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目的：观察慢性肾衰患者的肉碱代谢以指导临床治疗。方法：选择慢性肾衰保守治疗患者以及尿毒症血透患者为实验对象，并以正常人作对照，检测血浆游离肉碱（ＦＣ）浓度。结果：（１）慢性肾衰保守治疗患者血浆ＦＣ浓度明显高于正常人（Ｐ＜０．０５），并与血清尿素氮、尿酸显著相关（ｒ＝０．６６６０，ｒ＝０．６４２１，Ｐ＜０．０５），与血清肌酸酐无关。（２）尿毒症血透患者透前血浆ＦＣ浓度明显低于正常人和保守治疗患者（Ｐ＜０．０１），透后浓度显著低于透前（Ｐ＜０．００１）；一次血透后浓度下降７０％。另外，血透患者血浆ＦＣ浓度与血透时间呈非常显著相关（ｒ＝－０．８７９３，Ｐ＜０．００１），与肌酸酐清除率无关。结论：慢性肾衰患者存在明显的肉碱代谢异常，特别是血透患者ＦＣ缺乏，血透后及时给予补充肉碱是必要的。
Objective: To observe the carnitine metabolism in patients with chronic renal failure to guide clinical treatment. Methods: Patients with conservative treatment of chronic renal failure and patients with uremia hemodialysis were selected as experimental subjects, and plasma concentrations of free carnitine (FC) were determined by normal controls. Results: (1) The concentration of plasma FC in patients with conservative treatment of chronic renal failure was significantly higher than that in healthy people (P <0.05), and significantly correlated with serum urea nitrogen and uric acid (r = 0.6660, r = 0.6421, P <0.05), not related to serum creatinine. (2) The plasma concentration of FC in the hemodialysis patients before uremia was significantly lower than that in the normal and conservative groups (P <0.01) Concentration decreased by 70%. In addition, hemodialysis patients with plasma FC concentration and hemodialysis time was significantly correlated (r = -0.8793, P <0.001), and creatinine clearance rate has nothing to do. Conclusion: There are obvious carnitine metabolic abnormalities in patients with chronic renal failure, especially the lack of FC in hemodialysis patients. It is necessary to give carnitine supplemented promptly after hemodialysis.