维持性血透患者应用左卡尼汀治疗的临床分析  

The Clinical Analysis of L-Carnitine on Maintenance Hemodialysis Patient

作　　者：钱春梅[1] 王秦[1] 许涛[2] 盛晓华[2] 汪年松[2] 

机构地区：[1]上海交通大学附属第六人民医院南院肾内科,上海201499 [2]上海交通大学附属第六人民医院肾内科,上海201499

出　　处：《中国中西医结合肾病杂志》2014年第10期877-879,共3页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家自然基金面上项目(No.81270824);上海市国际科技合作基金资助项目(No.11410708500);上海市科委基金资助项目(No.114119a6100;11DZ1921904);上海市科委基础研究重大项目(No.11DJ1400101);上海市科委重大项目(No.11DZ1973103);上海交通大学医学院科技基金资助项目(No.11xj21058)

摘　　要：目的:观察重组人红细胞生成素联合蔗糖铁、左卡尼汀治疗维持性血液透析(MHD)患者的临床疗效,研究左卡尼汀对糖尿病肾病MHD患者炎症改善情况。方法:166例维持性血液透析患者随机分为A、B、C三组,其中A组单纯应用益比奥,B组益比奥联合应用蔗糖铁,C组益比奥联合应用蔗糖铁及左卡尼汀,疗程为1年,观察治疗前后3组患者血红蛋白(Hb)、血细胞比容(HCT)、C反应蛋白(CRP)和主要生化指标(三酰甘油、胆固醇、总蛋白、白蛋白等)的变化。同时将C组维持性血液透析患者根据原发疾病分为糖尿病组(18例)与非糖尿病组(40例),观察两组白细胞、中性粒细胞和CRP的组间差异。结果:3组患者血红蛋白均有所上升,但C组患者血红蛋白较A、B组有显著性明显改善(P<0.05);3组患者治疗前CRP水平无明显差异,治疗后均有显著性下降(P<0.05),同时治疗后C组较A组差异有统计学意义(P<0.05)。C组患者中糖尿病肾病组与非糖尿病肾病组CRP水平均显著性下降(P<0.05),但糖尿病肾病较非糖尿病肾病组下降更显著。结论:左卡尼汀联合EPO和蔗糖铁治疗肾性贫血疗效优于简单给予EPO和蔗糖铁治疗,并能有效控制糖尿病肾病MHD患者微炎症状态,改善患者生存质量。Objective：To observe the clinical effects of combined therapy with Human erythropoietin（EPO）、iron sucrose and L - Carnitine in Maintenance hemodialysis（MHD）patients. To research the improvement of inflammation by L - Carnitine in di-abetes mellitus patients undergoing MHD. Methods：One hundred and sixty - six MHD patients were randomly divided into three groups（A、B、C）. Every patients were treated by EPO,group B were treated by EPO and iron sucrose,group C were treated by EPO、iron sucrose and L - Carnitine. All the patients were treated for one year. Hemoglobin（Hb）,hematokrit（HCT）,Creactive protein （CRP）,Triglyceride,cholesterol,total protein and albumin were examined before and after the treatment. According to the protopa-thy,the group C were divided into diabetes mellitus group（n = 18）and non diabetes mellitus group（n = 40）. Observe the difference in CRP、white blood cell and neutrophile granulocyte between two groups treated with L - Carnitine. Results：The Hb level of all the three groups were higher than before. Compared with group A and group B,the HB level of group C showed much better. There was significant difference in HB level between group C and another two groups（P 〈 0. 05）. There was significant difference in CRP be-tween group C and group A（P 〈 0. 05）. In group C,diabetes nephropathy group showed significantly lower level of CRP（P 〈 0. 05）. Conclusion：The combined therapy with L - Carnitine,EPO and iron sucrose was better than the treatment of EPO and iron solely. It could effectively control micro - inflammation on diabetes nephropathy and improve the quality of life.

关 键 词：重组人红细胞生成素 蔗糖铁 左卡尼汀 维持性血液透析 C 反应蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]