Han Yajuan, Wang Min, Shen Jie, Zhang Zhen, Zhao Min, Huang Jing, Chen Youming, Chen Zhi, Hu Yulan, Wang Yubing
Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Department of Endocrinology and Tuberculosis, Guangzhou Chest Hospital, Guangzhou, China.
Minerva Endocrinol. 2018 Mar;43(1):11-18. doi: 10.23736/S0391-1977.16.02505-0. Epub 2016 Nov 30.
Diabetic hyperglycemia damages peripheral nerves by triggering ischemia, oxidative stress, and inflammation. Alpha-lipoic acid (ALA) and methylcobalamin (MC) are known to improve signs of diabetic peripheral neuropathy (DPN), possibly by enhancing neural and vascular endothelial cell metabolism and antioxidant capacity. We evaluated differences in efficacy following short-term MC or ALA treatment on DPN symptoms to guide clinical drug selection.
Forty DPN patients were randomly divided into MC and ALA treatment groups (both N.=20) and assessed by the Toronto Clinical Neuropathy Scoring System (TCSS), total symptom score (TSS), visual analog scale (VAS) of positive symptoms, and easy sensory test (EST) for negative symptoms before and after 2 weeks of treatment. Serum malondialdehyde (MDA) and superoxide dismutase (SOD) were also measured.
Neuropathy as measured by TCSS, TSS, and VAS scores was significantly reduced by both treatments (P<0.05) but magnitude varied by symptom. The VAS score reductions for burning and pain were significantly greater following ALA (P<0.01), while MC reduced numbness and paresthesia VAS scores to a slightly greater extent than ALA (P>0.05). Numbers of abnormal (low-response) points for pressure and pinprick sensation were reduced by MC but not by ALA, while both treatments induced a significant reduction in vibratory perception threshold (P<0.01). Neither MC nor ALA improved temperature sensation or tendon reflexes (P>0.05). Alpha-lipoic acid, increased SOD and reduced MDA (P<0.05), indicating enhanced antioxidant capacity, while MC had no effect.
Due to differences in efficacy, MC or ALA should be chosen according to the symptoms of individual patients.
糖尿病高血糖通过引发缺血、氧化应激和炎症来损害周围神经。已知α-硫辛酸（ALA）和甲钴胺（MC）可改善糖尿病周围神经病变（DPN）的症状，可能是通过增强神经和血管内皮细胞的代谢及抗氧化能力。我们评估了短期使用MC或ALA治疗DPN症状后的疗效差异，以指导临床药物选择。
40例DPN患者被随机分为MC治疗组和ALA治疗组（每组n = 20），并在治疗2周前后通过多伦多临床神经病变评分系统（TCSS）、总症状评分（TSS）、阳性症状视觉模拟量表（VAS）和阴性症状简易感觉测试（EST）进行评估。还测量了血清丙二醛（MDA）和超氧化物歧化酶（SOD）。
两种治疗方法均使TCSS、TSS和VAS评分所衡量的神经病变显著减轻（P<0.05），但减轻程度因症状而异。ALA治疗后灼痛和疼痛的VAS评分降低幅度更大（P<0.01），而MC降低麻木和感觉异常VAS评分的程度略大于ALA（P>0.05）。MC使压力和针刺感觉的异常（低反应）点数减少，而ALA则无此作用，两种治疗均使振动觉阈值显著降低（P<0.01）。MC和ALA均未改善温度觉或腱反射（P>0.05）。α-硫辛酸使SOD升高，MDA降低（P<0.05），表明抗氧化能力增强，而MC则无此作用。
由于疗效存在差异，应根据个体患者的症状选择MC或ALA。
