左卡尼汀联合超纯透析对维持性血液透析患者血清炎性因子、心功能、血管内皮功能的影响

Effect of Levocarnitine Combined with Ultrapure Dialysis on Inflammatory Factor, Cardiac Function and Vascular Endothelial Function in MHD Patients

目的:探讨左卡尼汀联合超纯透析对维持性血液透析(maintenance hemodialysis, MHD)患者血清炎性因子、心功能、血管内皮功能的影响。方法:选取2016年7月-2018年5月我院收治的98例MHD,按照随机数字表法分为观察组( n =51)与对照组( n =47)。两组均予常规处理,在此基础上,对照组予以常规血液透析治疗,观察组予以左卡尼汀联合超纯透析治疗,均治疗3个月。观察两组血清炎性因子[肿瘤坏死因子-α(tumor necrosis factor, TNF-α)、C-反应蛋白(C-reactive protein, CRP)及白细胞介素-6(interleukin 6, IL-6)]、心功能相关指标[室间隔舒张末期厚度(left ventricular septum thickness, LVST)、左室射血分数(left ventricular ejection fractions, LVEF)、左室舒张末期内径(left ventricular end diastolic diameter, LEVDD)]、血管内皮功能相关指标[内皮素-1(endothelin-1, ET-1)和一氧化氮(nitric oxide, NO)]变化,记录不良反应发生情况。结果:与对照组比较,观察组治疗后血清IL-6、TNF-α、CRP、ET-1、NO水平及LVST、LEVDD均降低,LVEF升高,差异有统计学意义( P <0.05);与本组治疗前比较,两组治疗后血清IL-6、TNF-α、CRP、ET-1、NO水平明显下降,且观察组治疗后LVEF明显升高,LVST、LEVDD显著降低,差异有统计学意义( P <0.05)。观察组、对照组不良反应发生率分别为17.65%(9/51)、31.91%(15/47),比较差异有统计学意义(χ 2=5.609、 P =0.033),且症状均较轻微,未予治疗自行缓解。结论:左卡尼汀联合超纯透析可显著改善MHD患者的血清炎性反应及血管内皮细胞功能,有效保护心功能,且安全性高。

Objective To investigate the effects of Levocarnitine combined with ultrapure dialysis on serum inflammatory factors, cardiac function and vascular endothelial function in patients undergoing maintenance hemodialysis (MHD). Methods A total of 98 patients undergoing MHD who were treated in our hospital from July 2016 to May 2018 were selected as the research subjects. According to random number table methods, they were divided into the observation group ( n =51) and the control group ( n =47). Both groups were given conventional treatment. In addition, the control group was given conventional dialysis, and the observation group was given Levocarnitine combined with ultrapure dialysis treatment. After 3 months of treatment, the serum inflammatory factors [Tumor necrosis factor-α(TNF-α), C-reactive protein (CRP) and interleukin 6 (IL-6)], cardiac function indicators [end-diastolic interventricular septum thickness (LVST), left ventricular ejection fraction (LVEF), and left ventricular end diastolic diameter (LEVDD)], vascular endothelial function indexes [endothelin-1(ET-1) and nitric oxide (NO)] were observed in two groups. And adverse reactions were recorded. Results Compared with the control group, the serum levels of IL-6, TNF-α, CRP, ET-1, NO, LVST and LEVDD in the observation group were significantly decreased and LVEF was increased significantly after treatment ( P <0.05). Compared with those before treatment, the serum levels of IL-6, TNF-α, CRP, ET-1 and NO in the two groups were decreased significantly after treatment. The LVEF in the observation group was increased significantly, while the levels of LVST and LEVDD were decreased significantly after treatment, showing significant significance ( P <0.05). The incidence of adverse reactions in the observation group and the control group were 17.65%(9/51) and 31.91%(15/47), respectively, and the difference was statistically significant (χ 2=5.609, P =0.033). The symptoms were mild and relieved without treatment. Conclusion Levocarnitine combined with ultrapure dialysis can significantly improve the serum inflammatory response and vascular endothelial cell function in patients undergoing MHD, which can protect the cardiac function of patients, with good safety.