论文部分内容阅读
目的探讨左卡尼汀对维持性血液透析(MHD)患者使用重组人促红细胞生成素(rhEPO)的剂量及微炎症状态的影响。方法将入选的326例MHD患者随机分为治疗组和对照组(每组163例),两组患者年龄、性别比、病程、常规治疗剂量等差异均无统计学意义,具有可比性。以维持患者血红蛋白(HB)水平在110～120 g/L、红细胞压积(HCT)水平在33%～35%为靶目标,对照组予以单纯rhEPO治疗,治疗组在予以rhEPO治疗基础上加予左卡尼汀治疗。8个月后,分别计算两组患者每周rhEPO的用量及促红细胞生成素反应指数(ERI),比较两组患者维持HB和HCT在靶目标水平所需每周rhEPO的用量及两组ERI的差异,同期监测血清超敏C反应蛋白(hs-CRP)等指标水平,观察患者微炎症状态的变化。结果治疗组维持HB和HCT在靶目标水平所需每周rhEPO的平均用量低于对照组[(106±20)IU/kg vs(141±23)IU/kg],治疗组ERI低于对照组[(0.93±0.11)IU.L.kg-1.g-1vs(1.35±0.29)IU.L.kg-1.g-1],差异均有统计学意义(P<0.05)。治疗组患者治疗后hs-CRP水平较治疗前下降[(5.21±3.20)mg/L vs(10.33±2.54)mg/L,P<0.05],且低于对照组治疗后水平(9.93±2.12)mg/L,P<0.05];对照组患者hs-CRP水平在治疗前、后差异无统计学意义。结论左卡尼汀可以减少MHD患者维持HB和HCT在靶目标水平所需rhEPO的用量,其机制可能与改善MHD患者微炎症状态、降低患者促红素抵抗性有关。
Objective To investigate the effects of levocarnitine on the dosage of rhEPO and the status of microinflammation in maintenance hemodialysis (MHD) patients. Methods A total of 326 MHD patients were randomly divided into treatment group and control group (163 cases in each group). There was no significant difference between the two groups in terms of age, sex ratio, course of disease and routine treatment dose. In order to maintain the patient’s hemoglobin (HB) level of 110 ~ 120 g / L, hematocrit (HCT) level of 33% to 35% as the target, the control group was treated with rhEPO alone, the treatment group was given rhEPO treatment on the basis of L-carnitine treatment. After 8 months, the weekly amount of rhEPO and erythropoietin response index (ERI) of two groups of patients were calculated. The amount of rhEPO needed to maintain HB and HCT at the target level and the two groups of ERI The levels of hs-CRP and serum hs-CRP in the same period were monitored to observe the change of microinflammatory state. Results The mean weekly doses of rhEPO needed to maintain HB and HCT at the target level in the treatment group were lower than those in the control group [(106 ± 20) IU / kg vs (141 ± 23) IU / kg] (0.93 ± 0.11) IU.L.kg-1.g-1vs (1.35 ± 0.29) IU.L.kg-1.g-1], the difference was statistically significant (P <0.05). The level of hs-CRP in the treatment group was significantly lower than that before treatment [(5.21 ± 3.20) mg / L vs (10.33 ± 2.54 mg / L, P <0.05], and lower than that in the control group (9.93 ± 2.12) mg / L, P <0.05]. There was no significant difference in hs-CRP level between the two groups before and after treatment. Conclusions L-carnitine can reduce the amount of rhEPO required for maintaining target levels of HB and HCT in MHD patients. The mechanism may be related to the improvement of micro-inflammatory status and the decrease of erythropoietin resistance in MHD patients.