左卡尼汀对糖尿病肾病透析病人炎性因子与红细胞免疫的影响

目的:观察静脉推注左卡尼汀对糖尿病肾病(DN)维持性血液透析(MHD)病人炎性因子与红细胞免疫功能的影响.方法:将89例MHD病人随机分为观察组(47例)和对照组(42例),2组均给予血液透析治疗,每周2~3次,每次4 h,观察组在每次透析结束前5 min静脉推注左卡尼丁注射液,每次1 g,治疗1个月、3个月后,2组采外周血检测炎性因子与红细胞免疫指标.结果:伴随治疗时间延长,观察组白细胞介素-6、肿瘤坏死因子-α、高敏-C反应蛋白逐步下降,对照组下降不明显;观察组治疗1个月、3个月后上述炎性因子水平显著低于对照组(P<0.01).2组病人治疗后红细胞C3b受体花环百分比、CD35阳性RBC百分比、超氧化物歧化物水平逐步上升,红细胞免疫复合物花环百分比逐步下降;观察组治疗1个月、3个月后红细胞C3b受体花环百分比、CD35阳性RBC高于对照组(P<0.05~P<0.01),而治疗1个月、3个月后红细胞免疫复合物花环百分比则显著低于对照组(P<0.01).结论:对MHD治疗的DN病人补充外源性左卡尼汀可明显改善病人微炎性反应状态,同时能提高红细胞免疫功能.

Effect of L-carnitine on inflammatory factors and RBC immunity in diabetic nephropathy patients treated with dialysis

Objective:To observe the effects of L-carnitine injection on inflammation and red blood cell(RBC) immune function in diabetic nephropathy(DN) patients treated with maintenance hemodialysis(MHD).Methods:Eighty-nine MHD patients were randomly into the observation group(47 cases) and control group(42 cases).Two groups were treated with peritoneal dialysis,2 to 3 times a week,4 h each time.The observation group was intravenously injected with L-carnitine for 5 min before the end of the dialysis,1 g each time.The inflammatory factors and RBC immune indexes in two groups were detected after 1 and 3 months of treatment.Results:With the prolonging of treatment,the levels of IL-6,TNF-α,and hs-CRP in observation group declined gradually,and the decreasing degree of those in control group was not obvious.The levels of inflammatory factors in observation group after 1 month and 3 months of treatment were significantly lower than those in control group(P< 0.01).After treatment,the percentages of RBC-C3bRR wreath and CD35 positive RBC,and level of SOD gradually increased,and the percentage of RBC-ICR wreath declined gradually in two groups.After 1 month and 3 months of treatment,the percentages of RBC-C3bRR wreath and CD35 positive RBC in observation group were significantly higher than those in control group(P<0.05 to P<0.01),but the percentage of RBC-ICR wreath in observation group after 1 month and 3 months of treatment was significantly lower than that in control group(P<0.01).Conclusions:The exogenous L-carnitine in DN patients treated with MHD can obviously improve micro-inflammation status,and erythrocyte immune function.