左卡尼汀在维持性血液透析和维持性腹膜透析患者中药代动力学特点

摘要

目的:研究外源性应用左卡尼汀注射液在维持性血液透析和维持性腹膜透析中的药代动力学特点.方法:共纳入120例持续透析患者,其中60例采用维持性血液透析,60例采用维持性腹膜透析,每次透析结束前3min静脉注射1 g左卡尼汀注射液,每周3次,持续8 ～10周.研究分两步进行,第一步检测给药前(T0)、给药后3min、10min、30min、1h、3h、10h、24h肉碱的血药浓度,第二步检测首次给药(给药0周)、给药1周、3周、6周和9周透析前后血浆和透析液中肉碱浓度.结果:单次注射左卡尼汀1g后两组肉碱血药动力学变化均符合二室开放模型.与血液透析组比,腹膜透析组的α、β较小(P＜0.05),V、Tt/2α和AUC较大(P＜0.05),其余指标无显著性差异(P＞0.05),两组0周透析前后及组间左卡尼汀浓度无显著差异(P＞0.05),1～9周,两组透析后血浆浓度高于透析前,腹膜透析组左卡尼汀浓度高于血液透析组(P＜0.05),在6～9周趋于稳定.结论:维持性血液透析和维持性腹膜透析的肉碱血药浓度符合二室开放模型.外源性应用左卡尼汀注射液可改善透析导致的肉碱缺乏,与血液透析比,腹膜透析滤过肉碱较少,浓度较高,在临床中可酌情减量和缩短疗程.%Objective:To study the pharmacokinetics characteristics of levocamitine in maintenance hemodialysis and maintenance peritoneal dialysis.Methods:A total of 120 consecutive dialysis patients were enrolled.60 cases received maintenance hemodialysis and 60 cases adopted maintenance peritoneal dialysis.1 g levocarnitine were given all patients after dialysis for 9 weeks.The carnitine concentrations in blood were detected before and after dialysis per time.In the first time,The camitine concentrations in blood were detected before and 3min、10min,30min,lh,3h,10h and 24h after dialysis.Results:The pharmacokinetics was consistent with the 2 compartment open model by the levocarnitine lg single injection.Compared with the hemodialysis group,α and [β had decreased(P ＜0.05),V,T1/2cα and AUC had increased (P ＜ 0.05) in the peritoneal dialysis group.There had no significant differences in two groups (P ＞0.05).Compared with the hemodialysis group,the concentrations of carnitine in the peritoneal dialysis group had increased (P ＞0.05).Conclusion:The phannacokinetics of levocarnitine is consistent with 2 compartment open model.Levocarnitine can improve carnitine in hemodialysis and peritoneal dialysis group.Compared with the hemodialysis group,the concentrations of earnitine had increased in the peritoneal dialysis group.