左卡尼汀联合超纯透析对维持性血液透析患者血清炎性因子、心功能、血管内皮功能的影响
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摘要
目的探讨左卡尼汀联合超纯透析对维持性血液透析(maintenance hemodialysis, MHD)患者血清炎性因子、心功能、血管内皮功能的影响。方法选取2016年7月—2018年5月我院收治的98例MHD,按照随机数字表法分为观察组(n=51)与对照组(n=47)。两组均予常规处理,在此基础上,对照组予以常规血液透析治疗,观察组予以左卡尼汀联合超纯透析治疗,均治疗3个月。观察两组血清炎性因子[肿瘤坏死因子-α(tumor necrosis factor, TNF-α)、C-反应蛋白(C-reactive protein, CRP)及白细胞介素-6(interleukin 6, IL-6)]、心功能相关指标[室间隔舒张末期厚度(left ventricular septum thickness, LVST)、左室射血分数(left ventricular ejection fractions, LVEF)、左室舒张末期内径(left ventricular end diastolic diameter, LEVDD)]、血管内皮功能相关指标[内皮素-1(endothelin-1, ET-1)和一氧化氮(nitric oxide, NO)]变化,记录不良反应发生情况。结果与对照组比较,观察组治疗后血清IL-6、TNF-α、CRP、ET-1、NO水平及LVST、LEVDD均降低,LVEF升高,差异有统计学意义(P<0.05);与本组治疗前比较,两组治疗后血清IL-6、TNF-α、CRP、ET-1、NO水平明显下降,且观察组治疗后LVEF明显升高,LVST、LEVDD显著降低,差异有统计学意义(P<0.05)。观察组、对照组不良反应发生率分别为17.65%(9/51)、31.91%(15/47),比较差异有统计学意义(χ~2=5.609、P=0.033),且症状均较轻微,未予治疗自行缓解。结论左卡尼汀联合超纯透析可显著改善MHD患者的血清炎性反应及血管内皮细胞功能,有效保护心功能,且安全性高。
Objective To investigate the effects of Levocarnitine combined with ultrapure dialysis on serum inflammatory factors, cardiac function and vascular endothelial function in patients undergoing maintenance hemodialysis(MHD). Methods A total of 98 patients undergoing MHD who were treated in our hospital from July 2016 to May 2018 were selected as the research subjects. According to random number table methods, they were divided into the observation group(n=51) and the control group(n=47). Both groups were given conventional treatment. In addition, the control group was given conventional dialysis, and the observation group was given Levocarnitine combined with ultrapure dialysis treatment. After 3 months of treatment, the serum inflammatory factors [Tumor necrosis factor-α(TNF-α), C-reactive protein(CRP) and interleukin 6(IL-6)], cardiac function indicators [end-diastolic interventricular septum thickness(LVST), left ventricular ejection fraction(LVEF), and left ventricular end diastolic diameter(LEVDD)], vascular endothelial function indexes [endothelin-1(ET-1) and nitric oxide(NO)] were observed in two groups. And adverse reactions were recorded. Results Compared with the control group, the serum levels of IL-6, TNF-α, CRP, ET-1, NO, LVST and LEVDD in the observation group were significantly decreased and LVEF was increased significantly after treatment(P<0.05). Compared with those before treatment, the serum levels of IL-6, TNF-α, CRP, ET-1 and NO in the two groups were decreased significantly after treatment. The LVEF in the observation group was increased significantly, while the levels of LVST and LEVDD were decreased significantly after treatment, showing significant significance(P<0.05). The incidence of adverse reactions in the observation group and the control group were 17.65%(9/51) and 31.91%(15/47), respectively, and the difference was statistically significant(χ~2=5.609, P=0.033). The symptoms were mild and relieved without treatment. Conclusion Levocarnitine combined with ultrapure dialysis can significantly improve the serum inflammatory response and vascular endothelial cell function in patients undergoing MHD, which can protect the cardiac function of patients, with good safety.
Objective To investigate the effects of Levocarnitine combined with ultrapure dialysis on serum inflammatory factors, cardiac function and vascular endothelial function in patients undergoing maintenance hemodialysis(MHD). Methods A total of 98 patients undergoing MHD who were treated in our hospital from July 2016 to May 2018 were selected as the research subjects. According to random number table methods, they were divided into the observation group(n=51) and the control group(n=47). Both groups were given conventional treatment. In addition, the control group was given conventional dialysis, and the observation group was given Levocarnitine combined with ultrapure dialysis treatment. After 3 months of treatment, the serum inflammatory factors [Tumor necrosis factor-α(TNF-α), C-reactive protein(CRP) and interleukin 6(IL-6)], cardiac function indicators [end-diastolic interventricular septum thickness(LVST), left ventricular ejection fraction(LVEF), and left ventricular end diastolic diameter(LEVDD)], vascular endothelial function indexes [endothelin-1(ET-1) and nitric oxide(NO)] were observed in two groups. And adverse reactions were recorded. Results Compared with the control group, the serum levels of IL-6, TNF-α, CRP, ET-1, NO, LVST and LEVDD in the observation group were significantly decreased and LVEF was increased significantly after treatment(P<0.05). Compared with those before treatment, the serum levels of IL-6, TNF-α, CRP, ET-1 and NO in the two groups were decreased significantly after treatment. The LVEF in the observation group was increased significantly, while the levels of LVST and LEVDD were decreased significantly after treatment, showing significant significance(P<0.05). The incidence of adverse reactions in the observation group and the control group were 17.65%(9/51) and 31.91%(15/47), respectively, and the difference was statistically significant(χ~2=5.609, P=0.033). The symptoms were mild and relieved without treatment. Conclusion Levocarnitine combined with ultrapure dialysis can significantly improve the serum inflammatory response and vascular endothelial cell function in patients undergoing MHD, which can protect the cardiac function of patients, with good safety.
引文
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[13] 何媛芳,李月婷.不同透析液钠浓度对血液透析患者血压与心脏功能的影响[J].中国预防医学杂志,2018,19(10):752-756.
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[17] 孙婷.连续性血液净化对严重脓毒症患者预后及内皮细胞功能的影响[D].滨州医学院,2010.
[18] 冀旭,孟宇,薛泮宏.左卡尼汀联合超纯透析对维持性血液透析患者血管内皮细胞功能的影响[J].内科急危重症杂志,2018,24(5):425-427.
[2] Fu D L,Zhao T T,Peng W H,et al.Effect of Dialysis on Antiplatelet Drug Efficacy in Uremic Patients with Coronary Heart Disease[J].Chin Med J (Engl),2017,130(16):1914-1918.
[3] Zhang Z,Chen J,Sun Z,et al.Effects of high-flux hemodialysis on FGF-23 and micro-inflammatory state in end-stage renal diseases patients[J].Zhonghua Yi Xue Za Zhi,2015,95(26):2074-2078.
[4] 赵田,于洋,李英.超纯透析液在血液净化治疗中的应用[J].中国血液净化,2017,16(6):427-430.
[5] 周慧敏.左卡尼汀对缺血性心力衰竭心室重构、心肌酶学及血脂代谢的影响[J].中国老年学杂志,2014,34(15):4168-4169.
[6] 葛均波,徐永健,王辰.内科学[M].北京:人民卫生出版社,2018:124-130.
[7] Deger S M,Ellis C D,Bian A,et al.Obesity,diabetes and survival in maintenance hemodialysis patients[J].Ren Fail,2014,36(4):546-551.
[8] 张以来,李佳,魏善斋,等.左卡尼汀联合超纯透析对维持性血液透析患者炎症指标及营养状况的影响[J].海南医学,2016,27(1):43-45.
[9] 左玉梅,冯健,王媛,等.维持性血液透析患者心血管并发症致病机制及防治研究进展[J].人民军医,2016,59(1):79-81.
[10] Mácsai E,Németh I,Benke A,et al.Effect of diabetes on the relation between troponin T and inflammatory markers in patients on hemodialysis[J].Orv Hetil,2014,155(16):627-633.
[11] Wojciechowska C,Romuk E,Tomasik A,et al.Oxidative stress markers and C-reactive protein are related to severity of heart failure in patients with dilated cardiomyopathy[J].Mediators Inflamm,2014,2014:147040.
[12] 林燕,林咸楚.左卡尼汀辅助治疗对维持性血液透析患者血清营养指标及炎症因子水平的影响[J].中国药师,2015,18(11):1914-1915,1921.
[13] 何媛芳,李月婷.不同透析液钠浓度对血液透析患者血压与心脏功能的影响[J].中国预防医学杂志,2018,19(10):752-756.
[14] 贾莉,朱文龙,邢杰,等.维持性血液透析患者心脏结构及功能特点分析[J].临床军医杂志,2015,43(2):116-118,203.
[15] 朱凤喜,杨渊,黄玮.左卡尼汀改善心力衰竭疗效的Meta分析[J].第三军医大学学报,2014,36(13):1428-1430.
[16] 宋洁,李辉,陈会民.左卡尼汀在维持性血液透析患者中的临床应用[J].临床误诊误治,2010,23(1):85-87.
[17] 孙婷.连续性血液净化对严重脓毒症患者预后及内皮细胞功能的影响[D].滨州医学院,2010.
[18] 冀旭,孟宇,薛泮宏.左卡尼汀联合超纯透析对维持性血液透析患者血管内皮细胞功能的影响[J].内科急危重症杂志,2018,24(5):425-427.
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