Психоорганический синдром при сахарном диабете 1 типа: осложнение диабета или сопутствующая патология? Обзор литературы

Психоорганический синдром (ПОС), также известный как энцефалопатия, характеризуется снижением когнитивных функций, недержанием эмоций (эмоциональной лабильностью) и астеническими симптомами. Он может развиваться вследствие целого ряда экзогенных и эндогенных факторов, и, несмотря на использование термина «диабетическая энцефалопатия», доказательства существования специфического диабетического генеза ПОС остаются ограниченными. В обзоре подробно рассмотрена история возникновения термина «ПОС» и его определение, компоненты ПОС и его возможные причины, «за» и «против» существования ПОС диабетического генеза. Обсуждены вероятность влияния дисгликемии на развитие ПОС и изменения в головном мозге у больных сахарным диабетом 1 типа (СД1) по данным нейровизуализации, а также их взаимосвязь друг с другом и с другими клиническими параметрами, в том числе с возрастом манифестации CД, длительностью заболевания, острыми осложнениями СД, диабетической ретинпатией как маркером длительного воздействия гипергликемии. У молодых взрослых с СД1 показатели когнитивных функций находятся в пределах возрастной нормы, а ассоциации с выраженностью гипергликемии или другими осложнениями диабета не воспроизводятся в крупных исследованиях. Анализ нейровизуализационных и патоморфологических данных также не дает убедительного подтверждения уникальных для СД1 изменений в структурах головного мозга. Таким образом, вопрос ПОС (энцефалопатии) при СД1 остается недостаточно изученным и противоречивым. Текущие данные не позволяют однозначно принять мнение о специфическом диабетическом характере ПОС при СД1. Необходимы дальнейшие исследования для определения вклада диабета и сопутствующих факторов в развитие ПОС, включая гистологические данные.

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