左卡尼汀改善维持性血液透析患者微炎症状态的疗效观察

目的探讨左卡尼汀(L-CN)治疗对终末期肾病维持性血液透析(MHD)患者微炎症状态的改善作用。方法选择我院终末期肾病维持性血液透析患者62例作为观察对象,其中治疗组33例,对照组29例。两组患者均使用碳酸氢盐透析液及相同的基础用药方案,治疗组于每次血液透析后给予L-CN 1.0 g+0.9%氯化钠注射液20 m L静脉注射,对照组不用。检测并比较两组治疗前后的血红蛋白(Hb)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNFα)和L-CN水平,分析治疗组患者L-CN水平与炎性因子、Hb的关系。结果治疗后,对照组L-CN水平显著低治疗组[(19.8±7.5)μmol/L vs.(33.6±10.7)μmol/L],差异具有显著统计学意义(P<0.01);对照组Hb水平显著低于治疗组[(81.3±11.9)g/L vs.(97.5±18.2)g/L],差异具有显著统计学意义(P<0.01);而炎性指标(hs-CRP和TNFα)治疗组则显著低于对照组,差异具有显著统计学意义(P<0.01)。Hb水平与L-CN水平呈正相关,而hs CRP和TNFα水平则与L-CN水平呈负相关。结论 MHD患者存在L-CN缺乏,并与Hb水平和微炎症状态相关,补充L-CN治疗可以改善患者的贫血和微炎症状态。

L-Carnitine Ameliorates Micro-Inflammatory State in Maintenance Hemodialysis Patients

Objective To evaluate the efficacy of L-camitine （L-CN） in ameliorating the micro-inflammatory state of patients with end-stage renal disease undergoing maintenance hemodialysis （MHD）. Methods 62 patients with end-stage renal disease undergoing MHD in our hospital were selected and divided into the treatment group （n = 33） and the control group （n = 29）. Both groups were given same basic drug treatment and treated with bicarbonate dialysate, in addition, patients in the treatment group were given L-CN after hematodialysis. The levels of hemoglobin （Hb）, high-sensitivity C-reactive protein （hs-CRP）, tumor necrosis factor alpha （TNFα） and L-CN of two groups before and after therapy were detected and compared, and the relations between L-CN level and inflammatory cytokines, L-CN level and Hb were analyzed. Results After therapy, the L-CN level of control group was significantly lower than that of treatment group [（19.8 ± 7.5） μmol/L vs. （33.6 ± 10.7）μmol/L], P〈0.01. The Hb level of control group was （81.3 ± 11.9） g/L, significantly lower than （97.5 ± 18.2） g/L of treatment group （P 〈0.01）. The inflammatory markers （hs-CRP and TNFα） of treatment gropu were significantly lower than those of control group （P 〈0.01）. L-CN level was positively correlated with Hb level, but negatively correlated with hsCRP level and TNFα level. Conclusions MHD patients have L-camitine deficiency which is correlated with hemoglobin level and micro-inflammatory state. The supplement of L-CN can ameliorate MHD patient＇s anemia and micro-infiammatory state.