[ADA2009]Ziegler教授专访——抗氧化应激引领糖尿病治疗新理念

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[ADA2009]Ziegler教授专访——抗氧化应激引领糖尿病治疗新理念
专家访谈  来源:国际糖尿病 2009-6-16
内容概要：《国际糖尿病》现场特派记者第一时间采访了Ziegler教授，请他就氧化应激等方面的内容发表自己的观点。

International Diabetes: At this ADA conference， your presentation is that Oxidative Stress Predicts the Progression of Pe**heral and Cardiac Autonomic Nerve Dysfunction over 6-Years in Diabetic Patients. ?What is the objective and the clinical implications of this trial?
国际糖尿病：在ADA的会议上，您的演讲是“氧化应激可以预测超过6年病程的糖尿病患者外周和心脏自主神经功能异常的进展”，这一研究的目的与其临床意义是什么？
Prof. Ziegler:This is not a clinical trial， but a prospective study conducted over 6 years which shows for the first time that a marker of oxidative stress， plasma superoxide?production， is a predictor?for the development and progressionn of diabetic polyneuropathy and cardiac autonomic neuropathy. One of the most important implication is?that in future trials using antioxidants in diabetic PN， increased baseline levels of this marker could be used for on optimized patient selection
Ziegler教授：这不是一个临床研究。而是为期超过6年的前瞻性研究，它首次显示氧化应激的标记物（血浆超氧化物的产生）是糖尿病外周神经及心脏自主神经疾病的发生和发展预测因子。最重要的意义是在于将来筛选治疗糖尿病神经病变的抗氧化药物研究中，可以利用升高的氧化标记物来优化患者的选择。

International Diabetes:What do you think of the difference between this trial and the previous clinical trials on the antioxidant therapy of diabetes?
国际糖尿病：您认为这一研究与之前进行的糖尿病的抗氧化治疗的其他临床研究有什么区别吗？
Prof. Ziegler: As I said before， this was not a clinical trial. If you mean the NATHAN 1 trial: this was the longest controlled clinical trial ever conducted in DPN (4 years duration) suggesting that lipoic acid improves neuropathic deficits overv 4?years in patients with DPN.
Ziegler教授：如我之前所说，这并不是一个临床实验。如果你指的是ANTHAN1研究的话，那是迄今为止在糖尿病周围神经病变中持续时间最久的临床实验（4年），提示硫辛酸的确可以起到改善作用。

International Diabetes:There is considerable evidence to indicate that oxidative stress plays an important role in the etiology of diabetes and diabetic complications. Nevertheless there is controversy about which markers of oxidative stress are most reliable and suitable for clinical practice. Could you talk a little about the latest development in this field?
国际糖尿病：有大量的证据支持氧化应激在糖尿病及其并发症的发病中起着重要作用，尽管如此，关于氧化应激中何种物质是临床上最可信也最可行的检测物目前还有争议，您能谈一谈这方面的最新进展吗？
Prof. Ziegler: See below. Which markers are best in clinical practice is difficult to judge because this our trial was the first prospective one in this field.
Ziegler教授：临床中那种标记物是最佳的是很难判断的，因为我们的研究是目前为止本领域的第一个队列研究。

International Diabetes:Are there specific markers of oxidative stress for diabetic patients?
国际糖尿病：那么对糖尿病患者来说有没有氧化应激特异性的标记物呢？
Prof. Ziegler: In our hands the best marker was plasma superoxide anion. This fits well with the hypothesis by M. Brownlee suggesting that mitochondrial overproduction of superoxide is the major initial event in the causation of diabetic microvascular complication including DPN. There are also markers of nitrosative stress such as nitrotyrosine which may be useful.
Ziegler教授：我们认为最好的标记物是血浆的超氧化物阴离子，这与Brownlee提出的假设不谋而合，他认为线粒体产生的过多过氧化物是糖尿病微血管病变（包括糖尿病周围血管病变在内）的启动因素。当然，其他***应激的标记物如硝基酪氨酸也可能是有用的。

International Diabetes:. This concept of oxidation stress， being an important trigger in the onset and progression of diabetes and its complications， may offer a unique therapeutic option for the treatment of diabetes and its complications by using antioxidants. Could you share with us the latest data from the clinical trials on the antioxidant therapy of diabetes and its complications?
国际糖尿病：氧化应激被认为是糖尿病及其并发症发生和发展的重要启动因素。这一概念的提出使应用抗氧化药物治疗糖尿病及其并发症成为了糖尿病独特的选择。您能和我们分享一下关于糖尿病及其并发症的抗氧化治疗临床研究的最新进展吗？
Prof. Ziegler: NATHAN 1 trial: this was the longest controlled clinical trial ever conducted in DPN (4 years duration) suggesting that lipoic acid (600 mg per day) improves neuropathic deficits (Neuropathy Impairment Score)?over 4?years as compared with placebo treatment in patients with DPN.
Ziegler教授：NATHAN1研究是目前在糖尿病周围神经病变治疗方面时间最久的对照临床实验。发现与安慰剂组相比，硫辛酸（600mg/天）可以改善神经病变（神经损害评分）。
International Diabetes:.As a one of the most powerful antioxidant， alpha-lipoic acid has been shown to reduce the oxidative stress in diabetic patients and it has been used widely in clinical practice. ?In 2004， you published a meta-**ysis of controlled clinical trials of alpha-lipoic acid. What kind of new evidence emerged since the publication of your meta-**ysis， with regard to the effect of alpha-lipoic acid in the treatment of diabetes and its complicationsONT
国际糖尿病：作为最强的抗氧化剂之一，α硫辛酸已经被证实在糖尿病患者中有抗氧化应激的作用，并被广泛用于临床实践。在2004年，您发表了一篇有关α硫辛酸临床治疗的荟萃分析。近来还有什么新的有关α硫辛酸治疗糖尿病并发症的进展吗？

In the SYDNEY 2 study we showed that oral treatment using 600-1800 mg per day improves neuropathic symptoms and deficits after 5 weeks in type 2 diabetic patients with DPN.
Ziegler教授：在SYDNEY2研究中，我们发现口服600-1800mg每天，5周后可以改善2型糖尿病神经病变的症状。
NATHAN 1 trial: this was the longest controlled clinical trial ever conducted in DPN (4 years duration) suggesting that lipoic acid (600 mg per day) improves neuropathic deficits (Neuropathy Impairment Score)?over 4?years as compared with placebo treatment in patients with DPN.??

International Diabetes: What do you think of alpha-lipoic acid’s role and place among other commonly prescribed antioxidant treatments for diabetic patients?
国际糖尿病：您认为α硫辛酸在糖尿病治疗中的地位如何，与其他常用的抗氧化药物相比有何优点？

Prof. Ziegler:Alpha lipoic acid is useful for treatment of DPN via reduction of oxidative stress (disease-modifying treatment). This has not been demonstrated for any other antioxidant.
Ziegler教授：α硫辛酸是通过抗氧化应激发挥糖尿病周围神经病变治疗作用的，其他抗氧化药物是否有此种作用尚未证实。

International Diabetes: Could you talk a little bit about where you see the antioxidant therapy of diabetes and its complications headed? What are some of the advances that you expected to see in the near future?
国际糖尿病：您能谈一谈您对糖尿病及其并发症的抗氧化治疗的前景吗？您认为在不久的将来会有那些进展呢？
Prof. Ziegler: I hope that further markers of oxidative stress can be identified to help to select the ideal candidates/responders for/to this treatment. There is also a need for additional controlled clinical trials of antioxidants including alpha-lipoic acid in DPN.
Ziegler教授：我希望未来氧化应激的标记物可以用来帮助确定和选择需要治疗的患者。当然，包括α硫辛酸在内的抗氧化药物也需要更多的临床实验进行证实。

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能去听就好了:(