α-硫辛酸治疗糖尿病视网膜病变的疗效观察及其机制探讨

Effects of alpha lipoic acid on diabetic retinopathy and serum levels of serum asymmetric dimethylarginine and oxidative stress

目的 观察α-硫辛酸治疗糖尿病变视网膜病变（DR）的治疗效果,并探讨其疗效产生的可能机制,为α-硫辛酸临床治疗DR提供实验依据.方法 纳入75例DR患者,按随机数字表法分为对照组和治疗组：对照组进行正规降血糖、血压等综合治疗,治疗组在上述治疗基础上每天加用α-硫辛酸注射液600 mg＋0.9％氯化钠注射液250 ml避光静脉滴注治疗,共4周;治疗前后两组患者均进行眼底荧光血管造影检查及视力检查;高效液相色谱法检测两组患者治疗前后血清非对称性二甲基精氨酸（ADMA）水平,并检测血清脂质过氧化产物丙二醛（MDA）浓度和超氧化物歧化酶（SOD）活性以反映体内氧化应激.结果 与对照组比较,α-硫辛酸治疗的DR患者视力明显改善,对眼部病变改善的总有效率显著升高（84.21％ vs40.54％,X^2=15.28,P＜0.01）;血中内源性一氧化氮合酶抑制物ADMA[（0.32 ±0.13）μmol/L vs（0.51 ±0.26） μmol/L,P＜0.05]及MDA[（3.22 ±0.90） nmol/L vs （5.13 ±0.42） nmol/ml,P＜0.05]水平明显降低,抗氧化酶SOD[（72.68±1.31） U/ml vs （53.16±1.54） U/ml,P＜0.05]活性升高.结论 α-硫辛酸治疗DR患者有一定疗效,主要改善DR患者的眼部病变和视力,其机制可能与抗氧化和降低血清内源性一氧化氮合酶（NOS）抑制物ADMA水平有关.

Objective To investigate the effects of alpha lipoic acid on patients with diabetic retinopathy （DR）,explore the possible mechanisms,and provide experimental evidence for the treatment of DR with lipoic acid.Methods Totally 75 DR patients were randomly divided into control group and treatment group.Patients in control group received the standard hypoglycemic treatment,antihypertensive therapy,and other comprehensive treatment.Patients from the treatment group were treated with alpha lipoic acid 600 mg ＋ 250 ml 0.9% sodium chloride injection additionally,avoiding light intravenous therapy,for a total of 4 weeks.Before and after treatment,fundus fluorescein angiography and visual inspection were detected in two groups.In addition,serum level of asymmetric dimethylarginine （ADMA） were detected with high performance liquid chromatography,serum lipid peroxidation product malondialdehyde （MDA） content and superoxide dismutase （SOD） activity were detected to reflect the in vivo oxidative stress before and after treatment in two groups.Results Compared to the control group,visual acuity was improved significantly （P 〈 0.05）,and total efficiency of ocular lesions-improved was increased significantly （84.21% vs 40.54%,x2 =15.28,P 〈 0.01）.Serum levels of endogenous inhibitor of nitric oxide synthase ADMA [（0.32 ±0.13） μmol/L vs （0.51 ± 0.26） μmol/L,P 〈 0.05] and MDA [（3.22 ± 0.90） nmol/L vs （5.13 ± 0.42） nmol/ml,P 〈 0.05] were significantly decreased,while SOD levels [（72.68 ± 1.31） U/ml vs （53.16 ± 1.54） U/ml,P 〈0.05] were significantly increased in DR patients after alpha lipoic acid treatment.Conclusions Alpha lipoic acid had some therapeutic effects for DR patients,which mainly lied in the improvement of visual acuity and eye disease,might be related to the decrease of oxidative stress and serum level of endogenous nitric oxide synthase （NOS） inhibitor ADMA.