左旋卡尼汀对维持性血液透析患者充血性心力衰竭的作用

Effect of L-carnitine on congestive heart failure in patients on maintenance hemodialysis

目的:观察左旋卡尼汀对维持性血液透析合并充血性心力衰竭患者心功能的改善情况.方法:对长期正规血液透析、年龄(63.4±7.5)岁,心功能Ⅲ-Ⅳ级患者30例,分为治疗组和对照组.治疗组应用左旋卡尼汀注射液1.0g/d(5mL),于每次血透后加入500g/L葡萄糖40mL中静脉输注,3mo为1疗程.对照组采用洋地黄制剂、利尿剂、扩血管剂等常规治疗.观察1mo和3mo后患者对透析的耐受性和血浆肉毒碱浓度、左室射血分数(LVEF),左室短轴缩短率(LVFS)及心脏指数(CO)的改变,同时作血常规、生化检查.结果:应用左旋卡尼汀3mo后患者对透析的耐受性明显增强,血浆肉毒碱浓度从(30.4±8.0)μmol/L提高至(126.3±17.4)μmol/L;与治疗前比较患者心率(HR),收缩压(SBP),舒张压(DBP),LVEF分别有改善,其中LVEF较对照组有统计学差异(P<0.05);红细胞和血红蛋白及血浆白蛋白升高(P<0.05).结论:左旋卡尼汀可作为维持性血液透析患者纠正心功能的有效辅助治疗之一.

AIM： To observe the clinical effect of L-carnitine（L- CN） on the improvement of cardiac function of patients with congestive heart failure on maintenance hemodialysis （MHD）. METHODS： Thirty patients aged （ 63.4 ± 7.5 ） years and with heart function Ⅲ -Ⅳ level , who were undergoing MHD, were ran- domly assigned into control group treated with routine therapy （digitalis, diuretics, vasodilator, ACEI or blocker） and to experimental group with intravenous infusion of 1.0 g/d L-CN injection and 500 g/L glucose （40 mL） after each hemodialysis, 3 months as a course. The tolerance to hemodialysis, carnitine level in plasma, left ventricular ejection fraction （LVEF） , left ventricular fractional shortening （ LVFS ） and cardiac output （ CO ） were observed, and meanwhile blood routine and biochemical examinations were performed in all patients. RESULTS： After 3-month treatment,the carnitine level in plasma was increased from （30.4 ±8.0） μmol/L to （126. 3 ± 17.4） μmol/L. Compared with those before treatment, heart rate , systolic blood pressure （ SBP）, diastolic blood pressure （DBP）, LVEF were improved （P 〈 0.05） and the levels of erythrocytes, hemoglobin and albumin were promoted （ P 〈 0.05 ）. CONCLUSION ： L-CN might be one of effective assistant strategies to correct cardiac dysfunction for the patients with congestive heart failure on MHD.