Osio Maurizio, Muscia Francesco, Zampini Luisa, Nascimbene Caterina, Mailland Enrico, Cargnel Antonietta, Mariani Claudio
Clinica Neurologica, Università degli Studi di Milano, Milano, Italy.
J Peripher Nerv Syst. 2006 Mar;11(1):72-6. doi: 10.1111/j.1085-9489.2006.00066.x.
Antiretroviral toxic neuropathy causes morbidity in human immunodeficiency virus (HIV) patients under dideoxynucleoside therapy, benefits only partially from medical therapy, and often leads to drug discontinuation. Proposed pathogeneses include a disorder of mitochondrial oxidative metabolism, eventually related to a reduction of mitochondrial DNA content, and interference with nerve growth factor activity. Carnitine is a substrate of energy production reactions in mitochondria and is involved in many anabolic reactions. Acetyl carnitine treatment promotes peripheral nerve regeneration and has neuroprotective properties and a direct analgesic role related to glutamatergic and cholinergic modulation. The aim of this study was to evaluate acetyl-l-carnitine in the treatment of painful antiretroviral toxic neuropathy in HIV patients. Twenty subjects affected by painful antiretroviral toxic neuropathy were treated with oral acetyl-l-carnitine at a dose of 2,000 mg/day for a 4-week period. Efficacy was evaluated by means of the modified Short Form McGill Pain Questionnaire with each item rated on an 11-point intensity scale at weekly intervals and by electromyography at baseline and final visit. Mean pain intensity score was significantly reduced during the study, changing from 7.35 +/- 1.98 (mean +/- SD) at baseline to 5.80 +/- 2.63 at week 4 (p = 0.0001). Electrophysiological parameters did not significantly change between baseline and week 4. In this study, acetyl-l-carnitine was effective and well tolerated in symptomatic treatment of painful neuropathy associated with antiretroviral toxicity. On the contrary, no effect was noted on neurophysiological parameters.
抗逆转录病毒毒性神经病变会导致接受双脱氧核苷治疗的人类免疫缺陷病毒（HIV）患者发病，药物治疗仅能部分改善病情，且常导致停药。提出的发病机制包括线粒体氧化代谢紊乱，最终与线粒体DNA含量减少有关，以及对神经生长因子活性的干扰。肉碱是线粒体能量产生反应的底物，参与许多合成代谢反应。乙酰肉碱治疗可促进周围神经再生，具有神经保护特性，并具有与谷氨酸能和胆碱能调节相关的直接镇痛作用。本研究的目的是评估乙酰左旋肉碱治疗HIV患者疼痛性抗逆转录病毒毒性神经病变的效果。20名患有疼痛性抗逆转录病毒毒性神经病变的受试者接受口服乙酰左旋肉碱治疗，剂量为2000毫克/天，为期4周。通过改良的简短麦吉尔疼痛问卷进行疗效评估，每项在每周间隔时按11点强度量表评分，并在基线和末次访视时进行肌电图检查。在研究期间，平均疼痛强度评分显著降低，从基线时的7.35±1.98（平均值±标准差）降至第4周时的5.80±2.63（p = 0.0001）。基线和第4周之间的电生理参数没有显著变化。在本研究中，乙酰左旋肉碱在治疗与抗逆转录病毒毒性相关的疼痛性神经病变的对症治疗中有效且耐受性良好。相反，未观察到对神经生理参数有影响。
