CAJ | 학술논문

目的通过对维持性血液透析(MHD)合并心血管疾病患者采用左卡尼汀和曲美他嗪联合治疗,评估其对MHD患者左心室重塑的影响.方法选择透析龄≥3个月的MHD患者86例,已排除急性感染及其他活动性疾病,按照接受血液透析治疗的时间分为两组:患者治疗组(46例),每次透析结束后,静脉注射左卡尼汀1.0 g,3次/周,同时口服曲美他嗪20 mg,3次/d,疗程6个月;患者对照组(40例),不用左卡尼汀和曲美他嗪.分别检测治疗前后患者的血清游离脂肪酸(FFA)、游离肉碱(FC)和超声心动图以及血清高敏C反应蛋白(hs-CRP)、白细胞介素(IL).1β、IL-β、肿瘤坏死因子(TNF)-α、谷胱甘肽过氧化物酶(GSHPx)、超氧化物歧化酶(SOD)、丙二醛(MDA)等.另选择健康对照组40例.结果治疗前,患者治疗组和患者对照组血清FFA、hs-CRP、IL-1β、IL-6、TNF-αβ、MDA水平均显著高于健康对照组(P<0.05或<0.01),FC、GSHPx、SOD水平均显著低于健康对照组(P<0.05或<0.01);治疗6个月后与治疗前比较,患者治疗组FFA、hs-CRP、IL-1β、IL-6、TNF-α、MDA水平均显著下降(P<0.05或<0.01),FC、GSHPx、SOD水平均显著升高(P<0.05或<0.01);治疗6个月后与治疗前比较,患者治疗组的左房内径、左室舒张末内径、室间隔厚度、左室后壁厚度、左室心肌质量指数均显著下降(P<0.05),左室射血分数显著升高(P<0.05);患者对照组以上各项指标治疗前后均无明显变化,治疗6个月后患者治疗组与患者对照组以上各项指标比较差异均有统计学意义(P<0.05或<0.01).结论联合应用左卡尼汀和曲美他嗪可明显纠正MHD患者的高FFA血症和肉碱缺乏症以及微炎性反应和氧化应激状态,从而改善患者的左心室重塑.
목적 통과대유지성혈액투석(MHD)합병심혈관질병환자채용좌잡니정화곡미타진연합치료,평고기대MHD환자좌심실중소적영향.방법 선택투석령≥3개월적MHD환자86례,이배제급성감염급기타활동성질병,안조접수혈액투석치료적시간분위량조:환자치료조(46례),매차투석결속후,정맥주사좌잡니정1.0 g,3차/주,동시구복곡미타진20 mg,3차/d,료정6개월;환자대조조(40례),불용좌잡니정화곡미타진.분별검측치료전후환자적혈청유리지방산(FFA)、유리육감(FC)화초성심동도이급혈청고민C반응단백(hs-CRP)、백세포개소(IL).1β、IL-β、종류배사인자(TNF)-α、곡광감태과양화물매(GSHPx)、초양화물기화매(SOD)、병이철(MDA)등.령선택건강대조조40례.결과 치료전,환자치료조화환자대조조혈청FFA、hs-CRP、IL-1β、IL-6、TNF-αβ、MDA수평균현저고우건강대조조(P<0.05혹<0.01),FC、GSHPx、SOD수평균현저저우건강대조조(P<0.05혹<0.01);치료6개월후여치료전비교,환자치료조FFA、hs-CRP、IL-1β、IL-6、TNF-α、MDA수평균현저하강(P<0.05혹<0.01),FC、GSHPx、SOD수평균현저승고(P<0.05혹<0.01);치료6개월후여치료전비교,환자치료조적좌방내경、좌실서장말내경、실간격후도、좌실후벽후도、좌실심기질량지수균현저하강(P<0.05),좌실사혈분수현저승고(P<0.05);환자대조조이상각항지표치료전후균무명현변화,치료6개월후환자치료조여환자대조조이상각항지표비교차이균유통계학의의(P<0.05혹<0.01).결론 연합응용좌잡니정화곡미타진가명현규정MHD환자적고FFA혈증화육감결핍증이급미염성반응화양화응격상태,종이개선환자적좌심실중소.
Objective To investigate the effects of levocarnitine combined with urimetazidine on left ventricular remodeling in maintenance hemodialysis(MHD)patients.Methods All of 86 MHD patients and 40 healthy volunteers(health control group)were involved in the study.all of 86 MHD patients were randomly divided into two groups,disease treatment group(46 cases)and disease control group(40 cases),who had undergone hemodialysis for at least 3 months before the study and were in a stable clinical status without signs of infection or disease activity.In disease treatment group,1.0 g of levocarnitine was infused at the end of each dialysis treatment and 20 mg of trimetazidine was taken orally 3 times each day for 6 months,while the parameters for free fatty acid(FFA),free carnitine(FC),inflammation and oxidative stress were studied before and after the treatmenL In disease control group these two drugs were not used.The left ventricular end-diastolic diameter(LVDd),left ventricuhr end-systolic diameter(LVDs),left atrial diameter (LAD),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST)and left ventricular ejection fraction(LVEF)were detected by ultrasonic cardiography.Results Before treatment,the serum levels of FFA,high-sensitivity C-reactive protein(hs-CRP),intedeukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-αand malondialdehyde(MDA)were higher in disease treatment group and disease control group than those in health control group(P<0.05 or<0.01),while the serum levels of FC,glutathione peroxidase(GSHPx)and superoxide dismutase(SOD)were lower in disease treatment group and disease control group than those in health control group(P<0.05 or<0.01).Compared with those before treatment,the serum levels of FFA,hs-CRP,IL-1β,IL-6,TNF-α,MDA were decreased(P<0.05 or<0.01),FC,GSHPx,SOD were increased(P<0.05 or<0101),the scores of LVDd,LAD,IVST,LVPWT,LVMI were also decreased significantly(P<0.05),while LVEF increased markedly after treatmem in disease treatment group(P<0.05).There were significant differences in all indexes between disease treatment group and disease control group(P<0.05 or<0.01).Conclusion Supplements of levocarnitine combined with trimetazidine in MHD patients appear to be associated with an improvement of left ventricular remodeling.