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医学论文范文:左旋肉碱对腹膜透析病人贫血及肌力的影响
【摘要】 目的 观察静脉应用左旋肉碱（可益能)对腹膜透析病人血浆肉碱水平、血红蛋白水平及肌力的影响。方法 选择有明显疲乏无力、肌肉酸痛症状伴或不伴贫血的慢性腹膜透析患者 38例为实验组，同时选取29例无肌肉症状伴或不伴贫血的慢性腹膜透析患者作为对照组，观察两组患者血浆肉碱水平情况，静脉给予可益能15 mg/kg，隔日1次，应用24周后，血红蛋白水平及肌力的改善情况。结果 实验组血浆游离肉碱（FC)水平明显低于对照组，而酯酰肉碱（AC)与游离肉碱比值则相反；给予可益能静脉注射24周后，实验组血浆总肉碱（TC)、FC、AC较治疗前增加，AC/FC值下降，患者肌肉酸痛症状得到改善，上肢握力增加，贫血者血红蛋白（Hb)水平增高，促红素（rHuEPO)用量减少；静脉应用可益能对腹膜透析患者脂代谢无影响。结论 给予可益能静脉应用可以纠正腹膜透析患者肉碱缺乏所引起的相关症状，改善贫血，增加患者肌力，且无明显不良反应。
【关键词】 左旋肉碱；腹膜透析；贫血；促红素；握力
Effect of Lcarnitine Supplementation on Anemia and Muscle Strength in Peritoneal Dialysis Patients
MA Sha,XU Jiayun,GAO Xiang
First Affiliated Hospital，Henan University of Science and Technology, Luoyang 471003, China
Abstract:Objective To study the effect of carnitine supplementation on plasma carnitine fractions，heamoglobin levels and muscle strength in peritoneal dialysis patients. Methods 38 peritoneal dialysis patients with muscular weakness, fatigue, or cramps/aches,and anemia or not were included,also randomly selecting 29 peritoneal dialysis patients who were completely free of muscular symptoms, and anemia or not.Compared with plasma carnitine leves between those two groups,patients with muscular symptoms were given a dose of 15 mg/kg intravenous injection every other day for 24 weeks.Then,assess whether Lcarnitine treatment was sufficient to alleviate peritoneal dialysis patients’muscular symptoms and to understand how carnitine affectsed the Hb in anemia patients. Results Plasma free carnitine（FC)of patients who had muscular weakness and fatigue，was lower than those free of muscular symptoms，Acyl carnitine and free carnitine ratio (AC/FC)were opposite.After 24 weeks of Lcarnitine supplementation plasma FC,AC,and total carnitine (TC)had increased,conversely, AC/FC ratio were decreased.Almost all petients treated with Lcarnitine had improvement in muscular symptoms，muscular power were strengthened.At the end of study, in carnitine patients who had anemia the heamoglobin levels were increased and the dose of recombinant human erythropoietin（rHuEPO) were strongly reduced. After 24 weeks of Lcarnitine supplementation，lipid metablism showed no demonstrable changes. Conclusion Lcarnitine supplementation can alleviate dialysisassociated muscular symptoms, strengthen muscle strength and increase heamoglobin levels, reduce the rHuEPO requirement, with preventing negative lipid effects医.学全.在.线网站www.med126.com.
Key words:Lcarnitine；peritoneal；dialysis；anemia；rHuEPO；handgrip strength
肉碱（carnitine)又称肉毒碱，是脂肪酸氧化所必需的一种物质，能促使长链脂肪酸进入线粒体进行氧化，产生供肌肉和其他代谢所需要的能量。肉碱缺乏时可影响线粒体内游离脂肪酸的氧化，致使脂类在胞浆中聚集，不能进入三羧酸循环，对细胞产生毒性作用。肉碱在慢性肾衰病人中成为研究的热点，大量研究证实透析病人随着透析时间的延长血浆肉碱及骨骼肌肉碱缺乏[1]，尤其是血浆游离肉碱水平明显下降，病人出现疲劳乏力、肌肉酸痛等一系列症状，同时握力下降，而握力能够较好地反映机体肌肉蛋白质的储存情况[2]。贫血病人给予大剂量促红素仍难达到目标血红蛋白水平，导致促红素抵抗。国内外已有研究发现补充左旋肉碱后可以降低血透病人促红素用量，纠正贫血。本研究拟观察静脉补充左旋肉碱是否可以纠正腹膜透析病人贫血症状，改善病人疲劳乏力，肌肉酸痛等症状，增强肌力，同时了解其对腹膜透析患者血浆肉碱水平及脂代谢的影响。
