左卡尼汀对高通量维持性血液透析患者微炎症状态和生存质量的影响

Effects of Levocarnitine on Micro-inflammatory Status and Quality of Life in Patients with High-flux Maintenance Hemodialysis

目的分析左卡尼汀联合高通量血液透析(HFHD)对维持性血液透析(MHD)患者微炎症状态和生存质量的影响。方法选取2015年1月—2017年1月收治的304例MHD,按治疗方式分为研究组和对照组,每组152例。对照组给予HFHD治疗,研究组在对照组基础上给予左卡尼汀静脉注射。观察2组治疗前后微炎症指标、营养状况指标的变化情况,同时采用SF-36健康调查量表进行患者生存质量评估,并记录治疗后不良反应发生情况。结果治疗后,研究组血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平均低于对照组,血清血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PAB)水平高于对照组(P<0.05)。治疗后,研究组SF-36量表各维度评分高于对照组(P<0.05)。研究组不良反应发生率低于对照组(P<0.05)。结论左卡尼汀联合HFHD治疗不仅可以提高MHD患者血清Hb、Alb、PAB水平,纠正患者营养不良状况,提高患者对透析的耐受性,而且可以有效降低患者体内炎性因子水平,改善患者微炎症状态,安全性较好。

Objective To investigate effects of Levocarnitine combined with high-flux hemodialysis （HFHD） on micro-inflammatory status and quality of life in patients with maintenance hemodialysis （MHD）. Methods A total of 304 MHD patients admitted during January 2015 and January 2017 were divided into study group and control group （ u = 152 for each group） according to different treatment methods. Control group was treated with HFHD, while study group was intravenously injected with Levocarnitine on the basis of treatment for control group. In two groups, changes of microinflammatory and nutritional status indexes before and after treatment were observed, and quality of life was assessed sirrauhaneously by SF-36 health survey scale, and then incidence rates of adverse reactions were recorded. Results After treatment, in study group, levels of serum high sensitivity C-reactive protein （hs-CRP）, tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） were significantly lower （ P 〈 0.05 ）, while levels of hemoglobin （ Hb）, albumin （Alb） and prealbumin （PAB） were significantly higher than those in control group （P 〈 0.05 ）. After treatment, all scores by SF- 36 health survey scale in study group were significantly higher than those in control group （P 〈 0.05 ）. Incidence rate of complications in study group was significantly lower than that in control group （P 〈 0.05 ）. Conclusion Levocarnitine combined with HFHD may not only improve levels of serum Hb, Alb and PAB in patients with MHD, correct malnutrition and improve patients＇tolerance to dialysis, but also can effectively reduce level of inflammatory cytokines and improve micro-inflammatory status with good safety.