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目的探讨左卡尼汀纠正维持性血液透析患者肾性贫血效果及对内皮素和左室重构的影响。方法将安阳市人民医院自2010年11月—2014年11月收治的维持血液透析6个月以上的尿毒症患者206例作为研究对象,随机分为研究组和对照组各103例,对照组患者给予促红细胞生成素,研究组患者在对照组治疗的基础上静脉推注左卡尼汀注射液,治疗6个月后,检测血红蛋白(Hb)、红细胞比容(HCT),测定血清内皮素(ET),并由有经验的超声诊断医师测量左心房内径(LAD)、左心室收缩末期内径(LVDs)、左心室舒张末期内径(LVDd)的变化等。结果治疗后两组Hb和HCT均明显升高,ET水平明显降低,与同组治疗前比较差异具有统计学意义(P<0.05);且研究组患者以上指标的改变水平显著优于对照组,组间比较差异具有统计学意义(P<0.05);两组患者治疗后LAD、LVDs、LVDd均发生不同程度的降低,且研究组显著低于对照组,组间比较差异具有统计学意义(P<0.05)。结论左卡尼汀联合促红细胞生成素治疗维持性血液透析患者肾性贫血可提高治疗效果,降低血浆内皮素水平,有效改善或抑制左室重构的发生和发展,有效预防心衰的发生,效果显著,可推广使用。
Objective To investigate the effect of levocarnitine on the treatment of renal anemia in maintenance hemodialysis patients and its effect on endothelin and left ventricular remodeling. Methods 206 patients with uremia who maintained hemodialysis for more than 6 months in Anyang People’s Hospital from November 2010 to November 2014 were randomly divided into study group and control group with 103 cases in each group and control group The patients in the study group were given intravenous injection of levocarnitine on the basis of the control group. After 6 months of treatment, hemoglobin (Hb) and hematocrit (HCT) were measured, and serum endothelin ET), and the changes of left atrium diameter (LAD), left ventricular end-systolic diameter (LVDs) and left ventricular end-diastolic diameter (LVDd) were measured by experienced diagnostic physicians. Results After treatment, the Hb and HCT in both groups were significantly increased, the ET level was significantly lower than that in the same group before treatment (P <0.05); and the levels of the above indexes in the study group were significantly better than those in the control group (P <0.05). The LAD, LVDs and LVDd in both groups decreased to some extent after treatment, and the study group was significantly lower than the control group, the difference between the two groups was statistically significant (P <0.05). Conclusion L-carnitine combined with erythropoietin in maintenance hemodialysis patients with renal anemia can improve the therapeutic effect, reduce plasma endothelin level, effectively improve or inhibit the occurrence and development of left ventricular remodeling, effectively prevent the occurrence of heart failure, The effect is significant, can be promoted to use.