左旋肉碱对维持性血液透析1015例患者心脑血管事件的影响

目的探讨老年与中青年维持性血液透析患者应用左旋肉碱对心脑血管事件的影响。方法入选血液透析患者1015例,其中老年(年龄≥60岁)患者537例,分为老年常规透析组(老年常规组)277例,老年常规透析+左旋肉碱组(老年治疗组)260例;中青年患者478例,分为中青年常规透析组(中青年常规组)232例,中青年常规透析+左旋肉碱组(中青年治疗组)246例。分析主要终点为随访期内心肌梗死、心绞痛、急性心力衰竭、心律失常、脑卒中及全因死亡,次要终点为患者营养状况(血红蛋白及血浆白蛋白)、透析相关低血压。结果老年常规组较老年治疗组心血管事件发生风险高(RR=1.76,95%CI:1.06～2.79),差异有统计学意义(χ~2=4.86,P<0.05)。中青年常规组与中青年治疗组心血管事件、脑血管事件及全因死亡率的减少差异无统计学意义(P>0.05)。结论老年维持性血液透析患者补充左旋肉碱,能降低随访期内心血管事件的发生,但对脑血管事件及全因死亡无明显影响。各组患者透析后补充左旋肉碱均能改善营养状况,减少透析相关低血压的发生。

Effect of L-carnitine on cardiovascular and cerebrovascular events in 1015 patients undergoing maintenance hemodialysis

Objective To study the effect of L-carnitine(LC) on cardiovascular and cerebrovascular events in elderly,middle-aged and young patients undergoing maintenance hemodialysis (MHD).Methods Of the 1015 patients enrolled in this study,537 were elderly patients with their age≥60 years.The patients were divided into elderly conventional hemodialysis group(n= 277),elderly conventional hemodialysis and LC group(n=260),middle-aged and young conventional hemodialysis group(n = 232),and middle-aged and young conventional hemodialysis and LC group(246).Following factors were analyzed,including myocardial infarction,angina pectoris,arrhythmia, acute left heart failure,stroke and death due to all causes,nutritional status(hemoglobin and serum albumin level),and hemodialysis-related hypotension during the follow-up period.Results The rick of cardiovascular events was higher in elderly conventional hemodialysis group than in elderly conventional hemodialysis and LC group(RR = 1.76,95%CI:1.06-2.79,χ~2= 4.86,P<0.05).No significant difference was oberserved in cardiovascular and cerebrovascular events and death due to all causes between middle-aged and young conventional hemodialysis group and conventional hemodialysis and LC group.Conclusion LC can reduce the cardiovascular events in elderly patients undergoing MHD during the follow-up period with no significant effect on cerebrovascular events and death due to all causes,improve the nutritional status and reduce the incidence of hemodialysis-related hypotension in the 4 groups of patients undergoing MHD.