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目的探讨左卡尼汀联合缬沙坦对维持性血液透析(MHD)患者左室结构和功能的影响。方法选择42例行MHD的尿毒症患者,在常规治疗基础上加用缬沙坦80～160 mg,每天1次;左卡尼汀1.0 g于每次透析结束前静脉注射,疗程6个月。根据超声心动图结果,记录患者治疗前后各项反映左室结构和功能的指标的变化,包括左室形态学指标:左室舒张末径(LVEDD)、左室收缩末径(LVESD)、室间隔厚度(IVST)、左室后壁舒张末期厚度(LVPWT)、左室质量指数(LVMI);左室舒张功能指标:二尖瓣口舒张早期/晚期最大血流速度比(E/A)、二尖瓣E峰减速时间(DT)、左心房容积(LAV)、二尖瓣血流传播速度(VP);左室收缩功能指标:左心室射血分数(LVEF)、每搏量(SV)、二尖瓣环收缩期速度(Sa)。结果治疗6个月后,LVEDD、LVESD、IVST、LVPWT、LVMI、DT、LAV均较治疗前明显下降,E/A、VP、LVEF、SV、Sa均较治疗前明显提高(均P<0.05)。结论左卡尼汀与缬沙坦联合应用能有效抑制MHD患者的心肌重构,同时改善心肌收缩与舒张功能。
Objective To investigate the effects of levocarnitine and valsartan on left ventricular structure and function in maintenance hemodialysis (MHD) patients. Methods Forty-two uremic patients with MHD were enrolled. Patients were given valsartan 80-160 mg on a routine basis once a day. L-carnitine 1.0 g was intravenously injected before the end of each dialysis for 6 months. According to the results of echocardiography, the changes of left ventricular structure and function were recorded before and after treatment, including left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic diameter (LVESD), ventricular septum (IVST), left ventricular end-diastolic thickness (LVPWT) and left ventricular mass index (LVMI); left ventricular diastolic function index: early diastolic / late maximum blood flow velocity ratio Peak echocardiographic time (DT), left atrial volume (LAV) and mitral flow velocity (VP); left ventricular systolic function index (LVEF), stroke volume Mitral annulus systolic velocity (Sa). Results After 6 months of treatment, LVEDD, LVESD, IVST, LVPWT, LVMI, DT and LAV were significantly decreased compared with those before treatment. E / A, VP, LVEF, SV and Sa were significantly increased (all P < . Conclusion L-carnitine combined with valsartan can effectively inhibit myocardial remodeling in MHD patients and improve myocardial contractility and diastolic function.