左卡尼汀改善尿毒症血透患者营养不良和心功能的临床研究

目的 评价左卡尼汀对尿毒症维持血液透析患者营养不良及心功能的改善作用。方法 将2012年12月-2013年12月中国人民解放军海军总医院收治的尿毒症患者74例随机分成治疗组（37例）和对照组（37例）。对照组采用常规血液透析治疗，治疗组在常规血液透析的基础上，于每次透析结束后iv左卡尼汀注射液1 g，连续治疗3个月。观察治疗前后两组患者的血清总蛋白（TP）、白蛋白（Alb）、转铁蛋白（TRF）、前白蛋白（PA）和以及心功能情况。结果 治疗组患者治疗后血清营养学指标TP、Alb、TRF、PA均较治疗前有所升高，治疗前后比较差异有统计学意义（P〈0.05）；治疗组总胆固醇（TC）水平较治疗前显著下降，治疗前后比较差异有统计学意义（P〈0.05），且显著低于对照组治疗后水平（P〈0.05）；治疗后，治疗组TP、Alb、TRF、PA水平均显著高于对照组，两组比较差异有统计学意义（P〈0.05）。治疗后两组患者的左心房内径（LAD）、左室后壁厚度（LVPWT）、室间隔厚度（IVST）较治疗前均有显著性减小，同组治疗前后差异有统计学意义（P〈0.05），且治疗组左室收缩末内径（LVDs）、左室舒张末内径（LVDd）较治疗前变化显著，治疗前后差异有统计学意义（P〈0.05）。治疗后，治疗组LAD、LVDs、LVDd和LVPWT值均低于对照组，两组比较差异有统计学意义（P〈0.05）。治疗后两组患者的舒张期始末血流速度E、A峰比值（E/A）、左室射血分数（EF）均较治疗前显著增加，治疗前后差异有统计学意义（P〈0.05），治疗组计算左房每搏量（SV）较治疗前显著性减小，治疗前后差异有统计学意义（P〈0.05）。治疗后，治疗组E/A、EF均显著高于对照组，治疗组SV显著性低于对照组，两组差异具有统计学意义（P〈0.05）。结论 iv左卡尼汀可明显改善尿毒症血液透析患者营养不良的状况，保护心肌细胞，延缓心脏结构及功能的进一步损害，值得临床推广应用。

Clinical research on improvement of L-carnitine for malnutrition and cardiac function in uraemia patients with hematodialysis

Objective To evaluate the effect of L-carnitine on improving the malnutrition and cardiac fimction in uremia with hematodialysis. Methods Seventy four cases in Navy General Hospital of PLA from December 2012 to December 2013 were randomly divided into treatment （37 cases） and control （37 cases） groups. The patients in each group were given a conventional hematodialysis therapy, while the patients in the treatment group were iv given lg L-carnitine injection after the end of each dialysis for 3 months. The levels of total protein （TP）, albumin （Alb）, transferrin （TRF）, and prealbumin （PA） as well as the cardiac function were observed before and after the treatment. Results After the treatment, the levels of TP, Alb, TRF, and PA were increased and there was a significant difference among them before and after the treatment （P〈0,05）. The total cholesterol was significantly lower in the treatment group than that before treatment and there was a significant difference before and after the treatment （P〈O.05）, which was significantly lower than that after the treatment in the control group （P〈0.05）. After the treatment, the TP, Alb, TRF, and PA in the treatment group were significantly higher than those in the control group （P〈0.05）. After the treatment, the left ventricular diameter （LAD）, left ventricular posterior wall thickness （LVPWT）, and the inter-ventricular septum thickness （IVST） were significantly reduced in the two groups than those before the treatment （P〈0.05）. There was a significant difference before and after the treatment in the same group （P〈0.05）, and comparing to that before the treatment, the left ventricular end systolic diameter （LVDs） and left ventricular end diastolic diameter （LVDd） in the treatment group were obviously improved with a significant difference （P〈0.05）. After the treatment, the levels of LAD, LVDs, LVDd, and LVPWT in the treatment group were lower than those in the control group with a significant difference （P〈0.05）. After the treatment, the E/A value and the left ventricular ejection fraction （EF） were more significantly increased than those before the treatment in the two groups （P〈0.05）, and the calculated left atrial stroke volume （SV） after the treatment was obviously decreased than that before the treatment in the treatment group with a significant difference （P〈0.05）. After the treatment, the E/A and EF values in the treatment group were significantly higher than those in the control group, while the SV value was significantly lower than that in the control group. There was a significant difference between the two groups （P〈0.05）. Conclusion Iv injection of L-camitine could significantly improve the situation of malnutrition in hemodialysis patients, protect the myocardial cells and delay the further damage of the cardiac structure and function, which is worthy of clinical application.