口服和静脉给予左卡尼汀治疗血液透析患者肉碱缺乏症的多中心随机对照研究

目的　比较左卡尼汀口服液与静脉注射左卡尼汀对维持性血液透析患者肉碱缺乏症的治疗作用和不良反应。方法　随机选取 4家医院血液净化中心接受维持性血液透析的尿毒症患者 10 8例 ,分别给予每周 2次静脉注射左卡尼汀 1g(静脉注射组 )、口服左卡尼汀 1g/d(口服Ⅰ组 )或 2 g/d(口服Ⅱ组 )治疗 ,总观察时间为 8周。 结果　 3组治疗前后的症状、体征评分均显著下降 ;治疗前血浆肉碱浓度分别为 (2 6 .5 2± 10 .2 9)、(2 5 .5 9± 9.17)、(2 2 .5 6± 15 .0 2 ) μmol/L ,治疗后分别为 (113.16± 5 6 .86 )、(10 3.2 5± 4 2 .4 1)、(12 1.4 3± 5 9.33) μmol/L(P <0 .0 1)。经过 8周治疗后 ,静脉注射组的血小板、口服Ⅱ组的血红蛋白和红细胞均较治疗前明显上升 ,口服Ⅰ组促红细胞生长素 (EPO)的用量则较治疗前显著降低 ;静脉注射组的白蛋白、尿素氮、肌酐水平 ,以及口服Ⅰ组的前白蛋白水平 ,口服Ⅱ组的白蛋白、尿酸水平均较治疗前显著升高 ;口服组和静脉注射组的不良反应均轻微。结论　口服补充左卡尼汀可显著提高维持性血液透析肉碱缺乏症患者的血浆游离肉碱浓度 ,改善肉碱缺乏的相关临床症状和体征 ,并对部分营养学指标和血红蛋白有不同程度的改善作用 ,其疗效与静脉给药相似 ,且更为经济、方便。

Effects of intravenous and oral L-carnitine supplements on carnitine deficiencies in maintenance hemodialysis patients: a multicenter, randomized, controlled study

Objective To compare the effects and safety of intravenous and oral L carnitine supplements on maintenance hemodialysis patients (MHD) with carnitine deficiencies. Methods 108 MHD patients recruited from four blood purification centers were randomly divided into 3 groups. Group A was infused twice per week with 1 g of L carnitine intravenously, while group B and C received 1 g or 2 g oral L carnitine, respectively. The total observation period was 8 weeks. Results The symptom and sign scores were decreased and plasma free carnitine level was significantly increased in all 3 groups. After 8 weeks of supplementation, platelet count in group A, hemoglobin and red blood cell count in group C increased significantly, while weekly erythropoietin(EPO) dose in group B fell. Serum albumin, BUN and creatinine in group A, prealbumin in group B, and albumin, uric acid in group C were markedly elevated at the end of the study. Side effects were negligible in both groups. Conclusion Oral supplementation of L carnitine to MHD patients with carnitine deficiencies can increase plasma free carnitine level, ameliorate the symptom and signs, with concomitant partial improvement of nutritional parameters and uremic anemia. Comparing with the intravenous route, oral supplementation is also efficacious and being safer and more convenient.