高通量血液透析联合左卡尼汀对尿毒症患者血脂代谢的影响

目的 探讨高通量血液透析 (HFHD)联合左卡尼汀对维持性血液透析（MHD）患者血脂代谢的影响。方法 选取MHD患者72例，随机分为常规血液透析（HD）、HFHD、HFHD+左卡尼汀3组各24例。HD组给予每周3次低通量血液透析，HFHD组给予每周3次HFHD，HFHD+左卡尼汀组给予每周3次HFHD，且每次透析后静脉推注左卡尼汀1 g。观察治疗前和治疗3个月后患者甘油三酯（TG）、胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、血红蛋白（Hb）、白蛋白（Alb）及尿素清除指数（Kt/V值）、尿素清除率（URR）的变化。结果 HD组治疗后TG较治疗前升高（P<0.05）；HFHD组和HFHD+左卡尼汀组治疗后TG较治疗前降低，Hb较治疗前升高（P<0.05），与HD组相比，两组治疗后TG水平降低，Hb水平升高（P<0.05）；HFHD组和HFHD+左卡尼汀组间在TG水平下降及Hb水平升高方面差异无统计学意义（P>0.05）；而HFHD+左卡尼汀组可有效降低LDL，与HD组和HFHD组相比，差异均有统计学意义（P<0.05）。结论 HFHD联合左卡尼汀更能有效改善尿毒症患者的血脂代谢。

Effects of high-flux hemodialysis combined with L-carnitine treatment on lipid metabolism in uremic patients

Objective To investigate the effect of high flux hemodialysis(HFHD) combined with L carnitine therapy on lipid metaolism in uremic patients.Methods Seventy two uremic patients were randomly divided into three groups. Group hemodialysis（HD）was treated by low flux hemodialysis three times a week. Group HFHD was treated by HFHD three times a week. Group HFHD+L carnitine was treated by HFHD three times a week, and the patients were given L carnitine injection treatment at the end of each HFHD.All patients were followed up for 3 months. TC，TG，HDL，LDL, Hb, Alb were measured before and after the 3 months’ treatments, then the KT/V ratio and URR was calculated. Results TG increased in group HD before and after treatment (P<0.05). Compared to HD group, TG decreased and Hb increased significantly in group HFHD and HFHD+L carnitine before and after treatment (P<0.05). However, TG decrease and Hb increase had no significant differences between HFHD and HFHD+L carnitine group (P>0.05). LDL reduction is more significant in group HFHD+L carnitine than in group HD and HFHD (P<0.05). Conclusion HFHD combined with L carnitine might effectively improve lipid metabolism in MHD patients.