左旋卡尼汀对尿毒症血液透析患者微炎症状态的影响

目的 探讨左旋卡尼汀对维持性血液透析患者微炎症状态的影响。方法 将42例维持性血液透析患者随机分为两组,试验组21例,对照组21例。每次透析后,试验组给予静脉注射左旋卡尼汀1g,对照组给予静脉注射生理盐水5ml,试验时间为3个月。结果 试验结束时,试验组IL-6、CRP含量明显降低,白蛋白、转铁蛋白水平升高,差异均具有统计学意义（P〈0．05）,而对照组各项指标试验前后无明显改变。结论 左旋卡尼汀可降低维持性血液透析患者IL-6、CRP浓度,升高白蛋白、转铁蛋白浓度,改善患者营养及微炎症状态。     

左旋卡尼汀治疗维持性血液透析患者肉碱缺乏症的临床研究

目的研究静脉注射左旋卡尼汀对维持血液透析（ＨＤ）患者肉碱缺乏症的治疗作用。方法采用多中心、双盲、随机、对照的研究方法,选择ＨＤ患者１９７例,分为治疗组、对照组和开放组,每次透析结束后,治疗组和开放组静脉注射左旋卡尼汀１ｇ,对照组注射生理盐水,为期３个月。结果治疗组和开放组体力、精神状态、食欲、恶心、呕吐、透析耐受性、透析中肌痉挛或低血压等症状的改善十分显著,血浆肉碱浓度明显升高（治疗前比治疗后：２８８２±１２５８ｖｓ．１８１３１±７４５７,Ｐ＜００１）,对照组以上各项均无变化,治疗组与对照组相比变化差异十分显著（Ｐ＜００１）;治疗组及开放组血浆总蛋白、白蛋白、前白蛋白和转铁蛋白等营养参数也明显升高。左旋卡尼汀治疗主要不良反应为转氨酶轻度升高和血小板降低,发生率分别为５．３％和２．３％,停药即可恢复正常。结论左旋卡尼汀能安全有效地治疗维持ＨＤ患者肉碱缺乏症。     

左卡尼汀联合生脉注射液改善血液透析相关性低血压临床观察

目的观察左卡尼汀联合生脉注射液改善血液透析相关性低血压的疗效。方法选择血液透析相关性低血压患者30例，透析开始后1～2h给予生脉注射液40m1加入0．9％氯化钠溶液100ml静脉滴注，且透析结束后30min内给予左卡尼汀1．0g静脉推注，持续使用3个月，观察所有患者用药后3个月内透析前、透析中、透析后的血压、干体质量、超滤量及医务人员的干预情况。结果左卡尼汀联合生脉注射液治疗后患者在透析中及透析后的平均收缩压均比治疗前明显上升（P〈0．01），而治疗后，透析中的低血压、症状性低血压发生例次与治疗前比较有统计学差异（P〈O．05）。30例患者中，显效18例（占60．0％），有效8例（占26．7％），无效4例（占13．3％）。结论左卡尼汀联合生脉注射液改善血液透析相关性低血压有效且安全。     

左卡尼汀对血液透析患者肾性贫血和左心功能的影响

目的观察左卡尼汀联合人重组促红细胞生成素（〉HuEPO）对维持性血液透析（MHD）患者肾性贫血、左心功能的影响。方法将78例MHD患者随机分为对照组和治疗组,每组39例。治疗组于每次血液透析结束时静脉注射左卡尼汀1.0g;对照组每次血液透析结束时静脉注射生理盐水5ml。疗程均为6个月。2组同时于血液透析后皮下注射r-HuEPO（每周75-150U／kg）。观察2组治疗前后的临床症状、体征相关的实验室检查以及超声心动图的变化。结果治疗组治疗后3个月患者血红蛋白（Hb）、红细胞压积（Hct）、血清白蛋白（Alb）、前白蛋白（PA）水平显著高于治疗前及同期对照组（P〈0.01）,〉HuEPO用量减少,且患者精神状态、体力、食欲、恶心、呕吐、透析耐受性、透析中肌痉挛、心律失常或低血压等症状明显改善,治疗后6个月患者左心功能较治疗前及同期对照组明显改善（P〈0.01）。结论左卡尼汀联合r-HuEPO可以明显改善尿毒症血液透析患者肾陛贫血和左心功能。     

左卡尼汀联合红细胞生成素治疗心肾贫血综合征

目的 评价左卡尼汀(LC)联合红细胞生成素(EPO)治疗维持性血液透析心肾贫血综合征(CRAS)患者的临床效果.方法 将91例维持性血液透析患者分为LC联合EPO组(A组)35例、EPO组(B组)30例和对照组26例.各组按常规剂量服用琥珀酸亚铁、叶酸和肌肉注射维生素B12.A组于血液透析后以1.0 g LC加入20 ...     

左卡尼汀对维持性血液透析患者心功能不全的影响

目的:观察左卡尼汀治疗维持性血液透析患者心功能不全的疗效.方法:将80例合并不同程度心功能不全的维特性血液透析患者随机分为两组,治疗组与对照组分别为40例与40例,对照组给予血液透析、纠正贫血及降压、补钙治疗;治疗组在对照组治疗基础上,同时每次透析结束后左卡尼汀1.0 g,治疗6月.观察患者治疗前和治疗后血红蛋白、红细胞压积、血压情况,定期心脏彩超测定心脏指数(CI)、左宣射血分数(LVEF)、左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、心缩力指数(HI)、每搏输出量(SV)、每分输出量(CO).结果:治疗组治疗后血红蛋白、红细胞压积、心肌收缩力增强,心功能指数较治疗前压对照组均明显改善(P<0.01).治疗组比对照组的血压升高率明显降低(P<0.05).结论:左卡尼汀可以显著改善维持性透析患者的心功能.     

补充左卡尼汀对老年血液透析患者左心功能的影响

目的探讨老年血液透析患者补充左卡尼汀对左心功能的影响。方法选择老年血液透析患者（〉65岁）66例，随机分为治疗组和对照组，于每次血液透析结束时，治疗组静脉注射左卡尼汀1g，对照组静脉注射0．9％NaCl溶液5ml，疗程4个月。观察两组患者治疗前后的临床症状、有关的实验室检查以及超声心动图的变化。结果治疗组使用左卡尼汀治疗4个月后，患者体力增强，食欲改善，透析过程中低血压、肌痉挛等并发症明显减少，促红细胞生成素（EPO）用量较治疗前减少[（106±48）U／kg比（145±28）U／kg]，且贫血明显改善，左心房缩小，左心室的收缩和舒张功能明显提高，血浆胆固醇和三酰甘油水平明显下降，差异均有统计学意义（P〈0．05或〈0．01）。对照组治疗前后无明显变化。结论老年血液透析患者补充左卡尼汀可以明显改善临床症状，减少透析并发症，增加对EPO的反应，提高左心功能，未见明显的不良反应，值得推荐使用。     

左卡尼汀改善血液透析患者生存质量的研究

目的 探讨左旋卡尼汀对血液透析患者生存质量的改善作用.方法 采用随机、对照的研究方法 ,选择本院血透室透析一年以上的维持性血液透析患者60例,将患者随机分为观察组33例和对照组27例,并给观察组每次透析后静脉注射左卡尼汀1g,两组患者其余治疗方案相同.观察过程共12周.结果 治疗后观察组患者的主观症状明显改善(P<0.05);营养状态明显优于对照组(P<0.05);其血 C反应蛋白、磷酸肌酸激酶等指标的水平显著低于对照组(P<0.05).而治疗前两组患者的相关指标无显著性差异(P>0.05).结论 长期使用左卡尼汀能改善血液透析患者的生存质量.     

血液透析患者应用左旋卡尼汀注射剂的临床疗效观察

左旋卡尼汀(L-carnitine,肉碱)是促使长链脂肪酸进入线粒体进行β氧化必需的营养素,血液透析(hemodialysis,HD)患者由于肉碱合成和摄入减少,以及透析中丢失,出现肉碱缺乏[1].为此,本文观察了左旋卡尼汀注射剂对维持性血透患者的肉碱浓度变化及临床疗效.     

参附针联合左卡尼汀针治疗透析相关性低血压的临床观察

透析相关性低血压是维持性血液透析（MHD）的常见并发症[1],积极探索治疗透析相关性低血压的有效方法在提高透析充分性及患者的生存质量等方面有重要的临床意义。本文采用参附针联合左卡尼汀针治疗透析相关性低血压取得了一定疗效,现报告如下。     

High dose of L-carnitine increases platelet aggregation and plasma triglyceride levels in uremic patients on hemodialysis

Uremic patients undergoing chronic hemodialysis demonstrate a secondary systemic carnitine deficiency. We studied the effect of carnitine replacement with high doses (L-carnitine, 3 g/day) similar to those used in the treatment of primary systemic carnitine deficiency. 10 uremic patients on hemodialysis were randomly selected into a control group (4 patients) treated by placebo and a treatment group (6 patients) treated by L-carnitine. Plasma lipoprotein concentration and composition as well as platelet aggregation were studied before and after treatment. Following carnitine administration, a paradoxical rise in plasma triglyceride concentration from 180 +/- 66 to 219 +/- 88 mg% (p less than 0.05) was noted. No other significant changes in lipoprotein concentration and composition or in plasma apoprotein A-I and B concentration were observed. Carnitine treatment caused a significant rise in platelet aggregation induced by epinephrine, ADP, and thrombin. These findings suggest a harmful effect of L-carnitine replacement therapy when given in high doses, causing aggravation of uremic hypertriglyceridemia and increased platelet aggregation in patients predisposed to thromboembolic phenomena.     

左卡尼汀对血液透析患者微炎症及营养状况的影响

目的探讨左卡尼汀对维持性血液透析患者微炎症及营养状况的影响。方法选择62例维持性血液透析患者,随机分为左卡尼汀组和对照组,检测二组患者治疗前、治疗后血C反应蛋白（CRP）、血红蛋白（Hb）、白蛋白（Alb）和血肌酐（SCr）值,计算Kt／V值。结果与治疗前及对照组治疗后比较,左卡尼汀组患者治疗后CRP水平下降,Alb、Hb升高,差异有统计学意义（P〈0．05）;对照组患者治疗前后CRP、Alb、Hb无统计学差异（P〉0.05）;二组患者治疗前后SCr、Kt/V值均无统计学差异（P〉0．05）。结论左卡尼汀可减轻维持性血液透析患者微炎症反应,改善患者营养状态。     

L-carnitine administration reverses acute mental status changes in a chronic hemodialysis patient with hepatitis C infection

A chronic hemodialysis patient presented with elevated serum ammonia concentration (189 micromol/l) and acutely altered mental status. He had been adequately dialyzed over the prior months and had no evidence of liver dysfunction, despite serological evidence for hepatitis C virus infection. His mental status deteriorated to coma despite vitamin replenishment, intensive hemodialysis, lactulose treatment, and blood pressure control over a 3-day period. Blood free L-carnitine concentration was depressed, and total carnitine concentrations was normal. Three hours after a single 2 g dose of L-carnitine was administered intravenously, the mental status reverted to normal. Hyperammonemia resolved over a 5-week period. We suspect that subclinical liver dysfunction and dialysis status in tandem contributed to the carnitine deficiency, hyperammonemia, and confusion and that the L-carnitine administration reversed these biochemical and clinical abnormalities.     

Multicenter trial of L-carnitine in maintenance hemodialysis patients. I. Carnitine concentrations and lipid effects

Previous studies have reported conflicting results of carnitine supplementation on plasma lipids in patients with chronic renal failure. We therefore performed a four center, double-blind placebo controlled trial to evaluate the effects of post-hemodialysis intravenous injection of L-carnitine in ESRD patients on maintenance hemodialysis. Thirty-eight patients received up to six months of L-carnitine infusions (20 mg/kg) post-dialysis and 44 patients received placebo infusions. In both groups of patients, baseline pre-dialysis plasma and red blood cell total carnitine levels were normal, but pre-dialysis plasma-free carnitine concentrations and free/total ratios were subnormal, and plasma acyl levels were elevated. Post-dialysis plasma free and total carnitine concentrations were also subnormal. Plasma and red blood cell total carnitine levels rose eightfold in carnitine recipients, but were unchanged from baseline in those receiving placebo. There were no significant changes observed in plasma triglycerides, HDL-cholesterol or other lipoprotein parameters in either the carnitine or placebo treated groups. We conclude that carnitine metabolism is altered in uremia. Furthermore, in a randomly-selected hemodialysis population, L-carnitine injection at the dose of 20 mg/kg results in significant increases in blood (and perhaps tissue) carnitine levels, but this is not associated with any major effects on lipid profiles.     

Effect of L-carnitine supplementation in hemodialysis patients.

BACKGROUND/AIM: L-Carnitine is important in beta-oxidation of fatty acids. A lack of carnitine in hemodialysis patients is caused by insufficient carnitine synthesis and especially by its loss during dialysis. The aim of our study was to test the influence of carnitine supplementation on plasma lipids, red blood cell count, and metabolism of free radicals. METHODS: Twelve regularly dialyzed patients (average age 55.5 years, average dialysis treatment period 22.5 months) were given 15 mg/kg L-carnitine intravenously three times weekly (after each hemodialysis session) for 6 months. Laboratory markers of oxidative stress, lipid metabolism, and red blood cell count were measured before the supplementation and then controlled during two 3-month intervals. Nine patients were retested 3 months after the supplementation had ended. RESULTS: All supplemented patients showed increased plasma free carnitine in comparison with the pretreatment values (113.3 +/- 11.2 vs. 62.3 +/- 16.7 micromol/l, p < 0.001). The proportion of decreased L-carnitine values after hemodialysis was reduced from 79 to 22%. Plasma total cholesterol (4.66 +/- 0.30 mmol/l after treatment vs. 5.65 +/- 1.53 mmol/l before treatment, p < 0.05) and LDL cholesterol (1.74 +/- 0.86 vs. 2.81 +/- 1.43 mmol/l, p < 0.05) decreased. The albumin concentration significantly increased from 34.8 +/- 7.3 to 46.0 +/-5.4 g/l (p < 0.05). Intraerythrocyte reduced glutathione increased from 1.65 +/- 0.25 to 2.23 +/- 0.16 mmol/l (p < 0.001), and the plasma antioxidant capacity increased from 1.65 +/- 0.09 to 2.06 +/- 0.17 mmol/l (p < 0.001). At the same time, plasma malondialdehyde decreased from 4.18 +/- 0.72 to 3.07 +/- 0.35 micromol/l (p < 0.001). The erythropoietin dose could be reduced from an average value of 5,500 to 3,500 U/week. No significant changes in the above-mentioned parameters were observed in a control group of dialyzed patients without L-carnitine supplementation. CONCLUSION: Regular carnitine supplementation of hemodialysis patients can improve their lipid metabolism, protein nutrition, red blood cell count, and antioxidant status.     

左卡尼汀及饮食干预对维持性血液透析患者营养不良的影响

目的探讨左卡尼汀及饮食干预对维持性血液透析患者营养状态的疗效。方法选择维持性血液透析营养不良患者30例,随机分对照组（A组）、饮食干预组（B组）和左卡尼汀组（c组）,每组10例;均给予每周3次血液透析治疗,B、C组患者给予饮食干预,C组每次血液透析后静脉注射左卡尼汀,连续观察12周,比如治疗前后体质量指数（BMI）、血总蛋白（TP）、白蛋白（Alb）、前白蛋白（PA）、血肌酐（SCr）、尿素氮（BUN）、总胆固醇（Tc）及甘油三酯（TG）的变化。结果A组各项指标治疗前后无显著差异（P〉0．05）;B组BMI、TP、Alb、PA、SCr、BUN、TC及TG在治疗前后有统计学差异（P〈0．05）;C组BMI、TP、Alb、PA、SCr及BUN治疗前后有统计学差异（P〈0．05）;C组BMI、TP、Alb、PA、SCr及BUN较B组升高更明显（P〈0．05）。结论通过充分的血液透析、饮食干预及左卡尼汀治疗能显著改善维持性血液透析患者的营养状态。     

维生素C和左旋肉碱联合促红细胞生成素治疗维持性血液透析患者肾性贫血的临床观察

目的观察维生素C和左旋肉碱在维持性血液透析合并肾陛贫血患者治疗中的作用。方法将75例维持性血液透析患者随机分成A组、B组、C组,3组患者均皮下注射促红细胞生成素6000U,每周2次;除此之外,A组每次血液透析结束时静脉注射左旋肉碱2g,每周2次;B组每日口服维生素C300mg（分3次口服）;C组联合使用左旋肉碱和维生素C0观察时间为3个月。结果C组患者血细胞比容、血红蛋白上升幅度明显高于A组和B组（P〈0．05或P〈0．01）,而C组血C反应蛋白水平明显低于A组和B组（P〈0．01）。结论对于维持性血液透析患者联合使用维生素C和左旋肉碱可减轻体内微炎症反应,改善对促红细胞生成素的敏感性,减少其用量,提高其疗效,安全性较好。     

Dramatic decrease of carnitine esters after interruption of exogenous carnitine supply in hemodialysis patients

L-carnitine supplementation is extensively used in patients on maintenance hemodialysis (HD) to improve dialysis-related clinical symptoms. In a series of studies, we investigated the dynamics of carnitine pool in carnitine-supplemented HD patients; here we report dramatic decrease with special changes of the ester profile due to interruption of the exogenous intake after the last HD session. Serum samples were collected from 18 L-carnitine-repleted end-stage renal disease (ESRD) patients before the L-carnitine supplementation, after completion of a carnitine supplementation period treatment (12 weeks, 1 g/IV/HD), right before the HD session, and 44 h after the dialysis. Levels of free carnitine (FC) and the individual esters were determined using electrospray MS/MS technique. Normally, L-carnitine supplementation causes significant elevation of all carnitine compounds to supraphysiological levels, which reaches a standard steady-state-like profile. In this study we found a dramatic decrease in the level of FC, and in short- and medium-chain acylcarnitines (ACs) 44 h after the last dialysis. At the end of this interdialytic period, FC levels increased to only 65% of the predialysis level, whereas the amounts of C2 and C3 esters recovered to only 50%. The level of C6 was 65% of the predialysis level, whereas the amount of C8 chain length ACs returned to 72% of the predialysis level. No significant change was seen in AC concentrations above C10 chain length. Omission of one single dosage of supplemental carnitine in long-term administration schemes results in dramatic decrease and reprofiling of carnitine esters even after the usual 44 h of interdialytic period.     

Effects of L-carnitine supplementation in maintenance hemodialysis patients: a systematic review

There are many causes for carnitine depletion during maintenance hemodialysis. Supplementation with L-carnitine in animals has been associated with improvement in some abnormalities also present in chronic renal failure. However, it is still controversial whether restoring plasma or tissue carnitine will correct clinical or biologic symptoms observed in maintenance hemodialysis. A systematic review is here performed to determine the effects of L-carnitine in maintenance hemodialysis patients. Eighty-three prospective trials were identified from 1978 to 1999 in which L-carnitine was randomly allocated in 21 trials. Change in serum triglycerides, cholesterol fractions, hemoglobin levels, erythropoietin dose, and other symptoms (muscle function, exercise capacity, and quality of life) were examined. A total of 482 patients in 18 trials were considered for analysis. There was no effect of L-carnitine on triglycerides, total cholesterol, or any of its fractions. Before the erythropoietin (EPO) era, L-carnitine treatment was associated with improved hemoglobin (P < 0.01) and with a decreased EPO dose (P < 0.01) and improved resistance to EPO when patients routinely received EPO. Muscle function, exercise capacity, and quality of life could not be reliably assessed because of the noncombinable nature of end points and the limited number of trials. In conclusion, L-carnitine cannot be recommended for treating the dyslipidemia of maintenance hemodialysis patients. By contrast, this review suggests a promising effect of L-carnitine on anemia management. The route of L-carnitine administration should be evaluated because there is no evidence as to the most efficient method of administration in maintenance hemodialysis.     

L-carnitine and platelet aggregation in uremic patients subjected to hemodialysis

It has been reported that treatment with L-carnitine at a daily dose of 3 g orally may cause a rise in platelet aggregation and serum triglyceride concentration in hemodialyzed patients. The present double-blind cross-over study has been performed to evaluate the influence of L-carnitine when compared with placebo on platelet aggregation and plasma concentrations of various factors involved in platelet activation. In addition, the concentration of triglycerides, cholesterol and HDL-cholesterol has been evaluated. 18 uremic patients on maintenance hemodialysis for at least 1 year were randomly allocated either to a control group receiving placebo or to a group treated with L-carnitine. Statistical analysis performed by means of ANOVA did not show any significant change in the serum concentration of cholesterol, HDL-cholesterol and triglycerides. Furthermore, platelet aggregation tests (performed with adenosine 5'-diphosphate, epinephrine, thrombin and collagen) and plasma beta-thromboglobulin concentration did not show any statistically significant difference. In addition, the plasma concentration of several coagulation markers, such as factor VIIIc, antithrombin III, alpha 2-antiplasmin, and fibrinopeptide A, did not show any significant variation. The results suggest that under our experimental conditions L-carnitine neither increases the risk of thromboembolism nor alters the serum lipid content in uremic patients on chronic hemodialysis.