care physicians, cardiologists and other medical professionals involved in prevention and treatment of DM. On behalf of the Working Group