左卡尼汀和曲美他嗪联合治疗对维持性血液透析患者左心室重塑的影响  

Effects of levocarnitine combined with trimetazidine on left ventricular remodeling in maintenance hemodialysis patients

作　　者：邬碧波[1] 张黎明[1] 梅长林[2] 唐琦[1] 芦怡舟[1] 

机构地区：[1]上海市闸北区中心医院肾内科,200070 [2]第二军医大学长征医院肾内科解放军肾脏病研究所,200003

出　　处：《中国医师进修杂志》2010年第16期8-12,共5页Chinese Journal of Postgraduates of Medicine

基　　金：上海市卫生局科技发展基金（2009255,2007Y71）;上海市闸北区卫生局科研基金（2009ZB-MXX02）;上海市闸北区中心医院＂789攀登计划＂基金

摘　　要：目的 通过对维持性血液透析（MHD）合并心血管疾病患者采用左卡尼汀和曲美他嗪联合治疗,评估其对MHD患者左心室重塑的影响.方法 选择透析龄≥3个月的MHD患者86例,已排除急性感染及其他活动性疾病,按照接受血液透析治疗的时间分为两组：患者治疗组（46例）,每次透析结束后,静脉注射左卡尼汀1.0 g,3次/周,同时口服曲美他嗪20 mg,3次/d,疗程6个月;患者对照组（40例）,不用左卡尼汀和曲美他嗪.分别检测治疗前后患者的血清游离脂肪酸（FFA）、游离肉碱（FC）和超声心动图以及血清高敏C反应蛋白（hs-CRP）、白细胞介素（IL）.1β、IL-β、肿瘤坏死因子（TNF）-α、谷胱甘肽过氧化物酶（GSHPx）、超氧化物歧化酶（SOD）、丙二醛（MDA）等.另选择健康对照组40例.结果 治疗前,患者治疗组和患者对照组血清FFA、hs-CRP、IL-1β、IL-6、TNF-αβ、MDA水平均显著高于健康对照组（P〈0.05或〈0.01）,FC、GSHPx、SOD水平均显著低于健康对照组（P〈0.05或〈0.01）;治疗6个月后与治疗前比较,患者治疗组FFA、hs-CRP、IL-1β、IL-6、TNF-α、MDA水平均显著下降（P〈0.05或〈0.01）,FC、GSHPx、SOD水平均显著升高（P〈0.05或〈0.01）;治疗6个月后与治疗前比较,患者治疗组的左房内径、左室舒张末内径、室间隔厚度、左室后壁厚度、左室心肌质量指数均显著下降（P〈0.05）,左室射血分数显著升高（P〈0.05）;患者对照组以上各项指标治疗前后均无明显变化,治疗6个月后患者治疗组与患者对照组以上各项指标比较差异均有统计学意义（P〈0.05或〈0.01）.结论 联合应用左卡尼汀和曲美他嗪可明显纠正MHD患者的高FFA血症和肉碱缺乏症以及微炎性反应和氧化应激状态,从而改善患者的左心室重塑.Objective To investigate the effects of levocarnitine combined with urimetazidine on left ventricular remodeling in maintenance hemodialysis（MHD）patients.Methods All of 86 MHD patients and 40 healthy volunteers（health control group）were involved in the study.all of 86 MHD patients were randomly divided into two groups,disease treatment group（46 cases）and disease control group（40 cases）,who had undergone hemodialysis for at least 3 months before the study and were in a stable clinical status without signs of infection or disease activity.In disease treatment group,1.0 g of levocarnitine was infused at the end of each dialysis treatment and 20 mg of trimetazidine was taken orally 3 times each day for 6 months,while the parameters for free fatty acid（FFA）,free carnitine（FC）,inflammation and oxidative stress were studied before and after the treatmenL In disease control group these two drugs were not used.The left ventricular end-diastolic diameter（LVDd）,left ventricuhr end-systolic diameter（LVDs）,left atrial diameter （LAD）,left ventricular posterior wall thickness（LVPWT）,interventricular septal thickness（IVST）and left ventricular ejection fraction（LVEF）were detected by ultrasonic cardiography.Results Before treatment,the serum levels of FFA,high-sensitivity C-reactive protein（hs-CRP）,intedeukin（IL）-1β,IL-6,tumor necrosis factor（TNF）-αand malondialdehyde（MDA）were higher in disease treatment group and disease control group than those in health control group（P〈0.05 or〈0.01）,while the serum levels of FC,glutathione peroxidase（GSHPx）and superoxide dismutase（SOD）were lower in disease treatment group and disease control group than those in health control group（P〈0.05 or〈0.01）.Compared with those before treatment,the serum levels of FFA,hs-CRP,IL-1β,IL-6,TNF-α,MDA were decreased（P〈0.05 or〈0.01）,FC,GSHPx,SOD were increased（P〈0.05 or〈0101）,the scores of LVDd,LAD,IVST,LVPWT,LVMI were also decreased significantly（P〈0.

关 键 词：曲美他嗪 心室重构 血液透析 卡尼汀 

分 类 号：R54[医药卫生—心血管疾病] R692[医药卫生—内科学] R45[医药卫生—临床医学]