左旋肉碱对血液透析患者微炎症状态及肾性贫血的临床观察

摘要

Objective To observe the effects of L-carnitine (L-CN) supplement on micro-inflammation and renal anemia in maintenance hemodialysis (MHD) patients. Methods Forty MHD patients who met the study criteria were randomly divided into treatment group and control group. In treatment group (n 20), patients were intravenously given L-CN 1 g in 20ml normal saline through internal fistula before the end of a dialysis session, 3 times/week for 12 weeks; in control group, the injection was 20ml normal saline without L-CN. Serum C-reactive protein (CRP), interleukin-6 (IL-6), hemoglobin (Hb) and hematocrit (Hct) were measured before and after the LCN therapy. Results In treatment group after L-CN therapy, CRP [ (8.47 ± 6.96)mg/L vs. (13.38 ± 5.01)mg/ L, t=2.560,P ＜ 0.02] and IL-6 [(23.18 ± 5.64)pg/ml vs. (31.86 ± 9.39)pg/ml, t=3.542,P＜ 0.02] significantly decreased. When comparisons were made between treatment group and control group after L-CN therapy, CRP [(8.47 ± 6.96)mg/L vs. (13.62 ± 5.83)mg/L,t 2.550,P＜ 0.02] and IL-6 [(23.18 ± 5.64)pg/ml vs. (31.17 ± 8. 76)]pg/ml, t=3.429, P＜ 0.02] also decreased, and Hb [(95.1 ± 11.3)g/L vs. (108.8 ± 12.9)g/L, t=3.577, P＜ 0.02] and Hct[(25.9％ ± 4.8％) vs (35.3％ ± 3.7％),t=6.962P＜ 0.02] also increased treatment group. Additionally,erythropoietin dosage reduced in treatment group after L-CN therapy. Conclusion Micro-inflammation and renal anemia improved in MHD patients after intravenous administration of L-CN for 12 weeks.%目的 观察外源性左旋肉碱(l-carnitine,L-CN)对维持性血液透析(maintenance hemodialysis,MHD)患者微炎症状态及肾性贫血相关指标的影响.方法 选择符合入选标准的MHD患者40例随机分为2组,每组20例,治疗组每次透析结束前于内瘘静脉注射L-CN1g加生理盐水(normal saline,NS)20ml,对照组以同样方法给予等体积NS2O ml,每周3次,共12周.检测每组治疗前及治疗12周后患者的C反应蛋白(c-reactie protein,CRP)、白介素-6(interleukin-6,IL-6)、血红蛋白(hemoglobin,Hb)、红细胞压积(hematocrit value,Hct).结果 ①治疗组治疗后与治疗前相比,血CRP[(8.47±6.96)mg/L比(13.38±5.01)mg/L,t=2.560,P＜0.02]及IL-6[(23.18±5.64)pg/ml比 (31.86±9.39)pg/ml,t=3.542,P＜0.02]降低具有统计学差异.治疗组治疗后与对照组治疗后相比,血CRP[(8.47±6.96)mg/L比(13.62±5.83)mg/L,t =2.550,P＜0.02]、IL-6[(23.18±5.64)pg/ml比(31.17±8.76)]pg/ml,t=3.429,P＜0.02]降低具有具有统计学差异.②治疗组治疗后与治疗前相比,血Hb[(95.1±11.3)g/L比(108.8±12.9)g/L,t =3.577,P＜0.02]及Hct(25.9%±4.8% 比 35.3%±3.7%,t=6.962,P＜0.02)升高,治疗组治疗后与对照组治疗后相比血Hb[(108.8±12.9)g/L 比 (97.5±10.6)g/L,t=3.029,P＜0.02]及Hct(35.3%±3.7%比26.1%±5.1%,t= 6.571,P＜0.02)升高,治疗组治疗后EPO用量较治疗前明显减少[(8127±889)IU/周比(9890±1135)IU/周,t=5.475,P＜0.02],均具有统计学差异.结论 MHD患者经左旋肉碱治疗后微炎症状态及肾性贫血均有所改善.