文献DOI：10.1177/1938640012451317
文献PMID：22843543
文献原文链接：https://sci-hub.se/10.1177/1938640012451317
I read with great interest the recent article by Suder and Wukich1 in a recent issue of your esteemed journal. The article is highly thought provoking. Interestingly, the past few years have seen the emergence of a number of novel new agents for the management of diabetic neuropathy. One such emerging agent with significant potential in the management of diabetic neuropathy is α-lipoic acid (ALA).
For instance, the SYDNEY study showed that intravenous administration of ALA resulted in significant amelioration of pain in patients with diabetic neuropathy.2 Response rates as high as 53% have been seen after intravenous administration.3 When administered orally, ALA in a daily dose of 600 mg seems to be safe and effective.4 ALA exerts these pain-ameliorating effects by attenuating the glycation process in peripheral neurons.5 Treatment with ALA is also less expensive and is associated with fewer side effects in comparison with other routinely used agents such as gabapentin.6 α-Lipoic acid can also be combined with other antioxidants such as superoxide dismutase resulting in drug combinations that result in significant subjective and physiological improvements in patients with diabetic neuropathy.7 Similarly, the neuroprotective effects of ALA are significantly enhanced when it is administered in combination with dipyridamole.8 Interestingly, ALA is more effective in younger adults and females.9 Besides these peripheral neuropathic effects, ALA also decreases the effects of autonomic neuropathy in internal tissue such as cardiac and gastric tissue.10 There is a clear need to increase education among physicians about these effects of ALA. Hopefully, this will result in better management of pain in patients with diabetic neuropathy.
亲爱的编辑：
我非常感兴趣地阅读了Suder和Wukich1最近在您最受尊敬的期刊上发表的一篇文章。这篇文章非常引人深思。有趣的是，过去几年出现了一些用于治疗糖尿病神经病变的新型新药。其中一种在糖尿病神经病变管理中具有显著潜力的新兴药物就是α-硫辛酸（ALA）。
例如，SYDNEY研究显示静脉注射ALA可显著改善糖尿病神经病变患者的疼痛2。静脉注射后反应率高达53％3，口服给药时，ALA每日剂量为600毫克似乎是安全和有效的4。ALA通过减弱外周神经元中的糖化过程发挥这些疼痛改善作用 5。用ALA治疗也较便宜，与其他常规使用的药物（例如加巴喷丁）相比，副作用较少 6。α-硫辛酸还可以与其他抗氧化剂（如超氧化物歧化酶）结合使用，从而药物组合在糖尿病神经病变患者中产生显著的主观和生理改善7。 同样，与双嘧达莫联合使用，ALA的神经保护作用显著增强 8。有趣的是，ALA在年轻人和女性中更有效 9，除了这些外周神经病变效应外，ALA还可降低自主神经病变对心脏和胃组织等内部组织的影响10。显然需要增加医生对ALA这些影响的教育。希望这将有助于更好地管理糖尿病神经病变患者的疼痛。
Shailendra Kapoor, 博士
References
1. Suder NC, Wukich D. Prevalence of diabetic neuropathy in patients undergoing foot and ankle surgery. Foot Ankle Spec. 2012;5:97-101.
2. Ametov AS, Barinov A, Dyck PJ, et al; SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care. 2003;26:770-776.
3. Ziegler D, Nowak H, Kempler P, Vargha P, Low PA. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med. 2004;21:114-121.
4. Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006;29:2365-2370.
5. Vallianou N, Evangelopoulos A, Koutalas P. Alpha-lipoic acid and diabetic neuropathy. Rev Diabet Stud. 2009;6:230-236.
6. Ruessmann HJ, German Society of Outpatient Diabetes Centres AND (Arbeitsgemeinschaft niedergelassener diabetologisch tatiger Arzte e.V.). Switching from pathogenetic treatment with alpha-lipoic acid to gabapentin and other analgesics in painful diabetic neuropathy: a real-world study in outpatients. J Diabetes Complications. 2009;23:174-177.
7. Bertolotto F, Massone A. Combination of alpha lipoic acid and superoxide dismutase leads to physiological and symptomatic improvements in diabetic neuropathy. Drugs R D. 2012;12:29-34.
8. Al-Zamil MK. The use of dipyridamole (curantyl) in combination with alpha-lipoic acid in the treatment of diabetic neuropathy with retinopathy. Zh Nevrol Psikhiatr Im S S Korsakova. 2008;108:23-26.
9. Negrisanu G, Rosu M, Bolte B, Lefter D, Dabelea D. Effects of 3-month treatment with the antioxidant alpha-lipoic acid in diabetic peripheral neuropathy. Rom J Intern Med. 1999;37:297-306.
10. Gibson TM, Cotter MA, Cameron NE. Effects of alpha-lipoic acid on impaired gastric fundus innervation in diabetic rats. Free Radic Biol Med. 2003;35:160-168.