Hejazi Najmeh, Mazloom Zohreh, Zand Farid, Rezaianzadeh Abbas, Nikandish Reza
Nutrition and Food Sciences Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Shiraz Anesthesiology and Critical Care Research Center, Department of Anesthesia, Shiraz University of Medical Sciences, Shiraz, Iran.
Asian J Anesthesiol. 2018 Jun;56(2):45-55. doi: 10.6859/aja.201806_56(2).0002.
Critical illness is associated with oxidative stress and insulin resistance. These conditions affect the clinical outcomes in intensive care unit (ICU). The aim of this study was to determine whether intervention with α-lipoic acid (ALA) influences the oxidative stress, insulin resistance, and clinical outcomes in critically ill patients.
In this randomized double-blind placebo-controlled trial, 80 critically ill patients who were expected to stay at least seven days in the ICU and required enteral feeding were randomly allocated to two equal groups to receive either ALA (900 mg) or placebo daily for 10 days. Serum levels of total antioxidant capacity (TAC), malondialdehyde (MDA), insulin, glucose (GLC), C-reactive protein (CRP), albumin (Alb), prealbumin (preAlb), total protein (total-pr) and total lymphocyte count (TLC) as well as homeostasis model assessment-estimated insulin resistance (HOMA-IR) were measured at baseline and at the end of ALA supplement phase. Clinical outcomes (length of ICU/hospital stay, ICU/hospital mortality, and 28-day mortality and ventilator free days) were also recorded.
TAC increased significantly in the ALA supplemented group compared to the placebo group (p < 0.001). Moreover, serum levels of GLC decreased significantly in the ALA group compared to lack of changes in the placebo group (p = 0.011). ALA supplementation also hindered an increase in HOMA-IR (p = 0.015). There were no significant differences in other biochemical markers and clinical outcomes between the two groups.
ALA may be an effective supplement to improve antioxidant defense and insulin resistance in critically ill patients.
危重病与氧化应激和胰岛素抵抗有关。这些情况会影响重症监护病房（ICU）的临床结局。本研究的目的是确定α-硫辛酸（ALA）干预是否会影响危重病患者的氧化应激、胰岛素抵抗和临床结局。
在这项随机双盲安慰剂对照试验中，80名预计在ICU至少停留7天且需要肠内营养的危重病患者被随机分为两组，每组人数相等，分别接受ALA（900毫克）或安慰剂，每日一次，共10天。在基线和ALA补充阶段结束时，测量血清总抗氧化能力（TAC）、丙二醛（MDA）、胰岛素、葡萄糖（GLC）、C反应蛋白（CRP）、白蛋白（Alb）、前白蛋白（preAlb）、总蛋白（total-pr）和总淋巴细胞计数（TLC），以及稳态模型评估估计的胰岛素抵抗（HOMA-IR）。还记录了临床结局（ICU/住院时间、ICU/医院死亡率、28天死亡率和无呼吸机天数）。
与安慰剂组相比，补充ALA组的TAC显著增加（p < 0.001）。此外，与安慰剂组无变化相比，ALA组的血清GLC水平显著降低（p = 0.011）。补充ALA还阻碍了HOMA-IR的升高（p = 0.015）。两组之间的其他生化指标和临床结局无显著差异。
ALA可能是改善危重病患者抗氧化防御和胰岛素抵抗的有效补充剂。
