左卡尼汀对血液透析患者促红细胞生成素所需剂量及微炎症状态的影响

Effect of levocarnitine on rhEPO dose and microinflammatory state in maintenance hemodialysis patients

目的探讨左卡尼汀对维持性血液透析(MHD)患者使用重组人促红细胞生成素(rhEPO)的剂量及微炎症状态的影响。方法将入选的326例MHD患者随机分为治疗组和对照组(每组163例),两组患者年龄、性别比、病程、常规治疗剂量等差异均无统计学意义,具有可比性。以维持患者血红蛋白(HB)水平在110～120 g/L、红细胞压积(HCT)水平在33%～35%为靶目标,对照组予以单纯rhEPO治疗,治疗组在予以rhEPO治疗基础上加予左卡尼汀治疗。8个月后,分别计算两组患者每周rhEPO的用量及促红细胞生成素反应指数(ERI),比较两组患者维持HB和HCT在靶目标水平所需每周rhEPO的用量及两组ERI的差异,同期监测血清超敏C反应蛋白(hs-CRP)等指标水平,观察患者微炎症状态的变化。结果治疗组维持HB和HCT在靶目标水平所需每周rhEPO的平均用量低于对照组[(106±20)IU/kg vs(141±23)IU/kg],治疗组ERI低于对照组[(0.93±0.11)IU.L.kg-1.g-1vs(1.35±0.29)IU.L.kg-1.g-1],差异均有统计学意义(P<0.05)。治疗组患者治疗后hs-CRP水平较治疗前下降[(5.21±3.20)mg/L vs(10.33±2.54)mg/L,P<0.05],且低于对照组治疗后水平(9.93±2.12)mg/L,P<0.05];对照组患者hs-CRP水平在治疗前、后差异无统计学意义。结论左卡尼汀可以减少MHD患者维持HB和HCT在靶目标水平所需rhEPO的用量,其机制可能与改善MHD患者微炎症状态、降低患者促红素抵抗性有关。

Objective To study the effects of levocarnitine on recombinant human erythropoietin （rhEPO）dose and microinflammatory state in maintenance hemodialysis patients. Methods Totally 326 maintenance hemodialysis patients were randomly divided into 2 groups： the treatment group （n： 163） and the control group （n： 163）. The age, gender, course of disease, and conventional treatments were similar in the 2 groups. To maintain the hemoglobin （HB） within 110-120 g/L and hematocrit （HCT） at 33 %-35 %, the treatment group was given levocarnitine and rhEPO, and the control group was given rhEPO only. The weekly dose of rhEPO （IU/kg） and the erythropoietin response index （ERI） were calculated and compared between the two groups 8 months later. Meanwhile, the serum high sensitivity （2reactive protein （hs-CRP） was monitored in the 2 groups before and after 8 months. Results The weekly dose of rhEPO required for the treatment group was significantly lower than that required for the control group （[106q-20] IU/kg vs [14±23] IU/kg, P〈0.05）; the treatment group also had significantly lower ERI compared with the control group （[0.93±0.11] IU L kg-1 g vs [1.35±0.29] IU L kg 1 , g i, P〈0.05）. Serum hs-CRP level in the treatment group was significantly decreased 8 months after treatment （[5.21±3.20] mg/L vs [10.33±2.54] mg/L,P〈0.05）, and it was also significantly lower than that in the control group after the treatment （[5.21±3.20] mg/L vs [9.93±2.12] mg/L,P〈0.05）. Serum hs-CRP levels were not changed significantly in the control group before and after the treatment. Conclusion Levocarnitine can reduce the dose of rhEPO in MHD patients, which might be associated with improvements of the microinflammation and erythropoietin resistance in MHD patients.