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

Clinical observation of L-carnitine to micro-inflammation and renal anemia in patients on hemodialysis

目的观察外源性左旋肉碱(l-carnitine,L-CN)对维持性血液透析(maintenancehemodialysis,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(normalsaline,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。

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 1g 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 L-CN 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,P0.02] and IL-6 [（23.18±5.64）pg/ml vs.（31.86±9.39）pg/ml,t=3.542,P0.02] 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,P0.02] and IL-6 [（23.18±5.64）pg/ml vs.（31.17±8.76）]pg/ml,t=3.429,P0.02] 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=6.962P0.02] 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.