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目的:通过观察静脉注射左旋卡尼丁对维持性血液透析(maintenancehemodialysis,MHD)患者相关营养和炎症指标的影响,探讨左旋卡尼丁对MHD患者微炎症的治疗作用。方法:选择透析龄超过6个月的MHD患者62例,随机分为治疗组和对照组,已排除急性感染及其他活动性疾病,每次透析结束后,治疗组给予静脉注射左旋卡尼丁1g,进行为期3个月随访,分别检测治疗前、治疗1月后、治疗3月末患者的主要人体学指标、改良SGA评分、血生化指标、C反应蛋白(CRP)、透析充分性(Kt/V)和蛋白分解代谢率(PCR)。结果:(1)治疗组1月后,MHD患者的干体重、上臂肌围(MAMC)就有上升;治疗组3个月后,患者平均干体重、MAMC平均值较治疗前显著升高(均P<0.05)。改良SGA评分较治疗前明显下降(P<0.01);对照组以上各项均无变化,治疗组与对照组比较有统计学差异(均P<0.05)。(2)治疗组3个月后,MHD患者的血白蛋白(Alb)(P<0.05)、前白蛋白(PA)和血红蛋白(Hb)(均P<0.01)较治疗前明显升高;对照组以上各项均无变化,治疗组与对照组比较有统计学差异(均P<0.05)。(3)治疗组CRP平均值较治疗前明显下降、与对照组相比差异十分显著(P<0.01)。(4)两组血总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和脂蛋白(a)[Lp(a)]水平治疗前后无统计学差异(P>0.05)。(5)治疗组PCR值较治疗前明显上升,与对照组相比有统计学差异(均P<0.01);两组Kt/V治疗前后无明显变化(P>0.05)。结论:左旋卡尼丁可明显改善患者的营养状态,同时降低血CRP浓度及微炎症状态,这种作用可能通过调整由前炎症因子和氧化应激造成的特异性胞内信号传导级联的激活,从而提高细胞对慢性炎症和氧化应激的防御功能。
OBJECTIVE: To investigate the effect of levocarnidine on microinflammation in patients with MHD by observing the effects of intravenous injection of levodinid on the nutrition and inflammation indexes in patients with maintenance hemodialysis (MHD). Methods: Sixty-two patients with MHD who were over 6 months of dialysis were randomly divided into treatment group and control group, and acute infection and other active diseases were excluded. After each dialysis, the treatment group was given intravenous injection of 1 g , Followed by 3 months of follow-up. The main anthropometric indexes, modified SGA scores, blood biochemical parameters, C-reactive protein (CRP), dialysis adequacy (Kt / V ) And protein catabolism rate (PCR). Results: (1) After 1 month of treatment, the body weight and MAMC increased in MHD patients. After 3 months of treatment, the average body weight and MAMC of patients in treatment group were significantly higher than those before treatment (both P <0.05). The improved SGA score was significantly lower than that before treatment (P <0.01). There was no significant difference between the control group and the control group (all P <0.05). (2) The serum levels of Alb (P <0.05), prealbumin (PA) and hemoglobin (Hb) of MHD patients (all P <0.01) There was no change in all the above groups, there was a significant difference between the treatment group and the control group (all P <0.05). (3) The CRP in the treatment group was significantly lower than that before treatment, and the difference was significant compared with the control group (P <0.01). (4) The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and lipoprotein (a) [Lp )] There was no significant difference between before and after treatment (P> 0.05). (5) Compared with the control group, the PCR value of the treatment group was significantly increased (all P <0.01). There was no significant difference between the two groups before and after Kt / V treatment (P> 0.05). Conclusion: L-carnitine can significantly improve the patient’s nutritional status, while reducing blood CRP concentration and micro-inflammatory state, this effect may be by adjusting the pro-inflammatory factors and oxidative stress caused by the activation of specific intracellular signaling cascade , Thereby increasing the cell’s defense against chronic inflammation and oxidative stress.