左卡尼汀在肾性贫血治疗中的应用效果  

Efficacy of Levocarnitine on Renal Anemia

作　　者：张华贞 刘鹏[1] 王俊录 李可爽 ZHANG Hua-zhen;LIU Peng;WANG Jun-lu;LI Ke-shuang(Department of Nephrology,Sanmenxia Central Hospital Affiliated to Henan University of Science and Technology,Sanmenxia 472000,China)

机构地区：[1]河南科技大学附属三门峡市中心医院肾内科,河南三门峡472000

出　　处：《实用临床医学（江西）》2018年第12期1-4,共4页Practical Clinical Medicine

基　　金：河南省医学科技攻关计划项目(201602333)

摘　　要：目的在促红细胞生成素(EPO)及蔗糖铁治疗肾性贫血中联合使用左卡尼汀,观察其临床效果与安全性。方法将108例尿毒症行血液透析治疗的肾性贫血患者按随机数字表法分为对照组和治疗组,每组54例。对照组给予促红细胞生成素联合蔗糖铁治疗,治疗组在对照组治疗基础上加用左卡尼汀,2组均治疗24周。比较2组治疗总有效率及治疗前与治疗12、24周后贫血指标[包括血红蛋白(Hb)、红细胞压积(Hct)、铁蛋白(SF)和转铁蛋白饱和度(TSAT)等]和氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)等]变化情况,观察2组治疗期间高血压发生情况。结果治疗组治疗总有效率显著高于对照组(88.89%比72.22%,χ~2=4.788、P=0.029)。治疗组治疗12、24周后Hb、Hct、SF、TSAT、SOD、GSH-Px水平均较治疗前显著升高(P<0.05或P<0.01),MDA均较治疗前显著降低(P<0.05或P<0.01);对照组治疗12、24周后Hb、Hct、SF、TSAT水平均较治疗前显著升高(P<0.05或P<0.01),而MDA、SOD、GSH-Px水平与治疗前比较差异均无统计学意义(P>0.05)。2组治疗后贫血指标与氧化应激指标比较差异均有统计学意义(P<0.05或P<0.01)。治疗组治疗期间高血压不良反应事件发生率较对照组显著降低(7.40%比31.48%,P<0.01)。结论在促红细胞生成素及蔗糖铁治疗肾性贫血患者中使用左卡尼汀能显著提高临床疗效,改善患者贫血症状,减少氧化应激反应,降低高血压发生率。Objective To explore the clinical efficacy and safety of levocarnitine combined with erythropoietin(EPO)and iron sucrose in the treatment of renal anemia.Methods A total of 108 uremic hemodialysis patients with renal anemia were treated with EPO and iron sucrose(control group,n=54)or in combination with levocarnitine(treatment group,n=54)for 24 weeks.Anemia indexes hemoglobin(Hb),hematocrit(Hct),serum ferritin(SF)and transferrin saturation(TSAT)and oxidative stress indicators malondialdehyde(MDA),superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)were measured before and treatment for 12 and 24 weeks.In addition,the total effective rate and incidence of hypertension were compared between the two groups.Results The total effective rate in treatment group was higher than that in control group(88.89% vs 72.22%,χ^2=4.788,P=0.029).After treatment for 12 and 24 weeks,the levels of Hb,Hct,SF,TSAT,SOD and GSH-Px increased and MDA levels decreased in treatment group(P<0.05 or P<0.01).In control group,the levels of Hb,Hct,SF and TSAT increased(P<0.05 or P<0.01),but the levels of MDA,SOD and GSH-Px were not changed after treatment(P>0.05).There were significant differences in anemia indexes and oxidative stress indicators between the two groups after treatment(P<0.05 or P<0.01).The incidence of hypertension in treatment group was lower than that in control group(7.40% vs 31.48%,P<0.01).Conclusion The combined treatment with EPO,iron sucrose and levocarnitine can improve clinical efficacy,relieve anemia symptoms,reduce oxidative stress response and decrease the incidence of hypertension in patients with renal anemia.

关 键 词：左卡尼汀 蔗糖铁 促红细胞生成素 肾性贫血 氧化应激反应 

分 类 号：R556[医药卫生—血液循环系统疾病]