左卡尼汀对维持性血液透析慢性肾衰竭患者血管硬化及血管内皮功能的影响研究  

The effect of levocarnitine on vascular sclerosis and vascular endothelial function in patients with chronic renal failure on maintenance hemodialysis

作　　者：郭继磊 李凤荣 Guo Jilei;Li Fengrong(Department of Nephrology,Shan County Central Hospital of Shandong Province,Heze 274300,China)

机构地区：[1]山东省单县中心医院肾内科,菏泽274300

出　　处：《中国医师进修杂志》2023年第10期909-913,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨维持性血液透析(MHD)联合左卡尼汀对慢性肾衰竭患者血管硬化及血管内皮功能的影响。方法前瞻性选择2019年6月至2020年5月山东省单县中心医院收治的接受MHD治疗的102例慢性肾衰竭患者,按随机数字表法分为观察组(53例)和对照组(49例),对照组采用MHD治疗,观察组在对照组治疗的基础上联合左卡尼汀治疗,两组均治疗6个月。比较两组治疗前及治疗后肾功能指标和核因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)等微炎性反应指标及晚期氧化蛋白产物(AOPP)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)等氧化应激指标,采用飞利浦彩色多普勒超声诊断仪观察颈动脉管壁情况,比较两组治疗前后内皮素-1(ET-1)水平和血管反应性充血指数(RHI)。结果两组治疗后血清肌酐(SCr)、尿素氮(BUN)比较差异无统计学意义(P>0.05);观察组治疗后TNF-α及NF-κB低于对照组[(20.22±7.15)μg/L比(26.14±5.96)μg/L、(6.10±0.80)mg/L比(6.55±1.10)mg/L],差异有统计学意义(P<0.05)。观察组治疗后AOPP、MDA低于对照组,GSH-PX水平高于对照组[(78.52±17.41)μmol/L比(97.96±18.29)μmol/L、(4.44±1.02)μmol/L比(6.07±1.26)μmol/L、(110.14±22.17)mg/L比(90.63±19.28)mg/L],差异有统计学意义(P<0.05)。观察组治疗后脉搏波传导速度(PWV)和ET-1、血管性假血友病因子(vWF)水平低于对照组[(7.29±0.59)m/s比(7.89±0.63)m/s,(44.15±10.27)ng/L比(52.41±12.74)ng/L,(30.26±7.45)U/L比(35.71±6.23)U/L],RHI高于对照组(1.54±0.25比1.45±0.20),差异有统计学意义(P<0.05)。结论左卡尼汀联合用于MHD治疗中可缓解微炎性反应和氧化应激反应,改善血管内皮功能,降低动脉硬化的发生。Objective To investigate the effect of maintenance hemodialysis(MHD)combined with levocarnitine on vascular sclerosis and vascular endothelial function in patients with chronic renal failure.Methods Patients with chronic renal failure receiving MHD treatment admitted to Shanxian Central Hospital of Shandong Province from June 2019 to May 2020 were selected as the research object and they were divided into the observation group(53 cases)and the control group(49 cases)by the random number table method.The patients in the control group were treated with maintenance hemodialysis and the patients in the observation group were treated with combined levocarnitine on the basis of the control group.The levels of serum creatinine(SCr),blood urea nitrogen(BUN)and other renal function indicators were determined before and 6 months after the treatment.The levels of nuclear factor kappa B(NF-κB),tumor necrosis factor(TNF-α)and other microinflammatory indexes,and advanced oxidation protein products(AOPP),malondialdehyde(MDA),glutathione peroxidase(GSH-Px)and other oxidative response indexes were determined.The levels of endothelin-1(ET-1),von Willebrand factor(vWF)and vascular reactive hyperemia index(RHI)were measured.Common carotid atherosclerosisβand pulse wave conduction velocity(PWV)were measured by color Doppler ultrasonography.Results The levels of SCr,BUN in the two groups after treatment had no significant differences(P>0.05).The levels of TNF-αand NF-κB in the observation group after treatment were lower than those in the control group:(20.22±7.15)μg/L vs.(26.14±5.96)μg/L,(6.10±0.80)mg/L vs.(6.55±1.10)mg/L,there were statistical differences(P<0.05).The levels of AOPP,MDA in the observation group after treatment were lower than those in the control group and the level of GSH-PX was higher than that in the control group:(78.52±17.41)μmol/L vs.(97.96±18.29)μmol/L,(4.44±1.02)μmol/L vs.(6.07±1.26)μmol/L,(110.14±22.17)mg/L vs.(90.63±19.28)mg/L,there were statistical differences(P<0.05).The levels of PWV

关 键 词：肾功能不全 慢性 血液透析滤过 动脉硬化 左卡尼汀 

分 类 号：R692.5[医药卫生—泌尿科学]