Lebrun C, Alchaar H, Candito M, Bourg V, Chatel M
Department of Neurology, Hôpital Pasteur, 30 voie romaine, 06002 Nice, France.
Mult Scler. 2006 Jun;12(3):321-4. doi: 10.1191/135248506ms1275oa.
Nutritional factors and comedications are among the postulated causes of fatigue, a highly prevalent symptom in the multiple sclerosis (MS) population, with serious impact on patients' quality of life. Deficiency of carnitine may play a role by reducing energy production through fatty acid oxidation and numerous MS therapies can induce fatigue syndrome. The aim of this prospective open-labelled study was to collect and study serum carnitine levels in MS patients with and without disease-modifying treatment-induced fatigue syndrome. We investigated whether restoration of the carnitine pool might improve treatment-induced fatigue in MS patients. In our study, there was no statistical difference in fatigue frequency between treated and untreated patients (P=0.5). Matched to age, gender and treatments, carnitine levels were lower for MS treated patients compared to untreated MS patients (P <0.05) or controls (P <0.001). Consecutive patients with low plasma carnitine levels who experienced fatigue were substituted. Treatment consisted of oral levocarnitine, 3-6 g daily. All patients achieved normal plasma carnitine levels. For 63% of patients treated with immunosuppressive or immunomodulatory therapies, oral levocarnitine adjunction decreased fatigue intensity, especially in patients treated with cyclophosphamide and interferon beta.
营养因素和合并用药被认为是疲劳的成因之一，疲劳是多发性硬化症（MS）患者中极为常见的症状，对患者的生活质量有严重影响。肉碱缺乏可能通过减少脂肪酸氧化产生能量而发挥作用，并且许多MS治疗方法可诱发疲劳综合征。这项前瞻性开放标签研究的目的是收集和研究患有和未患有疾病修饰治疗诱发疲劳综合征的MS患者的血清肉碱水平。我们调查了补充肉碱储备是否可能改善MS患者治疗引起的疲劳。在我们的研究中，接受治疗和未接受治疗的患者在疲劳频率上没有统计学差异（P = 0.5）。与年龄、性别和治疗相匹配，接受治疗的MS患者的肉碱水平低于未接受治疗的MS患者（P <0.05）或对照组（P <0.001）。对连续出现疲劳且血浆肉碱水平低的患者进行替代治疗。治疗方法为口服左卡尼汀，每日3 - 6克。所有患者的血浆肉碱水平均恢复正常。对于63%接受免疫抑制或免疫调节治疗的患者，口服左卡尼汀辅助治疗降低了疲劳强度，尤其是在用环磷酰胺和干扰素β治疗的患者中。
