左卡尼汀联合血液透析对尿毒症患者Treg/Th17细胞、血清炎症因子和肾功能指标的影响
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摘要
目的探究左卡尼汀联合尿毒症血液透析对尿毒症患者调节性T细胞(Treg)/辅助性T细胞17(Th17)细胞、血清炎症因子及肾功能指标的影响。方法将2016年6月至2018年7月河南省南阳市中心医院收治的80例尿毒症患者随机分为观察组和对照组,各40例。对照组给予普通血液透析治疗,观察组给予左卡尼汀联合血液透析治疗,比较2组治疗前后Treg/Th17细胞水平、营养指标、炎症因子[白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CPR)]、肾功能指标[肌酐(SCr)、血尿素氮(BUN)、24 h尿蛋白定量]变化,并统计并发症发生情况。结果治疗后观察组Treg细胞、Th17细胞、Treg/Th17细胞水平显著低于对照组,差异有统计学意义(P<0.05);治疗后观察组营养指标改善情况显著优于对照组,差异有统计学意义(P<0.05);治疗后观察组IL-6、IL-17、TNF-α、hs-CPR、SCr、BUN、24 h尿蛋白定量水平显著低于对照组,差异有统计学意义(P<0.05);且观察组并发症发生率12.50%(5/40)显著低于对照组32.50%(13/40),差异有统计学意义(P<0.05)。结论外源性补充左卡尼汀可帮助血液透析尿毒症患者维持较好的营养状态,改善机体微环境、免疫功能及炎症反应,减轻肾功能损伤,且安全性良好。
Objective To investigate the effects of L-carnitine combined with hemodialysis on regulatory T cell/helper T cell 17(Th17)cells,serum inflammatory factors and renal function indicators in uremia patients. Methods 80 uremia patients admitted to Nanyang Central Hospital,Henan,Province from June 2016 to July 2018 were randomly divided into observation group and control group,40 cases each. The control group was given normal hemodialysis treatment,while the observation group was treated with hemodialysis and L-carnitine. The Treg/Th17 cell levels, nutritional indicators, inflammatory factors[interleukin-6(IL-6),Interleukin-17(IL-17),tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CPR)],and renal function indicators[serum creatinine(SCr),blood urea nitrogen(BUN),24 h urine protein quantitation] changes in the 2 groups before and after treatment were compared,and the incidence of complications was statistically analyzed. Results After treatment,the levels of Treg cells,Th17 cells and Treg/Th17 cells in the observation group were significantly lower than those in the control group(P<0.05). The improvement of nutritional indicators in the observation group was significantly better than that in the control group(P<0.05). The levels of IL-6,IL-7,TNF-α,hs-CPR,SCr,BUN and 24 h urine protein in the observation group were significantly lower than those in the control group(P<0.05). The incidence of complications in the observation group was 12.50%(5/40),which was significantly lower than that in the control group[32.50%(13/40)](P<0.05). Conclusion Exogenous supplementation of L-carnitine can help uremia patients undergoing hemodialysis maintain good nutritional status,improve the microenvironment,immune function and inflammatory response,reduce renal damage,and have good safety.
Objective To investigate the effects of L-carnitine combined with hemodialysis on regulatory T cell/helper T cell 17(Th17)cells,serum inflammatory factors and renal function indicators in uremia patients. Methods 80 uremia patients admitted to Nanyang Central Hospital,Henan,Province from June 2016 to July 2018 were randomly divided into observation group and control group,40 cases each. The control group was given normal hemodialysis treatment,while the observation group was treated with hemodialysis and L-carnitine. The Treg/Th17 cell levels, nutritional indicators, inflammatory factors[interleukin-6(IL-6),Interleukin-17(IL-17),tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CPR)],and renal function indicators[serum creatinine(SCr),blood urea nitrogen(BUN),24 h urine protein quantitation] changes in the 2 groups before and after treatment were compared,and the incidence of complications was statistically analyzed. Results After treatment,the levels of Treg cells,Th17 cells and Treg/Th17 cells in the observation group were significantly lower than those in the control group(P<0.05). The improvement of nutritional indicators in the observation group was significantly better than that in the control group(P<0.05). The levels of IL-6,IL-7,TNF-α,hs-CPR,SCr,BUN and 24 h urine protein in the observation group were significantly lower than those in the control group(P<0.05). The incidence of complications in the observation group was 12.50%(5/40),which was significantly lower than that in the control group[32.50%(13/40)](P<0.05). Conclusion Exogenous supplementation of L-carnitine can help uremia patients undergoing hemodialysis maintain good nutritional status,improve the microenvironment,immune function and inflammatory response,reduce renal damage,and have good safety.
引文
[1]Su HH,Kao CM,Lin YC,et al.Relationship between serum total bilirubin levels and mortality in uremia patients undergoing long-term hemodialysis:A nationwide cohort study[J].Atherosclerosis,2017,265:155-161.
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[4]罗进辉.左卡尼汀对尿毒症行维持性血液透析患者营养状况和心功能的影响[J].国际泌尿系统杂志,2017,37(4):1239-1241.
[5]Etinger A,Kumar,Ackley W,et al.The effect of isohydric hemodialysis on the binding and removal of uremic retention solutes[J].Plos One,2018,13(7):e0192770.
[6]马婉乐,孙雪,喻婉莹,等.慢性肾疾病和尿毒症毒素对非肾清除影响的研究进展[J].中国临床药理学杂志,2016,32(9):861-864.
[7]Li WH,Yin YM,Chen H,et al.Curative effect of neutral macroporous resin hemoperfusion on treating hemodialysis patients with refractory uremic pruritus[J].Medicine,2017,96(12):e6160.
[8]Zhang ZH,Mao JR,Chen H,et al.Removal of uremic retention products by hemodialysis is coupled with indiscriminate loss of vital metabolites[J].Clinical Biochemistry,2017,50(18):1078-1086.
[9]王明波,谭永顺,王自良,等.血液透析对尿毒症患者Treg与Th17水平失衡的影响分析[J].重庆医学,2018,47(15):2045-2047.
[10]丁瑜,王健,梁新,等.尿毒症毒素对甲酚对单核细胞体外释放炎症因子的影响[J].解放军医学杂志,2015,40(1):35-39.
[11]胡波,商义,李蓓睿.尿毒症血液透析患者外周血单核细胞Nrf2、NQO1及血清TNF-α、IL-6的表达变化及意义[J].中国血液净化,2018,32(5):299-303.
[12]Berthelot L.Immune and inflammatory mechanisms[J].Nephrology Dialysis Transplantation,2016,30(10 Suppl):S3-8.
[13]尤亚红.调节性T淋巴细胞/辅助性T淋巴细胞17失衡在自身免疫性疾病中的研究进展[J].国际输血及血液学杂志,2015,38(6):541-545.
[14]吴风雷.左卡尼汀联合血液透析治疗尿毒症性周围神经病变38例疗效分析[J].蚌埠医学院学报,2015,40(12):1661-1663.
[15]贾明华,冯敏.左卡尼汀对尿毒症行维持性血液透析患者营养状况和心功能的影响[J].中华实用诊断与治疗杂志,2015,29(12):1239-1241.
[16]陈正芳.高通量血液透析联合左卡尼汀改善尿毒症患者免疫功能的影响[J].临床和实验医学杂志,2017,16(7):669-672.
[17]路静芬,王晓慧,姚颖,等.高通量血液透析联合左卡尼汀治疗对维持性血液透析患者营养状况和生存质量的影响[J].内科急危重症杂志,2016,22(4):262-266.
[18]Higuchi T,Abe M,Yamazaki T,et al.Levocarnitine improves cardiac function in hemodialysis patients with left ventricular hypertrophy:a randomized controlled trial[J].American Journal of Kidney Diseases,2016,67(2):260-270.
[2]Aliasgharpour M,Zabolypour S,Asadinoghabi A,et al.The effect of increasing blood flow rate on severity of uremic pruritus in hemodialysis patients:a single clinical trial[J].Journal of the National Medical Association,2018,110(3):270-275.
[3]Tashiro K,Kaida Y,Yamagishi SI,et al.L-carnitine supplementation improves self-rating depression scale scores in uremic male patients undergoing hemodialysis[J].Letters in Drug Design&Discovery,2017,14(6):737-742.
[4]罗进辉.左卡尼汀对尿毒症行维持性血液透析患者营养状况和心功能的影响[J].国际泌尿系统杂志,2017,37(4):1239-1241.
[5]Etinger A,Kumar,Ackley W,et al.The effect of isohydric hemodialysis on the binding and removal of uremic retention solutes[J].Plos One,2018,13(7):e0192770.
[6]马婉乐,孙雪,喻婉莹,等.慢性肾疾病和尿毒症毒素对非肾清除影响的研究进展[J].中国临床药理学杂志,2016,32(9):861-864.
[7]Li WH,Yin YM,Chen H,et al.Curative effect of neutral macroporous resin hemoperfusion on treating hemodialysis patients with refractory uremic pruritus[J].Medicine,2017,96(12):e6160.
[8]Zhang ZH,Mao JR,Chen H,et al.Removal of uremic retention products by hemodialysis is coupled with indiscriminate loss of vital metabolites[J].Clinical Biochemistry,2017,50(18):1078-1086.
[9]王明波,谭永顺,王自良,等.血液透析对尿毒症患者Treg与Th17水平失衡的影响分析[J].重庆医学,2018,47(15):2045-2047.
[10]丁瑜,王健,梁新,等.尿毒症毒素对甲酚对单核细胞体外释放炎症因子的影响[J].解放军医学杂志,2015,40(1):35-39.
[11]胡波,商义,李蓓睿.尿毒症血液透析患者外周血单核细胞Nrf2、NQO1及血清TNF-α、IL-6的表达变化及意义[J].中国血液净化,2018,32(5):299-303.
[12]Berthelot L.Immune and inflammatory mechanisms[J].Nephrology Dialysis Transplantation,2016,30(10 Suppl):S3-8.
[13]尤亚红.调节性T淋巴细胞/辅助性T淋巴细胞17失衡在自身免疫性疾病中的研究进展[J].国际输血及血液学杂志,2015,38(6):541-545.
[14]吴风雷.左卡尼汀联合血液透析治疗尿毒症性周围神经病变38例疗效分析[J].蚌埠医学院学报,2015,40(12):1661-1663.
[15]贾明华,冯敏.左卡尼汀对尿毒症行维持性血液透析患者营养状况和心功能的影响[J].中华实用诊断与治疗杂志,2015,29(12):1239-1241.
[16]陈正芳.高通量血液透析联合左卡尼汀改善尿毒症患者免疫功能的影响[J].临床和实验医学杂志,2017,16(7):669-672.
[17]路静芬,王晓慧,姚颖,等.高通量血液透析联合左卡尼汀治疗对维持性血液透析患者营养状况和生存质量的影响[J].内科急危重症杂志,2016,22(4):262-266.
[18]Higuchi T,Abe M,Yamazaki T,et al.Levocarnitine improves cardiac function in hemodialysis patients with left ventricular hypertrophy:a randomized controlled trial[J].American Journal of Kidney Diseases,2016,67(2):260-270.