透析前注射左卡尼汀对透析耐受性差维持性血液透析患者蛋白质能量消耗及钙磷代谢的改善状况分析  

Improvement of protein energy wasting and calcium-phosphorus metabolism after injection of L-carnitine before dialysis in patientswith poor tolerance under maintenance hemodialysis

作　　者：吴静[1] 何平红[1] 唐昕 沈燕[1] 胡英[1] 田茂露[1] 佟小雅 周朝敏[1] 查艳[1] WU Jing;HE Ping-hong;TANG Xin;SHEN Yah;HU Ying;TIAN Mao-lu;TONG Xiao-ya;ZH OU Chao-min;ZHA yan(Department of Nephrology,Guizhou Provincial People＇s Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院肾内科,贵州贵阳550002 [2]贵航贵阳医院肾内科,贵州贵阳550009

出　　处：《中国实用内科杂志》2018年第11期1090-1093,共4页Chinese Journal of Practical Internal Medicine

基　　金：贵州省科技厅-省医联合基金(黔科合L H字[2014]7001号)

摘　　要：目的分析透析前与透析后注入左卡尼汀对透析耐受性差的维持性血液透析(MHD)患者钙磷代谢紊乱、甲状旁腺激素亢进及蛋白质能量消耗(PEW)改善情况,为提高MHD患者生活质量提供依据。方法选取2003年1月至2016年12月在贵州省人民医院和贵阳市第一人民医院18~75岁透析耐受性差的维持性血液透析患者共50例。将其随机分成两组,将透析前使用左卡尼汀的25例患者作为观察组,透析结束时使用左卡尼汀的25例患者作为对照组。观察组在每次血液透析前15 min从内瘘静脉端注入左卡尼汀1 g,对照组在患者透析结束时注入相同剂量的左卡尼汀,两组患者每周透析3次,随访共3个月。采用治疗前后两组间比较及各组治疗前后自身对照比较评估两种给药方法对患者PEW、钙磷代谢、透析充分性等改善情况有无差异。结果给药3个月后,PEW相关指标比较,治疗后观察组前白蛋白、白蛋白及瘦体重较对照组明显升高,低密度脂蛋白胆固醇、C反应蛋白(CRP)降低,差异有统计学意义(P<0.05);对照组治疗后仅有三酰甘油明显下降,其余各指标变化差异均无统计学意义(P>0.05)。钙磷代谢及透析充分性指标比较,治疗后观察组血钙和Kt/V值较对照组明显升高,血磷、甲状旁腺激素、肌酐明显降低,差异有统计学意义(P<0.05)。结论 MHD患者透析前补充左卡尼汀,与透析后给药相比,更能有效改善患者PEW、全身系统性炎症、钙磷代谢紊乱及甲状旁腺功能亢进,提高透析充分性及患者透析耐受性,改善生存质量。Objective To analyze the difference of blood calcium ,blood phosphorus, iPTH and PEW on poorly-tolerated HD patients who were administrated L-camitine before and after HD, to provide evidence of improving the quality of life of MHD patients. Methods Totally 50 MHD patients aged 18-75 years with poorly-tolerated HD from Janaury 2003 to December 2016 were selected and divided into two groups randomly. Twenty-five patients entered the observation group and were injected 1 g L-carnitine 15 minutes before HD, and 25 patients entered the control group and were injected 1 g L-camitine after HD; all patients had 3 times of liD each week and were followed up for 3 months. The difference between the two groups and within eachgroup were analyzed before and after the treatment. Results After three months, higher levels of the PEW-relating index included prealbumin, albumin, and lean body mass were shown in the observation group（P〈0.05）, white low-density lipoprotein cholesterol （LDL-C） and CRP decreased significantly in observation group （P〈0.05）. Only triglycerides decreased in control group, and the rest of the various indexes showed no statistical significance （P〉0.05） after treatment. Blood calcium and Kt/V significantly increased in the oberservation group （P〈0.05）, whereas blood phosphorus, iPTH and serum creatinine decreased significantly （P〈0.05）. Conclusion MHD patients with injection of L-carnitine before HD can effectively improve the PEW-related index, general systematic inflammation, calcium-phosphorus metabolism disorder and hyperparathyroidism, and it can also improve the dialysis adequacy and dialysis tolerance, and deveplop the patient＇s quality of life.

关 键 词：左卡尼汀 蛋白质能量消耗 钙磷代谢 

分 类 号：R589.7[医药卫生—内分泌]