Инозитол и липоевая кислота в лечении инсулинорезистентности у женщин с синдромом поликистозных яичников

Пустотина О.А.

ЧОУ ДПО «Академия медицинского образования им. Ф.И. Иноземцева», Санкт-Петербург, Россия
Инсулинорезистентность (ИР) является триггером большинства патогенетических изменений при синдроме поликистозных яичников (СПКЯ). В реализации эффектов инсулина активное участие принимают стереоизомеры инозитола – мио-инозитол (МИ) и Д-хиро-инозитол (ДХИ). Соотношение МИ и ДХИ варьирует в зависимости от метаболических потребностей ткани и находится под строгим контролем инсулина. В плазме крови соотношение МИ/ДХИ составляет 40:1, тогда как в фолликулярной жидкости – 100:1. У женщин с СПКЯ и ИР концентрация ДХИ в чувствительных к инсулину тканях (мышцы, мозг, сердце, жировая ткань) резко снижается, что может быть обусловлено как недостатком общего потребления инозитола, так и нарушением экспрессии/синтеза эпимеразы, конвертирующей МИ в ДХИ. Яичники, наоборот, на избыток инсулина отвечают чрезмерной эпимеризацией МИ в ДХИ и снижением соотношения МИ/ДХИ в фолликулярной жидкости до 0,2:1. Экспериментальные и клинические исследования показали, что МИ в сочетании с ДХИ в соотношении 40:1, соответствующем физиологическому содержанию в плазме крови, является наиболее оптимальной терапевтической схемой для восстановления метаболических, гормональных и репродуктивных нарушений у женщин с СПКЯ. Регуляция метаболизма глюкозы происходит также независимо от инозитола, путем эндогенной альфа-липоевой кислоты (АЛК), синтезируемой в митохондриях.
Заключение. Дополнительный прием АЛК с инозитолом улучшает чувствительность к инсулину и репродуктивную функцию у женщин с СПКЯ, особенно при ожирении и наследственной предрасположенности к сахарному диабету. Таким образом, сочетание АЛК с МИ и ДХИ создает новую комплексную стратегию по преодолению ИР и ее последствий у женщин с СПКЯ.

Ключевые слова

мио-инозитол
Д-хиро-инозитол
альфа-липоевая кислота
инсулинорезистентность
ожирение
синдром поликистозных яичников

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Поступила 14.10.2020

Принята в печать 01.12.2020

Об авторах / Для корреспонденции

Пустотина Ольга Анатольевна, д.м.н., профессор кафедры акушерства и гинекологии с курсом репродуктивной медицины, ЧОУ ДПО «Академия медицинского образования им. Ф.И. Иноземцева», Санкт-Петербург. Тел.: +7(916)926-76-52. E-mail: pustotina@gmail.com. ORCID: 0000-0001-6117-7270.
190013, Россия, Санкт-Петербург, пр. Московский, д. 22, литер М, помещение Н.

Для цитирования: Пустотина О.А. Инозитол и липоевая кислота в лечении инсулинорезистентности у женщин с синдромом поликистозных яичников.
Акушерство и гинекология. 2020; 12: 209-216
https://dx.doi.org/10.18565/aig.2020.12.209-216

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