不同方法补充左卡尼汀对新生儿血浆肉碱水平的影响及临床意义

目的:评价采用不同剂量与用药途径补充外源性左卡尼汀对新生儿血浆肉碱水平的影响及其临床意义.方法:选取我院新生儿科的新生儿160名,随机分为4组,每组40例并予以不同干预方案:口服治疗组(口服组)予左卡尼汀口服液0.1 g/(kg· d)口服,1次/d；静脉小剂量治疗组(小剂量组)予左卡尼汀注射液0.1 g/(kg·d)静脉滴注,1次/d；静脉大剂量治疗组(大剂量组)予左卡尼汀注射液0.15 g/( kg·d)静脉滴注,1次/d；对照组只给予常规治疗.治疗以7d为1个疗程.在生后第1d治疗前、生后第3d及生后第7d,分别采集足跟血滤纸片,采用串联质谱检测法测定患儿血浆游离肉碱浓度.结果:(1)足月儿出生后第1d血浆游离肉碱(44.81±17.3) μmol/L,大于早产儿的(35.19±19.5)μmol/L( P＜0.05)；(2)无论大剂量还是小剂量静脉补充左卡尼汀,均能使患儿血浆游离肉碱浓度在7d内持续升高,且大剂量补充后未发生不良反应；而口服补充左卡尼汀血浆游离肉碱水平缓慢下降,但下降速度慢于对照组.以上三组患儿补充左卡尼汀前、生后第3d及第7d血浆游离肉碱浓度分别为大剂量组( 39.50± 13.5) μmol/L、( 148.85±96.1 )μmol/L、(218.55±161.9) μmol/L;小剂量组(37.46±9.7) μmol/L、( 134.73±109.4) μmol/L、( 194.12±160.9) μmol/L；口服组(35.87±9.6)μmol/L、(35.31±13.4)μmol/L、( 29.02±7.1)μmol/L( P＜0.05)；(3)对照组出生后血浆游离肉碱浓度逐渐下降且与静脉补充左卡尼汀组相比差异有统计学意义(P＜0.05),对照组患儿在出生后第1d、第3d和第7d的浓度分别为(35.43±14.3)μmol/L、(32.57±16.2)μmol/L、(24.02±9.7) μmol/L.结论:未给予左卡尼汀补充的新生儿在生后l周内血浆游离肉碱浓度逐渐下降,予以左卡尼汀补充可有效提高新生儿血浆游离肉碱浓度,经静脉途径补充效果较口服途径为好.

The Effects of Additional L-carnitine Supplement on Neonates

Objective:To compare the effects of several different ways of additional L-carnitine supplement on neonates.Methods:One hundred and sixty neonates were randomly divided into four groups(40 cases for each group).The patients in the control group were given routine therapy for seven days;the patients in the small dose group and large dose group were given L-carnitine by intravenous drip at dosage of 0.1 g/kg and 0.15 g/kg for seven days,once a day;the patients of oral supplement group were given L-carnitine 0.1 g/kg orally for seven days,once a day.Before and after the treatment,blood spot(heel prick) tests were performed to measure the level of plasma acylcarnitine by tandem mass spectrometry.Results:(1) Preterm neonates were born with a lower level of plasma L-carnitine(35.19±19.5) μmol/L compared with that of full-term infants(44.81±17.3) μmol/L(P<0.05).(2) There was a sustained rise of plasma L-carnitine in both small (37.46±9.7) μmol/L,(134.73±109.4) μmol/L,(194.12±160.9) μmol/L] and large dose group (39.50±13.5) μmol/L,(148.85±96.1) μmol/L,(218.55±161.9) μmol/L] during seven days of treatment(P<0.05),whereas,there was a slow decline of plasma L-carnitine level in oral group during treatment (35.87 ±9.6) μmol/L,(35.31±13.4) μmol/L,(29.02±7.1) μmol/L].None of them had side effects.(3) Those neonates without additional L-carnitine supplement had a consistent decrease in the level of plasma L-carnitine during the treatment (35.43±14.3) μmol/L,(32.57±16.2) μmol/L,(24.02±9.7) μmol/L] compared with that of small and large dose groups(P<0.05).Conclusions:Additional L-carnitine supplement dose play a positive role in bringing up the plasma level of L-carnitine,especially those who were given L-carnitine by intravenous drip.