左旋肉碱改善血液透析患者微炎症状态的机制探讨
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摘要
目的：
观察左旋肉碱对维持性血液透析(MHD)患者微炎症状态的影响,探讨左旋肉碱对MHD患者微炎症的作用机制。方法：
选择我院血液净化中心常规接受血液透析治疗且时间在6个月以上的患者43例,随机分为对照组21例和治疗组22例,对照组在每次透析治疗结束时从透析通路静脉端注入生理盐水20m1；治疗组在每次透析治疗结束时从透析通路静脉端推注左旋肉碱2.0g加生理盐水至20ml。2组在性别、年龄、原发病等方面经统计学处理,无显著性差异(P>0.05),观察时间均为3个月。统计两组在治疗过程中透析并发症的例数,并检测两组治疗前后微炎症指标：血清超敏c反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的水平及参与炎症反应的核因子kappaB (NF-κB)活性。
结果：
1.两组治疗前基线比较：炎症因子比较无显著性差异；
2.治疗前后相比较：治疗组治疗后CRP,IL-6,TNF-α较治疗前下降有统计学差异(P<0.05)；对照组CRP,IL-6,TNF-α治疗前后,差异无统计学意义(P>0.05)
3.治疗组同对照组相比较：治疗组在降低CRP,IL-6,TNF-α方面明显优于对照组,差异有统计学意义(P<0.05)
4.NF-κB活性水平与CRP,IL-6,TNF-α值呈正相关,相关系数分别为0.71(P<0.05)、0.56(P<0.05)、0.67(P<0.05)。
5.治疗组与对照组发生相透析并发症例数的比较：治疗组出现乏力1例、疲劳2例、肌肉痉挛1例、低血压2例;对照组出现乏力2例、疲劳3例、肌肉痉挛3例、低血压4例,治疗组临床症状的改善明显优于对照组,差异无统计学意义(P<0.05)。
结论：
1.左旋肉碱可以减低MHD患者炎症指标,有改善微炎症的作用；
2.左旋肉碱可通过抑制NF-κB的活性起到治疗炎症的作用。
3.左旋肉碱可降低MHD患者透析并发症的发生率,改善其生活质量。
4.左旋肉碱不良反应少,用药安全、方便,在改善MHD患者微炎症状态方面,值得进一步探讨。
Object:
To observe the influence of L-carnitine on microinflammation state in hemodialysis patients, and discuss L-carnitine's therapeutical effect and molecular mechanism on microinflammation state of hemodialysis patients.
Method:
Select 43 subjects chronic hemodialysis patients who comes from Blood Purification Center of our hosipital and have kept dialysis at least for 6 months. Subjects are randomized allocated to treatment group (22cases) and control group(21cases). Treatment group are injected with normal saline 20ml plus L-carnitine2.0g from dialysis access every time after dialysis.Control group are injected only with normal saline 20ml from dialysis access every time after dialysis. They are no significant differenc in gender, age, dialysis age, duration of dialysis, primary disease between the groups (P>0.05).They are comparable.The period of treatment of both groups are 3 months. Before and after the therapy, inflammatory markers such as CRP,IL-1,IL-6,TNF-a and the activation of NF-kB in both group are deteted.
Resut:
1. Comparing the two groups before treatment:inflammatory reaction was no significant difference
2. CRP,IL-1,IL-6,TNF-a in treatment group decreased after using L-carnitine than that before treatment(P<0.05),but not observed in Control group(P>0.05)
3.In the effects of decreasing the levels of CRP,IL-1,IL-6,TNF-a, the treatment group could do better than the control group(P<0.05)
4. Activity of NF-κB and level of CRP, IL-6, TNF-a were correlated positively. the correlation coefficients were 0.71 (P<0.05),0.56 (P<0.05),0.67 (P<0.05)
Conclusion:
1.L-carnitine can reduce inflammatory markers in chronic hemodialysis patients, to reduce the role of micro-inflammation
2.L-carnitine can play a role in the treatment of inflammatory by inhibiting the activity of NF-κB
3.L-carnitine is good for MHD patients with few adverse reactions. It is safe,convenient in medication and worthy of further research in MHD patients
观察左旋肉碱对维持性血液透析(MHD)患者微炎症状态的影响,探讨左旋肉碱对MHD患者微炎症的作用机制。方法：
选择我院血液净化中心常规接受血液透析治疗且时间在6个月以上的患者43例,随机分为对照组21例和治疗组22例,对照组在每次透析治疗结束时从透析通路静脉端注入生理盐水20m1；治疗组在每次透析治疗结束时从透析通路静脉端推注左旋肉碱2.0g加生理盐水至20ml。2组在性别、年龄、原发病等方面经统计学处理,无显著性差异(P>0.05),观察时间均为3个月。统计两组在治疗过程中透析并发症的例数,并检测两组治疗前后微炎症指标：血清超敏c反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的水平及参与炎症反应的核因子kappaB (NF-κB)活性。
结果：
1.两组治疗前基线比较：炎症因子比较无显著性差异；
2.治疗前后相比较：治疗组治疗后CRP,IL-6,TNF-α较治疗前下降有统计学差异(P<0.05)；对照组CRP,IL-6,TNF-α治疗前后,差异无统计学意义(P>0.05)
3.治疗组同对照组相比较：治疗组在降低CRP,IL-6,TNF-α方面明显优于对照组,差异有统计学意义(P<0.05)
4.NF-κB活性水平与CRP,IL-6,TNF-α值呈正相关,相关系数分别为0.71(P<0.05)、0.56(P<0.05)、0.67(P<0.05)。
5.治疗组与对照组发生相透析并发症例数的比较：治疗组出现乏力1例、疲劳2例、肌肉痉挛1例、低血压2例;对照组出现乏力2例、疲劳3例、肌肉痉挛3例、低血压4例,治疗组临床症状的改善明显优于对照组,差异无统计学意义(P<0.05)。
结论：
1.左旋肉碱可以减低MHD患者炎症指标,有改善微炎症的作用；
2.左旋肉碱可通过抑制NF-κB的活性起到治疗炎症的作用。
3.左旋肉碱可降低MHD患者透析并发症的发生率,改善其生活质量。
4.左旋肉碱不良反应少,用药安全、方便,在改善MHD患者微炎症状态方面,值得进一步探讨。
Object:
To observe the influence of L-carnitine on microinflammation state in hemodialysis patients, and discuss L-carnitine's therapeutical effect and molecular mechanism on microinflammation state of hemodialysis patients.
Method:
Select 43 subjects chronic hemodialysis patients who comes from Blood Purification Center of our hosipital and have kept dialysis at least for 6 months. Subjects are randomized allocated to treatment group (22cases) and control group(21cases). Treatment group are injected with normal saline 20ml plus L-carnitine2.0g from dialysis access every time after dialysis.Control group are injected only with normal saline 20ml from dialysis access every time after dialysis. They are no significant differenc in gender, age, dialysis age, duration of dialysis, primary disease between the groups (P>0.05).They are comparable.The period of treatment of both groups are 3 months. Before and after the therapy, inflammatory markers such as CRP,IL-1,IL-6,TNF-a and the activation of NF-kB in both group are deteted.
Resut:
1. Comparing the two groups before treatment:inflammatory reaction was no significant difference
2. CRP,IL-1,IL-6,TNF-a in treatment group decreased after using L-carnitine than that before treatment(P<0.05),but not observed in Control group(P>0.05)
3.In the effects of decreasing the levels of CRP,IL-1,IL-6,TNF-a, the treatment group could do better than the control group(P<0.05)
4. Activity of NF-κB and level of CRP, IL-6, TNF-a were correlated positively. the correlation coefficients were 0.71 (P<0.05),0.56 (P<0.05),0.67 (P<0.05)
Conclusion:
1.L-carnitine can reduce inflammatory markers in chronic hemodialysis patients, to reduce the role of micro-inflammation
2.L-carnitine can play a role in the treatment of inflammatory by inhibiting the activity of NF-κB
3.L-carnitine is good for MHD patients with few adverse reactions. It is safe,convenient in medication and worthy of further research in MHD patients
引文
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