维持性血液透析患者纠正贫血对逆转左心室肥大的影响

Effects of remedied amenia on left ventricular hypertrophy in maintenance hemodialysis patients

目的观察维持性血液透析(MHD)患者应用促红细胞生成素(EPO)、左旋卡尼汀纠正贫血的效果及贫血纠正对逆转左心室肥厚(LVH)的影响。方法MHD伴贫血[血红蛋白(Hb)<90g/L]患者40例,每周血透后予EPO(A组)或EPO+左旋卡尼汀(B组)治疗,为期24周,监测血压、左心室重量指数(LVWI)、红细胞压积(Hct)、网织红细胞(RCT)、血清白蛋白和肉碱浓度。结果治疗后两组LVH均明显下降(P<0.05或P<0.01),Hb均明显升高(P<0.05),且B组比A组更明显(P<0.05);白蛋白、肉碱浓度A组略有升高(P>0.05),B组明显升高(P<0.05或P<0.01),且高于A组(P<0.05或P<0.01)。结论EPO+左旋卡尼汀治疗能明显提高MHD患者Hb水平,同时可部分逆转LVH。

Objective To investigate the efficacy of recombinant human erythropoietin（EPO） in combination with L-carnitine on anemia in maintenance hemodialysis patients as well as the effect of remedied anemia on reversing the left ventricular hypertrophy （LVH）. Methods Forty patients underwent hemodialysis for at least three months prior to the study（Hb〈90 g/L） were selected and randomly divided into two groups. The patients in group A were treated with EPO, while those in group B with EPO in combination with L-carnitine. All patients received a six-month therapy, wherein the parameters for hematocrit （Hct）, reticulocyte （RCT）, systolic blood pressure, diastolic blood pressure,albumin,carnitine concentration and left ventricular mass index（LVMI were recorded and studied. Results After the six-month therapy,the Hb in both groups increased markedly with the Hb in group B much higher than that in group A（P〈0. 05 or P〈0. 01）. There was no significant increase in ALB or carnitine concentration in group A after the treatment（P〈0.05） but a noticeable drop in LVH（P〈0. 05）, which was significantly increased in both ALB and carnitine concentration（P〈0. 05 or P〈0. 01） with a noticeable drop in LVH（P〈0. 05） in group B after the treatment. The ALB and carnitine in group B after the treatment were much higher than those in group A（P〈0. 05 or P〈 0. 01） while LVH in group B was much lower than that in group A（P〈0. 05）. Conclusion The therapy of recombinant human EPO in combination with L-carnitine can markedly elevate Hb in MHD patients and LVH could be reversed partly at the same time.