左卡尼汀联合高通量血液透析对维持性血液透析患者微炎症和营养状况的影响

Effect of L-carnitine combined with high-flux dialysis on microinflammatory and nutritional status in patients with maintenance hemodialysis

目的观察左卡尼汀联合高通量血液透析对维持性血液透析患者微炎症和营养状况的影响,以期为维持性血液透析患者的治疗提供指导。方法采用随机数字表法将2022年1—12月赣南医学院第一附属医院收治的108例维持性血液透析患者分为血透组54例(采用高通量血液透析治疗6个月)和左卡尼汀组54例(在血透组基础上联用左卡尼汀治疗6个月)。比较2组治疗前后微炎症指标(白介素-6、肿瘤坏死因子-α、超敏C反应蛋白)、血红蛋白、白蛋白、β2微球蛋白、总胆固醇与内瘘厚度、直径、血流量及生活质量评分。结果治疗6个月后,2组上述微炎症指标低于治疗前,且左卡尼汀组低于血透组(P<0.01);2组血红蛋白、白蛋白水平高于治疗前,β2微球蛋白、总胆固醇水平低于治疗前,且左卡尼汀组升高/降低幅度大于血透组(P<0.05或P<0.01);2组内瘘厚度大于治疗前,内瘘直径小于治疗前,内瘘血流量少于治疗前,但左卡尼汀组内瘘厚度小于血透组,内瘘直径大于血透组,内瘘血流量多于血透组(P<0.05或P<0.01);2组生活质量评分高于治疗前,且左卡尼汀组高于血透组(P<0.01)。结论左卡尼汀联合高通量血液透析治疗维持性血液透析可显著改善患者的微炎症状态,有利于改善贫血、营养状况和血脂,从而有效提升患者的生活质量。

Objective To investigate the effect of L-carnitine combined with high-flux dialysis on microinflammatory and nutritional status in patients with maintenance hemodialysis.Methods From January to December 2022,108 patients with maintenance hemodialysis in the First Affiliated Hospital of Gannan Medical University were selected,and they were divided into the hemodialysis group(n=54)and the L-carnitine group(n=54).Patients in the hemodialysis group were treated with high-flux dialysis,and patients in the L-carnitine group were treated with L-carnitine and high-flux dialysis,both groups were treated for 6 months.Microinflammatory indexes(IL-6,TNF-α,hs-CRP),Hb,Alb,β2-MG,TC,thickness,diameter and blood flow of internal fistula,and score of quality of life before and after treatment were compared between the two groups.Results After 6 months of treatment,levels of microinflammatory indexes of the two groups were lower than pre-treatment,and the levels in the L-carnitine group were lower than those in the hemodialysis group(P<0.01);Levels of Hb,Alb in the two groups were higher than pre-treatment,levels ofβ2-MG,TC were lower than pre-treatment,and the increase/decrease in the L-carnitine group were greater than those in the hemodialysis group(P<0.05 or P<0.01);Thickness of internal fistula was increased in the two groups,diameter and blood flow of internal fistula were less than pre-treatment,and the thickness of internal fistula in the L-carnitine group was less than that in the hemodialysis group,internal diameter of internal fistula was larger than that in the hemodialysis group,blood flow of internal fistula was more than that in the hemodialysis group(P<0.05 or P<0.01);Score of quality of life of the two groups was higher than pre-treatment,and the L-carnitine group was higher than that in the hemodialysis group(P<0.01).Conclusion L-carnitine combined with high-flux dialysis can significantly improve the micro-inflammatory state of patients with maintenance hemodialysis,which is conducive to the improvement of anemia,nutritional status and blood lipid,thus effectively improve the quality of life of patients.