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目的研究左卡尼汀治疗终末期肾病维持血液透析患者对T淋巴细胞亚群及可溶性白细胞介素2受体(SIL-2R)的影响。方法选取2013年1月至2015年3月在天津市第五中心医院血液净化中心行维持血液透析的终末期肾病患者共84例,随机分为对照组和左卡尼汀组,每组42例。左卡尼汀组于每次透析结束后给予左卡尼汀1.0 g静脉注射,对照组不应用左卡尼汀。两组患者共治疗3个月。另外,同期于我院体检中心选择42例健康体检者作为健康对照组。检测并比较各组治疗前后T细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)和SIL-2R水平的变化情况。计量资料的比较用单因素方差分析、t检验,计数资料的比较用χ2检验或Fisher确切概率法。结果治疗前,对照组和左卡尼汀组CD3+、CD4+、CD8+及CD4+/CD8+差异均无统计学意义(P>0.05),但与健康对照组之间的差异均有统计学意义(P<0.05)。治疗后,左卡尼汀组患者CD3+、CD4+及CD4+/CD8+比值均较治疗前明显升高,CD8+则明显下降,差异均有统计学意义(P<0.01),对照组CD3+、CD4+、CD8+及CD4+/CD8+均未见明显变化。治疗前,对照组和左卡尼汀组SIL-2R水平[分别为(735.42±90.61)、(718.86±88.29)U/ml]均明显高于健康对照组[(241.58±37.45)U/ml],差异均有统计学意义(P<0.05),但对照组和左卡尼汀组之间的差异无统计学意义(P>0.05)。治疗后,左卡尼汀组患者SIL-2R水平[(357.54±42.17)U/ml]明显下降,与治疗前比较,差异有统计学意义(P<0.05),对照组SIL-2R水平未见明显变化。治疗后,左卡尼汀组与健康对照组之间T淋巴细胞亚群及SIL-2R水平差异均有统计学意义(P<0.05)。结论左卡尼汀治疗终末期肾病维持血液透析患者能够调节T淋巴细胞亚群,并降低SIL-2R,增强机体的细胞免疫功能。
Objective To investigate the effect of levocarnitine on maintenance of T lymphocyte subsets and soluble interleukin 2 receptor (SIL-2R) in hemodialysis patients with end-stage renal disease. Methods A total of 84 patients with end-stage renal disease who underwent hemodialysis at the Blood Purification Center of the Fifth Central Hospital of Tianjin from January 2013 to March 2015 were randomly divided into control group and levocarnitine group, 42 cases in each group . L-carnitine group was given L-carnitine 1.0 g intravenously after each dialysis, while the control group did not use L-carnitine. Two groups of patients were treated for 3 months. In addition, the same period in our hospital physical examination center choose 42 cases of healthy people as a healthy control group. The changes of T cell subsets (CD3 +, CD4 +, CD8 +, CD4 + / CD8 +) and SIL-2R levels before and after treatment were detected and compared. Comparison of measurement data using one-way ANOVA, t test, count data were compared using χ2 test or Fisher exact test. Results Before treatment, there were no significant differences in CD3 +, CD4 +, CD8 + and CD4 + / CD8 between the control group and levocarnitine group (P> 0.05), but there were significant differences between the control group and the healthy control group (P < 0.05). After treatment, the ratio of CD3 +, CD4 + and CD4 + / CD8 + of patients in L-carnitine group was significantly higher than that of before treatment and CD8 + was significantly decreased (P <0.01), and the levels of CD3 +, CD4 +, CD8 + No significant changes in CD4 + / CD8 +. Before treatment, the levels of SIL-2R in the control group and levocarnitine group [(735.42 ± 90.61) and (718.86 ± 88.29) U / ml] were significantly higher than those in the healthy control group [(241.58 ± 37.45) U / ml] (P <0.05), but there was no significant difference between the control group and levocarnitine group (P> 0.05). After treatment, the level of SIL-2R in L-carnitine group was significantly lower than that before treatment [(357.54 ± 42.17) U / ml], and there was no significant difference between the two groups (P> 0.05) obvious change. After treatment, the differences of T lymphocyte subsets and SIL-2R between L-carnitine group and healthy control group were statistically significant (P <0.05). Conclusion L-carnitine treatment of end-stage renal disease maintenance hemodialysis patients can regulate T lymphocyte subsets, and reduce SIL-2R, enhance the body’s cellular immune function.