左卡尼汀联合超纯透析对MHD患者心功能及外周血irisin、s-Klotho表达的影响

目的 探究左卡尼汀联合超纯透析对维持性血液透析(maintenance hemodialysis，MHD)患者的治疗效果及其对心功能及外周血鸢尾素(irisin)、Klotho蛋白（s-Klotho）表达的影响。 方法 选取 MHD患者186例，依照治疗方法不同分成观察组和对照组各93例。对照组予以常规透析治疗，观察组予以左卡尼汀联合超纯透析治疗，治疗3个月后观察2组生存质量、炎症因子、氧化应激指标、心功能、irisin和s-Klotho浓度以及并发症发生情况。 结果 治疗后，2组各维度健康调查简表(the MOS 36-item Short Form Health Survey，SF-36)评分均明显高于治疗前，观察组各维度SF-36评分高于对照组（P＜0.05）；2组白细胞介素6（interleukin-6，IL-6）、肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、C反应蛋白（C-reactive protein，CRP）水平均明显低于治疗前，观察组IL-6、TNF-α、CRP水平低于对照组（P＜0.01）；2组肝蛋白（superoxide dismutase，SOD）、丙二醛（malondialdehyde，MDA）及谷胱甘肽过氧化物酶（glutathione peroxidase，GSH-Px）水平明显低于治疗前，观察组SOD、MDA及GSH-Px水平低于对照组（P＜0.05或P＜0.01）；2组心排血量（cardiacoutput,CO）和左心室射血分数（left ventricular ejection fractions,LVEF）水平明显高于治疗前，观察组CO和LVEF水平明显高于对照组（P＜0.01）；2组irisin和s-Klotho水平明显高于治疗前，观察组irisin和s-Klotho水平明显高于对照组（P＜0.01）。观察组并发症发生率明显低于对照组(P＜0.01)。 结论 左卡尼汀联合超纯透析可显著改善MHD患者的炎症状态和氧化应激，提升患者心功能，并降低外周血Irisin、s-Klotho表达。

Effects of L-carnitine combined with ultrapure dialysis on cardiac function and expression of irisin and s-Klotho in peripheral blood of MHD patients

Objective To explore the therapeutic effect of levocarnitine combined with ultrapure dialysis on maintenance hemodialysis(MHD) patients and its effect on cardiac function and expression of irisin and Klotho protein(s-Klotho) in peripheral blood. Methods A total of 186 MHD patients were divided into observation group and control group according to different treatment methods. The patients in the control group were given routine dialysis treatment, while those in the observation group were treated with levocarnitine combined with ultrapure dialysis. After 3 months, the quality of life, inflammatory factors, oxidative stress index, cardiac function, irisin and s-Klotho concentrations and complications were observed. Results After treatment, the scores of SF-36 in the two groups were significantly higher than those before treatment, and the scores of SF-36 in the observation group were higher than those in the control group(P＜0.05); the levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and C-reactive protein(CRP) in the two groups were significantly lower than those before the treatment(P＜0.01), and the levels of IL-6, TNF-α and CRP in the observation group were lower than those in the control group(P＜0.05 or P＜0.01); the levels of SOD, MDA and GSH-Px in the two groups were significantly lower than before the treatment(P＜0.01), and the levels of SOD, MDA and GSH-Px in the observation group were significantly lower than those in the control group(P＜0.01). The levels of cardiac output(CO) and left ventricular ejection fraction(LVEF) in the two groups were significantly higher than those before treatment, and the levels of CO and LVEF in the observation group were significantly higher than those in the control group(P＜0.01), the levels of irisin and s-Klotho in the two groups were significantly higher than those before the treatment(P＜0.01), and the level of irisin and s-Klotho in the observation group was significantly higher than that in the control group(P＜0.01). The incidence of complications in the observation group was significantly lower than that in the control group(P＜0.01). Conclusion Levocarnitine combined with ultrapure dialysis can significantly improve the inflammatory state and oxidative stress of MHD patients, improve their cardiac function, and reduce the expression of irisin and s-Klotho in peripheral blood.