Mișcă Oana-Maria, Mișcă Liviu-Coriolan, Huzum Bogdan, Neamţu Andreea-Adriana, Cerbu Simona, Chioibaș Daniel-Raul, Crăiniceanu Petrișor Zorin, Motoc Andrei Gheorghe Marius
Plastic and Reconstructive Surgery Department-Casa Austria, Pius Brînzeu Clinical County Emergency Hospital Timişoara, Liviu Rebreanu Boulevard, No. 156, 300723 Timișoara, Romania.
Doctoral School Department, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Eftimie Murgu Square, No. 2, 300041 Timişoara, Romania.
Pharmaceuticals (Basel). 2025 Apr 15;18(4):575. doi: 10.3390/ph18040575.
: Fluoroquinolone-induced tendinopathy is a clinically significant adverse effect associated with this class of antibiotics, particularly affecting the Achilles tendon. Despite its growing recognition, the precise pathophysiological mechanisms remain incompletely understood, with hypotheses referencing increased matrix metalloproteinase activity, collagen degradation, and oxidative stress. : This prospective randomized pilot study evaluates the potential protective effectiveness of vitamin E and selenium supplementation in mitigating fluoroquinolone-induced tendinopathy. The study was conducted on 25 patients receiving 500 mg/day levofloxacin antibiotherapy, randomly divided into a control group and an experimental group-vitamin E (400 IU/day) and selenium (200 µg/day), oral supplementation for 28 days. Clinical assessment of the pain level through the VAS score and of functionality through the VISA-A score was performed, alongside ultrasound imaging of the Achilles tendon. To assess potential toxicity and ensure adherence to the supplementation protocol, serial biochemical analyses of serum vitamin E and selenium were performed at predetermined intervals. : A significant improvement was observed in pain scores ( = 0.0120) and functional outcomes ( = 0.0340) when comparing the control and experimental groups at the three-month follow-up. Ultrasound analysis revealed reduced tendon thickness and neovascularization, supporting structural recovery. Although the incidence of tendinopathy was lower in the interventional group (13.3% vs. 40%), statistical significance was not reached, possibly due to the small sample size. : These findings suggest that antioxidant supplementation with vitamin E and selenium may provide a protective effect against fluoroquinolone-induced tendinopathy, warranting further investigation in larger randomized clinical trials.
氟喹诺酮类药物引起的肌腱病是这类抗生素相关的一种具有临床意义的不良反应，尤其会影响跟腱。尽管其越来越受到关注，但其确切的病理生理机制仍未完全明确，有假说认为与基质金属蛋白酶活性增加、胶原蛋白降解和氧化应激有关。
这项前瞻性随机试点研究评估了补充维生素E和硒在减轻氟喹诺酮类药物引起的肌腱病方面的潜在保护效果。该研究针对25名接受每日500毫克左氧氟沙星抗菌治疗的患者进行，随机分为对照组和实验组——实验组补充维生素E（每日400国际单位）和硒（每日200微克），口服补充28天。通过视觉模拟评分法（VAS）评估疼痛程度，通过阿基里斯肌腱功能指数评分法（VISA - A）评估功能，同时对跟腱进行超声成像检查。为评估潜在毒性并确保遵守补充方案，在预定时间间隔对血清维生素E和硒进行系列生化分析。
在三个月的随访中比较对照组和实验组时，观察到疼痛评分（P = 0.0120）和功能结果（P = 0.0340）有显著改善。超声分析显示肌腱厚度和新生血管减少，支持结构恢复。尽管干预组肌腱病的发生率较低（13.3%对40%），但未达到统计学显著性，可能是由于样本量较小。
这些发现表明，补充维生素E和硒作为抗氧化剂可能对氟喹诺酮类药物引起的肌腱病提供保护作用，值得在更大规模的随机临床试验中进一步研究。
