维持性血透患者应用左卡尼汀治疗的临床分析

摘要

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.%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。