左卡尼汀对维持性血液透析病人微炎症状态及营养状况的影响

目的:探讨左卡尼汀对维持性血液透析(MHD)病人微炎症状态及营养状况的影响.方法:选取血液透析中心接受MHD的终末期肾脏疾病病人88例作为研究对象,随机分为观察组和对照组,各44例.均接受单纯透析治疗,并常规应用叶酸、铁剂、促红细胞生成素、骨化三醇等药物,观察组于透析结束时以左卡尼汀1.0 g加0.9％氯化钠注射液至20 mL从透析通路静脉端注入,对照组以0.9％氯化钠注射液20 mL从透析通路静脉端注入.2组于治疗前和治疗3个月、6个月后抽取清晨空腹静脉血,离心提取血清,采用透射比浊法检测超敏C反应蛋白(hs-CRP)水平,ELISA法检测肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8水平;采用全自动生化分析仪检测血红蛋白(Hb)、前白蛋白(PA)、白蛋白(ALB)、总胆固醇(TC)、三酰甘油(TG)水平及肾功能相关指标尿素氮(BUN)、肌酐(Cr)、β2-微球蛋白(β2-MG).结果:治疗3个月、6个月后,观察组hs-CRP、TNF-α、IL-6、IL-8水平均明显低于治疗前(P<0.01);治疗3个月、6个月后,观察组IL-6、IL-8、TNF-α水平均明显低于对照组(P<0.01).治疗3个月、6个月后,观察组Hb、ALB、PA水平均高于治疗前(P<0.05～P<0.01);治疗3个月后,观察组PA水平明显高于对照组(P<0.01);治疗6个月后,2组Hb、PA、ALB水平比较差异均有统计学意义(P<0.01).治疗3个月、6个月后,观察组β2-MG水平均低于治疗前(P<0.05和P<0.01);治疗6个月后,2组β2-MG水平差异均有统计学意义(P<0.01).结论:左卡尼汀可有效缓解MHD病人微炎症状态,改善营养不良状况.

Effect of levocarnitine on the microinflammation state and nutritional status in patients with maintenance hemodialysis

Objective:To explore the effects of levocarnitine on the microinflammation state and nutritional status in patients with maintenance hemodialysis(MHD). Methods:A total of 88 end-stage renal disease(ESRD) patients treated with MHD were randomly divided into the observation group and control group. Two groups were treated with pure hemodialysis, folic acid, ferralia, EPO, and calcitriol. After hemodialysis,the observation group was injected with levocarnitine(1. 0 g) and normal saline(20 mL) from the dialysis channel venous end,and the control group were only injected with normal saline(20 mL). Before treatment,and after 3 and 6 months of treatment,the level of hs-CRP,and levels of TNF-α,IL-6,and IL-8 in two groups were detected using transmission turbidimetry and ELISA,respectively,and the levels of Hb,PA,ALB,TC,TG,BUN,Cr,and β2-MG. in two groups were detected using full automatic biochemical analyzer. Results:The levels of hs-CRP,TNF-α,IL-6,and IL-8 at 3 and 6 months after treatment in the observation group were significantly reduced when compared with before treatment(P <0. 01). IL-6,IL-8,and TNF-α levels at 3 and 6 months after treatment in the observation group were significantly lower than those in the control group(P<0. 01). Hb,ALB,and PA levels at 3 and 6 months after treatment in the observation group were significantly elevated when compared with before treatment(P<0. 05 to P<0. 01). PA level at 3 months after treatment in the observation group was significantly higher than that in the control group(P<0. 01). The comparison of Hb, PA, and ALB levels at 6 months after treatment between the two groups was significantly different(P<0. 01). After 3 and 6 months of treatment, the level of β2-MG level in the observation group was significantly reduced when compared with before treatment(P<0. 05 and P<0. 01). After 6 months of treatment,the comparison of β2-MG level between the two groups was significantly different(P <0. 01). Conclusions:Levocarnitine can effectively alleviate the microinflammation state,and improve the malnutrition status in patients with MHD.