左卡尼汀联合腹膜透析治疗尿毒症的疗效观察

Efficacy of levocarnitine combined with peritoneal dialysis in the treatment of uremia based on TGF-β1/Smad signaling pathway

目的观察左卡尼汀+腹膜透析对尿毒症的影响,探究左卡尼汀治疗尿毒症的作用机制。方法选取2021年3月至2023年2月收治的尿毒症患者110例,随机分为对照组和观察组,每组55例。对照组给予腹膜透析治疗,观察组在对照组基础上配合左卡尼汀治疗。观察2组治疗前、治疗3个月后营养状况[白蛋白(Alb)、血红蛋白(Hb)、肱三头肌皮褶厚度(TSF)]、肾功能[血肌酐(Scr)、尿素氮(BUN)]、肾纤维化[血管紧张素II(AngII)、转化生子因子β1(TGF-β1)、结缔组织生长因子(CTGF)]、炎性指标[超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]、氧化应激[丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)]、TGF-β1/Smad信号通路[转化生长因子-β1(TGF-β1)、Mad相关蛋白3(Smad3)、Mad相关蛋白7(Smad7)]变化情况。结果观察组血清Hb、Alb水平及TSF均高于对照组(P<0.05);观察组BUN、Scr水平低于对照组(P<0.05);观察组血清AngII、TGF-β1、CTGF及hs-CRP、IL-6、TNF-α水平低于对照组(P<0.05);观察组血清MDA水平低于对照组,GSH-Px、SOD水平高于对照组(P<0.05);观察组TGF-β1、Smad3低于对照组,Smad7高于对照组(P<0.05)。结论左卡尼汀联合腹膜透析能改善尿毒症患者营养状况,减轻机体微炎症,降低氧化应激,并通过抑制TGF-β1/Smad信号通路活化而产生肾单位保护作用,以延缓肾纤维化进程。

Objective To explore the effects and the mechanism of levocarnitine and peritoneal dialysis on uremia.Methods Tally 110 patients with uremia in our hospital from March 2021 to February 2023 were selected,they were randomized 1∶1 to receive peritoneal dialysis(the control group)or levocarnitine combined with peritoneal dialysis(the observation group)for 3 months.Before treatment and after 3 months of treatment,the nutritional status(albumin[Alb],haemoglobin[Hb],triceps skinfold thickness[TSF]),renal function(blood creatinine[Scr],urea nitrogen[BUN]),renal fibrosis(angiotensin Ⅱ[AngⅡ],transforming growth factor β1[TGF-β1],connective tissue growth factor[CTGF]),inflammation(high-sensitivity C-reactive protein[hs-CRP],tumor necrosis factor α[TNF-α],interleukin 6[IL-6]),oxidative stress(malondialdehyde[MDA],glutathione peroxidase[GSH-Px],superoxide dismutase[SOD]),TGF-β1/Smad signaling pathway(transforming growth factor β1[TGF-β1],SMA-and MAD-related protein 3[Smad3],SMA-and MAD-related protein 7[Smad7])were included as comparisons in both groups.Results After treatment,the observation group had significantly elevated Hb,Alb and TSF,reduced BUN and Scr,down-regulated AngII,TGF-β1,CTGF,hs-CRP,IL-6,TNF-α and MDA,up-regulated GSH-Px and SOD,decreased TGF-β1,Smad3 and increased Smad7 compared with the control group(all P<0.05).Conclusion Levocarnitine combined with peritoneal dialysis can improve the nutritional status of uremia patients,reduce microinflammation,reduce oxidative stress,and produce nephron protection by inhibiting the activation of TGF-β1/Smad signaling pathway,then delay the progression of renal fibrosis.