nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical Universitynefr-137Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESГИПЕРГОМОЦИСТЕИНЕМИЯ И КАРДИОРЕНАЛЬНЫЙ АНЕМИЧЕСКИЙ СИНДРОМ ПРИ САХАРНОМ ДИАБЕТЕHYPERHOMOCYSTEINEMIA AND CARDIORENAL ANEMIA SYNDROME IN DIABETES MELLITUSХудяковаН. В.HudyakovaN. V.noemail@neicon.ruПчелинИ. Ю.PchelinI. Yu.ewan2008@bk.ruШишкинА. Н.ShishkinA. N.noemail@neicon.ruИвановН. В.IvanovN. V.noemail@neicon.ruВасильковаО. Н.VasilkovaO. N.noemail@neicon.ruСанкт-Петербургский государственный университет; Всероссийский центр экстренной и радиационной медицины им. А.М. Никифорова МЧС РоссииРоссияSaint Petersburg State University; The Nikiforov Russian Center of Emergency and Radiation MedicineRussian FederationСанкт-Петербургский государственный университетРоссияSaint Petersburg State UniversityRussian FederationСеверо-Западный государственный медицинский университет им. И.И. МечниковаРоссияNorth-West State Medical University named after I.I. MechnikovRussian FederationУО Гомельский государственный медицинский университетРоссияGomel State Medical UniversityRussian Federation2015011120151962027Copyright © Худякова Н.В., Пчелин И.Ю., Шишкин А.Н., Иванов Н.В., Василькова О.Н., 20152015Худякова Н.В., Пчелин И.Ю., Шишкин А.Н., Иванов Н.В., Василькова О.Н.Hudyakova N.V., Pchelin I.Y., Shishkin A.N., Ivanov N.V., Vasilkova O.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/137

Нарушения метаболизма гомоцистеина ассоциированы с поражением почек и анемией, что вносит дополнительный вклад в формирование микро- и макроангиопатий, являющихся основной причиной инвалидизации и смерти больных с сахарным диабетом (СД). Однако далеко не все аспекты взаимосвязи гипергомоцистеинемии (ГГЦ) и кардиоренального анемического синдрома при патологии углеводного обмена очевидны, поэтому изучение роли и условий реализации эффектов гомоцистеина приобретает особую значимость. В настоящем обзоре рассмотрены патогенетические связи нарушений метаболизма данной аминокислоты с сосудистыми осложнениями, поражением почек и анемией при СД. На основе анализа экспериментальных и клинических исследований последних лет суммированы данные о молекулярно-биологических аспектах влияния ГГЦ на иммунокомпетентные клетки и компоненты ренин-ангиотензин-альдостероновой системы, роли свободнорадикального окисления, дефицита витаминов и анемии в реализации эффектов гомоцистеина при кардиоренальном анемическом синдроме у пациентов с СД. Обосновано и сформулировано с позиций клинической значимости направление дальнейших исследований. Усовершенствовано патогенетическое обоснование данной проблемы, что открывает новые направления поиска диагностических и терапевтических стратегий при ГГЦ и кардиоренальном анемическом синдроме у пациентов с СД.

Abnormalities of homocysteine metabolism are associated with renal injury and anemia leading to the development and progression of micro- and macrovascular diabetic complications that are the main cause of disability and mortality in patients with diabetes mellitus (DM). Therefore, not all aspects of interaction between hyperhomocysteinemia (HHC) and cardiorenal anemia syndrome in carbohydrate metabolism disorder are evident, so study of realization role and factors of homocystein impact is very important. The present review summarizes the results of global studies and assesses their contribution towards better understanding molecular mechanisms of effects related to abnormalities of homocysteine metabolism. On the basis of recent experimental and clinical data we review molecular aspects of interaction between hyperhomocysteinemia and immunocompetent cells, as well as components of renin-angiotensin-aldosterone system, and the role of oxidative stress, vitamin deficiencies and anemia in realization of homocystein impacts in diabetic patients with cardiorenal anemia syndrome. Clinical rationale is given for declared direction of further studies. Moreover this pathogenic perspective leads to consideration of new pathogenic pathways becoming important diagnostic and therapeutic targets that can be translated into clinical treatment of hyperhomocysteinemia in diabetic patients with cardiorenal anemia syndrome.

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The authors declare that there are no conflicts of interest present.