左卡尼汀对维持性血液透析患者血浆可溶性肿瘤坏死因子样凋亡弱诱导因子蛋白的影响

Effect of L-carnitine on plasma soluble tumor necrosis factor-like weak inducer of apoptosis protein in the patients with maintenance hemodialysis

目的 观察左卡尼汀对维持性血液透析（MHD）患者血浆可溶性肿瘤坏死因子样凋亡弱诱导因子（sTWEAK）蛋白的影响.方法 选择46例MHD患者作为MHD组,另选择同期健康体检者40例作为对照组.采用酶联免疫吸附法（ELISA）检测血浆sTWEAK、高敏C反应蛋白（hs-CRP）、白细胞介素（IL）-6及血浆胰岛素样生长因子（IGF）-1水平.26例血浆sTWEAK蛋白水平高于对照组平均值的MHD患者作为治疗组,20例低于或等于对照组平均值的MHD患者作为未治疗组.治疗组给予左卡尼汀1.0 g加入0.9％氯化钠溶液20 ml每周1次血液透析后静脉推注,治疗3个月后观察sTWEAK、IGF-1、握力及蛋白能量消耗（PEW）等变化.结果 MHD组血浆sTWEAK蛋白、IL-6、hs-CRP均高于对照组[（464±102） ng/L比（346±159） ng/L、（986.54±123.12） ng/L比（407.12±180.25） ng/L、（18.8±2.9） mg/L比（1.0±1.2） mg/L],差异有统计学意义（P＜0.01）.与未治疗组比较,治疗组治疗3个月后血浆sTWEAK蛋白、IL-6、hs-CRP明显下降[（126±92） ng/L比（243±103） ng/L、（799.45±105.34） ng/L比（966.04±113.11）ng/L、（13.7±1.9） mg/L比（26.8±2.8）mg/L],IGF-1明显升高,握力增加,PEW改善,差异均有统计学意义（P＜0.01或＜0.05）.治疗组体质量指数虽较未治疗组增加,但比较差异无统计学意义（P＞0.05）.结论 左卡尼汀可降低MHD患者血浆sTWEAK蛋白水平,减轻炎性反应状态,提高IGF-1水平,增加握力,改善PEW.

Objective To observe the effect of L-carnitine on plasma soluble tumor necrosis factor-like weak inducer of apoptosis （sTWEAK） protein in maintenance hemodialysis （MHD） patients.Methods Forty-six cases of MHD patients were enrolled as MHD group,and 40 cases of the same period healthy subjects were enrolled as control group.The levels of plasma sTWEAK protein,high-sensitivity C-reactive protein （hs-CRP）,interleukin （IL）-6 and insulin-like growth factor （IGF）-1 were measured by enzyme-linked immunosorbent assay （ELISA）.Twenty-six MHD patients with the levels of sTWEAK protein higher than control group mean value as treatment group,were treated for L-carnitine 1.0 g in 0.9% sodium chloride solution 20 ml after hemodialysis by intravenous injection one time per week.Twenty MHD patients with the levels of sTWEAK protein lower than or equal to control group mean value as non-treatment group.The changes of sTWEAK protein,IGF-1,grip strength and protein energy waisting （PEW） were observed after 3 months treatment.Results The levels of plasma sTWEAK protein,IL-6 and hs-CRP in MHD group were higher than those in control group [（464 ± 102） ng/L vs.（346 ± 159） ng/L,（986.54 ± 123.12） ng/L vs.（407.12 ± 180.25） ng/L,（18.8 ± 2.9） mg/L vs.（1.0 ± 1.2） mg/L],there were significant differences （P〈 0.05）.Compared with non-treatment group,the levels of plasma sTWEAK protein,IL-6 and hs-CRP in treatment group after treatment of 3 months were decreased [（126 ± 92） ng/L vs.（243 ± 103） ng/L,（799.45 ± 105.34） ng/L vs.（966.04 ± 113.11） ng/L,（13.7 ± 1.9） mg/L vs.（26.8 ± 2.8） mg/L],IGF-1 was increased,grip strength was increased,PEW was improved,there were significant differences （P 〈 0.01 or 〈 0.05）.The body mass index in treatment group was more than that in non-treatment group,but there was no significant difference （P 〉 0.05）.Conclusions L-carnitine can reduce the levels of plasma sTWEAK protein in MHD patients,reduce inflammatory reaction,improve the levels of IGF-1,increase strength,improve the PEW.