تأثير دريافت مكمل آلفا ليپوييك اسيد بر سطح سرمي آهن، ظرفيت اتصالي كل آهن و شاخص هاي خون در بيماران مبتلا به بتا تالاسمي ماژور: كارآزمايي باليني متقاطع

Effects of Alpha-Lipoid Acid on Serum Iron, Total Iron Binding Capacity and Hematological Indices in β-Thalassemia Major Patients: A Cross Over Clinical Trial

ﺳﺎﺑﻘﻪ و ﻫﺪف: ﯾﮑﯽ از ﻋﻮارض ﺑﯿﻤﺎري ﺑﺘﺎﺗﺎﻻﺳﻤﯽ، ﺗﺠﻤﻊ آﻫﻦ ﺑﻪ ﻋﻠﺖ اﻧﺘﻘﺎل ﻣﮑﺮر ﺧﻮن در اﯾﻦ ﺑﯿﻤﺎران ﻣﯽ ﺑﺎﺷﺪ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺑﺮرﺳﯽ اﺛﺮ ﺷﻼﺗﻮري آﻟﻔﺎ ﻟﯿﭙﻮﯾﯿﮏ اﺳﯿﺪ ﺑﺮ ﺳﻄﺢ ﺳﺮﻣﯽ آﻫﻦ و ﺷﺎﺧﺺ ﻫﺎي ﺧﻮﻧﯽ در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺗﺎﻻﺳﻤﯽ ﻣﺎژور اﻧﺠﺎم ﺷﺪ. ﻣﻮاد و روشﻫﺎ: 22 ﺑﯿﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ﺗﺎﻻﺳﻤﯽ ﻣﺎژور ﺑﻪ دو ﮔﺮوه درﯾﺎﻓﺖ ﮐﻨﻨﺪه آﻟﻔﺎ ﻟﯿﭙﻮﯾﯿﮏ اﺳﯿﺪ )600mg/d( و داروﻧﻤﺎ ﺗﻘﺴﯿﻢ ﺷﺪﻧﺪ و ﺑﻪ ﻣﺪت 8 ﻫﻔﺘﻪ ﻣﮑﻤﻞ ﯾﺎ داروﻧﻤﺎ را ﻣﺼﺮف ﻧﻤﻮدﻧﺪ؛ ﺑﻌﺪ از ﯾﮏ دورة ﺷﺴﺘﺸﻮي )washout( 3 ﻫﻔﺘﻪ اي، ﺑﻪ اﻓﺮادي ﮐﻪ ﻗﺒﻼ ﻣﮑﻤﻞ ﻣﺼﺮف ﻣﯽ ﮐﺮدﻧﺪ اﯾﻦ ﺑﺎر داروﻧﻤﺎ و اﻓﺮادي ﮐﻪ داروﻧﻤﺎ ﻣﺼﺮف ﻣﯽ ﮐﺮدﻧﺪ ﻣﮑﻤﻞ ﺑﻪ ﻣﺪت 8 ﻫﻔﺘﻪ دﯾﮕﺮ داده ﺷﺪ. در اﻧﺘﻬﺎي ﻣﻄﺎﻟﻌﻪ، ﺗﻐﯿﯿﺮات ﺳﻄﺢ ﺳﺮﻣﯽ آﻫﻦ، ﻇﺮﻓﯿﺖ اﺗﺼﺎﻟﯽ ﮐﻞ آﻫﻦ(TIBC) و ﺷﺎﺧﺺ ﻫﺎي ﺧﻮﻧﯽ در ﺑﯿﻦ دو ﻧﻮع ﻣﺪاﺧﻠﻪ ﻣﻘﺎﯾﺴﻪ ﺷﺪ. ﯾﺎﻓﺘﻪﻫﺎ: ﺳﻄﺢ ﺳﺮﻣﯽ آﻫﻦ،TIBC و ﺷﺎﺧﺺ ﻫﺎي ﺧﻮﻧﯽ در زﻣﺎن ﻣﺼﺮف ﻣﮑﻤﻞ ﺗﻐﯿﯿﺮي ﭘﯿﺪا ﻧﮑﺮد )p>0/05(. ﺗﻐﯿﯿﺮات ﺷﺎﺧﺺ ﻫﺎي ﺧﻮﻧﯽ، ﺳﻄﺢ ﺳﺮﻣﯽ آﻫﻦ وTIBC در ﺑﯿﻦ دو ﻧﻮع ﻣﺪاﺧﻠﻪ ﻧﯿﺰ ﺗﻔﺎوت ﻣﻌﻨﯽ داري ﻧﺪاﺷﺖ )p>0/05(. ﺗﻌﺪادﮔﻠﺒﻮل ﻫﺎي ﺳﻔﯿﺪ در دوره ﻣﺼﺮف داروﻧﻤﺎ در ﻣﺮدان ﺑﻄﻮر ﻣﻌﻨﯽ داري اﻓﺰاﯾﺶ ﯾﺎﻓﺖ )p=0/04( و ﻣﺘﻮﺳﻂ ﻫﻤﻮﮔﻠﻮﺑﯿﻦ ﮔﻠﺒﻮﻟﯽ در دورة داروﻧﻤﺎ در ﮐﻞ اﻓﺮاد و در ﻣﺮدان ﮐﺎﻫﺶ ﻣﻌﻨﯽ داري داﺷﺖ )ﺑﺮاي ﻫﺮ دو p=0/02(. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻣﮑﻤﻞ آﻟﻔﺎ ﻟﯿﭙﻮﯾﯿﮏ اﺳﯿﺪ در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺗﺎﻻﺳﻤﯽ ﻣﺎژور اﺛﺮات ﻣﻌﻨﯽ داري ﺑﺮ ﺳﻄﺢ ﺳﺮﻣﯽ آﻫﻦ،TIBC و ﺷﺎﺧﺺ ﻫﺎي ﺧﻮﻧﯽ ﻧﺪاﺷﺖ. اﻧﺠﺎم ﻣﻄﺎﻟﻌﺎت دﯾﮕﺮ ﺑﺎ ﺗﻌﺪاد ﺑﯿﻤﺎران ﺑﯿﺸﺘﺮ و زﻣﺎن ﻣﺪاﺧﻠﻪ ﻃﻮﻻﻧﯽ ﺗﺮ ﺿﺮوري ﻣﯽ ﺑﺎﺷﺪ.

Accumulation of iron is the most common consequences of repeated blood transfusions in β-thalassemia major patients. Iron chelating effects of alpha-lipoic acid have been reported by several studies. The aim of this study was to investigate effects of supplementation with alpha-lipoic acid, as a chelator, on serum iron and hematological indices in these patients. Materials & Methods: Twenty-two β-thalassemia major patients were selected to receive 600 mg alpha-lipoic acid or placebo capsules for 8 w. After a 3-week washout period, order of intervention was replaced as patients who previously received placebo were administered the supplement vise versa for another 8 w. At the end of the study, changes in serum iron, total iron binding capacity and hematological parameters between the treatments were assessed. Results: Serum concentrations of iron and total iron binding capacity and hematological parameters did not change within the supplementation (p > 0.05). Changes in iron, total iron binding capacity and hematological indices were not significantly different between the two interventions (p > 0.05). White blood cell counts in placebo use increased significantly in males (p = 0.04). The mean corpuscular hemoglobin in placebo patients decreased significantly in all patients and males (p = 0.02 for both). Conclusion: Results of this study revealed that alpha-lipoic acid supplementation included no beneficial effects on iron, total iron binding capacity and hematological indices in β-thalassemia major patients. Further studies with more participants and longer times are indispensable.