左卡尼汀对维持性血液透析患者炎症状态的影响

Effect of levocarnitine on inflammatory state in patients with maintenance hemodialysis

目的研究静脉注射左卡尼汀对维持性血液透析(MHD)患者炎症及营养状态的干预作用。方法55例MHD 0.5年以上患者随机分为对照组(A组),左卡尼汀小剂量治疗组(B组)及大剂量治疗组(C组)。治疗组除给予和对照组相同的透析治疗外,在每次透析结束时B组静脉注射左卡尼汀1.0 g,C组则给予2.0 g静脉注射,随访3个月。分别检测各组治疗前、治疗1、3个月末患者的血生化指标,采用酶联免疫吸附法(ELISA)测定C反应蛋白(CRP)、白细胞介素6(IL-6)水平,比色法测定一氧化氮(NO)表达。结果A组1、3个月末时CRPI、L-6较透析前增加,(8.93±0.23)g/L,(9.44±0.27)g/L vs(8.67±0.38)g/L;(87.97±0.82)μg/L,(90.59±0.70)μg/L vs(86.75±1.52)μg/L(P<0.05),血红蛋白(Hb)、血白蛋白(ALB)、NO略有下降(P<0.05)。B组在1个月时CRPI、L-6较治疗前有所下降,3个月末则有明显下降,(6.60±0.11)g/L vs(8.82±0.21)g/L;(76.82±1.74)μg/Lvs(87.01±1.81)μg/L(P<0.01),在第3个月时,患者的Hb,ALB及NO水平较治疗前显著升高,(94.74±1.64)g/L vs(86.96±4.16)g/L;(40.25±0.89)g/L vs(37.66±0.46)g/L;(64.24±1.72)μmol/L vs(55.95±0.98)μmol/L(P<0.05),C组效果优于B组(P<0.05)。结论左卡尼汀可明显改善MHD患者的营养状态,抑制CRP、IL-6的产生,使NO水平升高,减轻MHD患者慢性炎症,改善内皮细胞功能,对血管粥样硬化病变可能有延缓作用。

Objective To investigate the effects of levocarnitine on inflammation and nutritional status in maintenance hemodialysis（MHD） patients. Methods Fifty-five patients with MHD more than half a year were randomized to control group （group A）, treatment group with low-dose levocarnitine （group B）, and high-dose levocarnitine（group C）. 1.0 and 2.0 g intravenous levocarnitine were administered to group B and C at the end of dialysis respectively besides the dialysis treatment which was also given to control group. The patients were followed up for three months. The blood biochemical indicators of each group were measured respectively before treatment, at the end of 1st and 3rd month. At the same time,C-reactive protein（CRP） and interleukin-6 （IL-6） were measured with enzyme-linked immunosorbent assay（ELISA） meathod,and nitricoxide（NO） expression with colorimetry. Results CRP and IL-6 of group A increased at the end of the 1st and 3rd month,compared with those of pre-dialysis, （8.93±0.23） g/L,（9. 44±0.27） g/L vs （8. 67±0.38） g/L;（87. 97±0.82） μg/L,（90.59±0.70）μg/L vs （86.75±1.52）μg/L（ P〈0.05）. However,hemoglobin,albumin and NO did not decrease significantly （ P〉0.05）. CRP and IL-6 declined a little at the end of the 1st month in group B,and obviously at the end of the 3rd month, （6. 60±0.11） g/L vs （8.82±0. 21） g/L; （76. 82±1.74） μg/L vs （87. 01±1.81）μg/L（ P〈0.01）. In the 3rd month, Hb,ALB and NO level rose significantly,（94. 74±1.64） g/L vs （86. 96±4.16） g/L; （40. 25±0.89） g/L vs （37.66±0.46） g/L; （64.24±1.72）μmol/L vs （55. 95±0.98）μmol/L（ P〈0.05）. The effect of group C was better than that of group B（ P 〈0.05）. Conclusion Levocarnitine can evidently improve nutritional state of MHD patients and inhibit the emergence of CRP, IL-6. The drug also can enhance NO level, relieve chronic infection and improve the effect of endothelial cell, may have effect to postpone atheroselerosis.