血液透析患者静脉应用左旋肉碱(可益能)的药代动力学研究  

Pharmacokinetics of intravenous administered L - carnitine in hemodialysis patients

作　　者：刘惠兰[1] 张晓洁[1] 曹峰[2] 

机构地区：[1]首都医科大学附属复兴医院肾内科,北京100038 [2]临床药理实验室

出　　处：《中国血液净化》2003年第6期298-300,310,共4页Chinese Journal of Blood Purification

摘　　要：目的 研究血液透析患者静脉应用左旋肉碱的药代动力学特点,探讨治疗肉碱缺乏的给药途径、剂量、疗程。方法 选择9例本透析中心病情稳定的患者,男5例,女4例。于每次血液透析结束回血前3分钟,静脉推注1g左旋肉碱,共用药8周(26次透析)。应用酶法检测首次给药前(0时)、给药后1.5分钟、3分钟、15分钟、30分钟、1小时、2小时、4小时、8小时、12小时、24小时肉碱的血药浓度,分析单次静脉应用左旋肉碱的药代动力学特点。另外,于首次给药、给药2周、4周、6周、8周分别检测透析前后、透析液中肉碱浓度,研究多次用药后血浆肉碱水平变化和透析液中的清除量。结果维持性血液透析患者用药前血浆肉碱浓度大大低于正常值40-50umol/L;首次于透析结束时静脉给予1g左旋肉碱的药代动力学符合二室开放模型。给药后血药浓度很快增加,然后迅速下降,AUC大,但半衰期与正常人接近;每次透析过程中均可清除大量的肉碱,并且随着血药浓度增加而清除增加;连续给药期6至8周后透析前后肉碱水平基本维持稳定。结论 血液透析患者外源性补充肉碱的药代动力学特点与正常人不同,透析清除是药物排泄的主要途径,因此须6-8周连续透析后补充用药,使组织及血浆肉碱水平恢复。Objective To evaluate the pharmacokinetic characters of intravenous administered L - camitine in hemodialysis patients. Methods One gram L - camitine was given by intravenous after hemodialysis in 9 patients, blood samples were taken at 0, 1.5, 3, 15min and 0.5、1、2、4、8、12、24h to investigate the pharmacokinetic parameters for single dose L - camitine. Then study the camitine levels in plasma before /after hemodialysis and in hemodialysates at 0、2、4、6、8 weeks during. Results The plasma camitine level were lower than normal in hemodialysis patients; The pharmacokinetic parameters for single dose L- camitine were fitted two- compartment open model; L -camitine conformed to during hemodialysis gready; After repeated administration of L- camitine for 6-8 weeks, the plasma camitine level can keep stable. Conclusion The pharmacokinetic characters of intravenous administered L-camitine in hemodialysis patients were different from normal. L - camitine was significantly eliminated to hemodialysate,so repeated supplementations were needed for 6 - 8 weeks after each hemodialysis.

关 键 词：血液透析 静脉应用 左旋肉碱 药代动力学 血药浓度 肉碱缺乏 

分 类 号：R459.5[医药卫生—治疗学] R977[医药卫生—临床医学]