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目的研究左卡尼汀治疗维持性血液透析(maintenance hemodialysis,MHD)患者蛋白质能量消耗(protein energy wasting,PEW)的效果。方法回顾性选取2003年1月至2015年6月在贵州省人民医院进行维持性血液透析并诊断为PEW患者99例。按患者是否使用左卡尼汀分为治疗组和对照组,其中治疗组75例,对照组24例。采用独立样本t检验和χ2检验比较两组患者生化指标(包括白蛋白、前白蛋白、血红蛋白、淋巴细胞总数等)、主观全面营养评估(subjective global assessment,SGA)评分、体格测量(包括体质量、体质量指数、上臂肌围、肱三头肌皮褶厚度、小腿围)和人体成分测量(瘦体质量、脂肪质量和相位角)结果。结果左卡尼汀治疗组治疗后血红蛋白、前白蛋白、白蛋白较治疗前升高,差异有统计学意义(P<0.05),也高于对照组(P<0.05)。用SGA评分判断,治疗组营养良好患者比例高于对照组(22.7%vs 4.2%),而轻中度营养不良和重度营养不良患者比例均显著低于对照组(76.0%vs 83.3%,1.3%vs 12.5%),差异有统计学意义(P<0.05)。体格测量显示,治疗组男性和女性的体质量指数、肱三头肌皮褶厚度、小腿围均分别高于对照组,差异有统计学意义(P<0.05)。生物电阻抗法检测体质成分结果显示,治疗组瘦体质量明显高于对照组(P<0.05),但脂肪质量和相位角较对照组差异无统计学意义(P>0.05)。结论 MHD患者经左卡尼汀治疗可有效改善营养状况,预防患者体质量丢失,尤其是瘦体质量的丢失,从而改善患者的PEW,有望将来用于预防MHD患者的肌肉减少症,提高生活质量。
Objective To investigate the effect of levocarnitine on protein energy wasting (PEW) in patients with maintenance hemodialysis (MHD). Methods Ninety-nine patients with PEW who underwent maintenance hemodialysis at Guizhou Provincial People’s Hospital from January 2003 to June 2015 were retrospectively selected. According to whether patients were treated with levocarnitine or not, the treatment group and the control group were divided into treatment group (75 cases) and control group (24 cases). The biochemical indexes (including albumin, prealbumin, hemoglobin, total lymphocytes, etc.), subjective global assessment (SGA) scores, physical measurements (including body mass , Body mass index, upper arm muscle circumference, triceps skinfold thickness, calf circumference) and body composition measurements (lean mass, fat mass and phase angle) results. Results After treatment, the levels of hemoglobin, prealbumin and albumin in L-carnitine treatment group were significantly higher than those before treatment (P <0.05), and also higher than those in control group (P <0.05). The proportion of well-nourished patients in the treatment group was significantly higher than that of the control group (22.7% vs 4.2%), while the proportion of patients with mild to moderate malnutrition and severe malnutrition was significantly lower than that of the control group (76.0% vs 83.3%, 1.3% vs 12.5%), the difference was statistically significant (P <0.05). Body measurements showed that body mass index, triceps skinfold thickness and calf circumference in the treatment group were significantly higher than those in the control group (P <0.05). Bioelectrical impedance test showed that the lean body mass in the treatment group was significantly higher than that in the control group (P <0.05), but there was no significant difference in fat mass and phase angle between the two groups (P> 0.05). Conclusion L-carnitine can effectively improve the nutritional status of patients with MHD and prevent the loss of body mass, especially the loss of lean mass, so as to improve the PEW in patients with MHD. It is expected to be used to prevent muscle diminution and improve the quality of life in patients with MHD .