醫(yī)學(xué)論文范文:左旋肉堿對(duì)腹膜透析病人貧血及肌力的影響

醫(yī)學(xué)論文范文:左旋肉堿對(duì)腹膜透析病人貧血及肌力的影響

【摘要】 目的 觀察靜脈應(yīng)用左旋肉堿（可益能)對(duì)腹膜透析病人血漿肉堿水平、血紅蛋白水平及肌力的影響。方法 選擇有明顯疲乏無(wú)力、肌肉酸痛癥狀伴或不伴貧血的慢性腹膜透析患者 38例為實(shí)驗(yàn)組，同時(shí)選取29例無(wú)肌肉癥狀伴或不伴貧血的慢性腹膜透析患者作為對(duì)照組，觀察兩組患者血漿肉堿水平情況，靜脈給予可益能15 mg/kg，隔日1次，應(yīng)用24周后，血紅蛋白水平及肌力的改善情況。結(jié)果 實(shí)驗(yàn)組血漿游離肉堿（FC)水平明顯低于對(duì)照組，而酯酰肉堿（AC)與游離肉堿比值則相反；給予可益能靜脈注射24周后，實(shí)驗(yàn)組血漿總?cè)鈮A（TC)、FC、AC較治療前增加，AC/FC值下降，患者肌肉酸痛癥狀得到改善，上肢握力增加，貧血者血紅蛋白（Hb)水平增高，促紅素（rHuEPO)用量減少；靜脈應(yīng)用可益能對(duì)腹膜透析患者脂代謝無(wú)影響。結(jié)論 給予可益能靜脈應(yīng)用可以糾正腹膜透析患者肉堿缺乏所引起的相關(guān)癥狀，改善貧血，增加患者肌力，且無(wú)明顯不良反應(yīng)。

【關(guān)鍵詞】 左旋肉堿；腹膜透析；貧血；促紅素；握力

Effect of L�瞔arnitine Supplementation on Anemia and Muscle Strength in Peritoneal Dialysis Patients

MA Sha,XU Jia�瞴un,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 L�瞔arnitine 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 L�瞔arnitine supplementation plasma FC,AC,and total carnitine (TC)had increased,conversely, AC/FC ratio were decreased.Almost all petients treated with L�瞔arnitine 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 L�瞔arnitine supplementation，lipid metablism showed no demonstrable changes. Conclusion L�瞔arnitine supplementation can alleviate dialysis�瞐ssociated muscular symptoms, strengthen muscle strength and increase heamoglobin levels, reduce the rHuEPO requirement, with preventing negative lipid effects醫(yī).學(xué)全.在.線網(wǎng)站m.bhskgw.cn.

Key words:L�瞔arnitine；peritoneal；dialysis；anemia；rHuEPO；handgrip strength

肉堿（carnitine)又稱肉毒堿，是脂肪酸氧化所必需的一種物質(zhì)，能促使長(zhǎng)鏈脂肪酸進(jìn)入線粒體進(jìn)行氧化，產(chǎn)生供肌肉和其他代謝所需要的能量。肉堿缺乏時(shí)可影響線粒體內(nèi)游離脂肪酸的氧化，致使脂類在胞漿中聚集，不能進(jìn)入三羧酸循環(huán)，對(duì)細(xì)胞產(chǎn)生毒性作用。肉堿在慢性腎衰病人中成為研究的熱點(diǎn)，大量研究證實(shí)透析病人隨著透析時(shí)間的延長(zhǎng)血漿肉堿及骨骼肌肉堿缺乏[1]，尤其是血漿游離肉堿水平明顯下降，病人出現(xiàn)疲勞乏力、肌肉酸痛等一系列癥狀，同時(shí)握力下降，而握力能夠較好地反映機(jī)體肌肉蛋白質(zhì)的儲(chǔ)存情況[2]。貧血病人給予大劑量促紅素仍難達(dá)到目標(biāo)血紅蛋白水平，導(dǎo)致促紅素抵抗。國(guó)內(nèi)外已有研究發(fā)現(xiàn)補(bǔ)充左旋肉堿后可以降低血透病人促紅素用量，糾正貧血。本研究擬觀察靜脈補(bǔ)充左旋肉堿是否可以糾正腹膜透析病人貧血癥狀，改善病人疲勞乏力，肌肉酸痛等癥狀，增強(qiáng)肌力，同時(shí)了解其對(duì)腹膜透析患者血漿肉堿水平及脂代謝的影響。

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