左卡尼汀联合血液透析对尿毒症患者Treg/Th17细胞、血清炎症因子和肾功能指标的影响

Effects of L-carnitine combined with hemodialysis on Treg/Th17 cells,serum inflammatory factors and renal function indexes in uremia patients

目的探究左卡尼汀联合尿毒症血液透析对尿毒症患者调节性T细胞(Treg)/辅助性T细胞17(Th17)细胞、血清炎症因子及肾功能指标的影响。方法将2016年6月至2018年7月河南省南阳市中心医院收治的80例尿毒症患者随机分为观察组和对照组,各40例。对照组给予普通血液透析治疗,观察组给予左卡尼汀联合血液透析治疗,比较2组治疗前后Treg/Th17细胞水平、营养指标、炎症因子[白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CPR)]、肾功能指标[肌酐(SCr)、血尿素氮(BUN)、24 h尿蛋白定量]变化,并统计并发症发生情况。结果治疗后观察组Treg细胞、Th17细胞、Treg/Th17细胞水平显著低于对照组,差异有统计学意义(P<0.05);治疗后观察组营养指标改善情况显著优于对照组,差异有统计学意义(P<0.05);治疗后观察组IL-6、IL-17、TNF-α、hs-CPR、SCr、BUN、24 h尿蛋白定量水平显著低于对照组,差异有统计学意义(P<0.05);且观察组并发症发生率12.50%(5/40)显著低于对照组32.50%(13/40),差异有统计学意义(P<0.05)。结论外源性补充左卡尼汀可帮助血液透析尿毒症患者维持较好的营养状态,改善机体微环境、免疫功能及炎症反应,减轻肾功能损伤,且安全性良好。

Objective To investigate the effects of L-carnitine combined with hemodialysis on regulatory T cell/helper T cell 17(Th17)cells,serum inflammatory factors and renal function indicators in uremia patients. Methods 80 uremia patients admitted to Nanyang Central Hospital,Henan,Province from June 2016 to July 2018 were randomly divided into observation group and control group,40 cases each. The control group was given normal hemodialysis treatment,while the observation group was treated with hemodialysis and L-carnitine. The Treg/Th17 cell levels, nutritional indicators, inflammatory factors[interleukin-6(IL-6),Interleukin-17(IL-17),tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CPR)],and renal function indicators[serum creatinine(SCr),blood urea nitrogen(BUN),24 h urine protein quantitation] changes in the 2 groups before and after treatment were compared,and the incidence of complications was statistically analyzed. Results After treatment,the levels of Treg cells,Th17 cells and Treg/Th17 cells in the observation group were significantly lower than those in the control group(P<0.05). The improvement of nutritional indicators in the observation group was significantly better than that in the control group(P<0.05). The levels of IL-6,IL-7,TNF-α,hs-CPR,SCr,BUN and 24 h urine protein in the observation group were significantly lower than those in the control group(P<0.05). The incidence of complications in the observation group was 12.50%(5/40),which was significantly lower than that in the control group[32.50%(13/40)](P<0.05). Conclusion Exogenous supplementation of L-carnitine can help uremia patients undergoing hemodialysis maintain good nutritional status,improve the microenvironment,immune function and inflammatory response,reduce renal damage,and have good safety.