2025 年第 7 期 第 20 卷

左卡尼汀联合维持性血液透析对慢性肾脏病患者炎症因子水平及心功能的影响

Effects of levocarnitine combined with maintenance hemodialysis on inflammatory factors levels and cardiac function in patients with chronic kidney disease

作者：冯季1孙亦兵1刘淑婷1刘月英1赵东霞2黄晓梦3

英文作者：Feng Ji1 Sun Yibing1 Liu Shuting1 Liu Yueying1 Zhao Dongxia2 Huang Xiaomeng3

单位：1河北北方学院附属第一医院血液净化科，张家口075000；2河北北方学院附属第一医院核医学科，张家口075000；3河北北方学院附属第一医院医务处，张家口075000

英文单位：1Department of Blood Purification the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China; 2Department of Nuclear Medicine the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China; 3Department of Medical Service the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China

关键词：慢性肾脏病；左卡尼汀；维持性血液透析；炎症因子水平；心功能

英文关键词：Chronickidneydisease;Levocarnitine;Maintenancehemodialysis;Inflammationfactorslevels;Cardiacfunction

• 摘要：

• 目的 探索左卡尼汀联合维持性血液透析（MHD）对慢性肾脏病（CKD）患者炎症因子水平及心功能的影响。方法 前瞻性选取2022年6月至2023年9月在河北北方学院附属第一医院透析治疗的106例CKD患者作为研究对象。根据随机数字表法分为对照组和观察组，各53例。对照组采用MHD治疗，观察组采用左卡尼汀联合MHD治疗，均治疗3个月。比较2组治疗前后炎症因子水平、肾功能、心脏功能、Klotho蛋白、鸢尾素水平，并分析患者炎症因子水平与心功能指标相关性。结果 观察组治疗后3个月C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、左心室射血分数（LVEF）、B型脑钠肽、心输出量、Klotho蛋白、鸢尾素水平改善情况均优于对照组（均P＜0.05）。同时，观察组治疗后1个月和3个月血尿酸、血尿素氮、血肌酐水平均低于对照组（均P＜0.05）。Pearson分析结果显示，CRP与B型脑钠肽呈正相关（P＜0.05）；TNF-α与LVEF、心输出量呈负相关，与B型脑钠肽呈正相关（均P＜0.05）；IL-6与LVEF、心输出量呈负相关，与B型脑钠肽呈正相关（均P＜0.05）。观察组透析期间并发症发生率低于对照组［3.8%(2/53)比15.1%(8/53)］（P=0.046）。结论 对CKD患者实施左卡尼汀联合MHD治疗，能更好地改善炎症状态，减轻心脏负荷，并降低透析相关并发症发生率。

• Objective  To explore the effects of levocarnitine combined with maintenance hemodialysis (MHD) on inflammatory factors levels and cardiac function in patients with chronic kidney disease (CKD). Methods A total of 106 CKD patients treated with dialysis in the First Affiliated Hospital of Hebei North University from June 2022 to September 2023 were prospectively selected as the research objects. According to the random number table method, they were divided into the control group and the observation group, with 53 cases in each group. The control group was treated with MHD, and the observation group was treated with levocarnitine combined with MHD. Both groups were treated for 3 months. The levels of inflammatory factors, renal function, cardiac function, Klotho protein and irisin before and after treatment were compared between the two groups, and the correlation between the levels of inflammatory factors and cardiac function indexes was analyzed. Results The improvement of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), left ventricular ejection fraction (LVEF), brain natriuretic peptide, cardiac output, Klotho protein and irisin levels in the observation group were better than those in the control group 3 months after treatment (all P＜0.05). At the same time, the levels of blood uric acid, blood urea nitrogen and serum creatinine in the observation group were lower than those in the control group at 1 month and 3 months after treatment (all P＜0.05). Pearson analysis showed that CRP was positively correlated with brain natriuretic peptide (all P＜0.05). TNF-α was negatively correlated with LVEF and cardiac output, and positively correlated with brain natriuretic peptide (all P＜0.05). IL-6 was negatively correlated with LVEF and cardiac output, and positively correlated with brain natriuretic peptide (all P＜0.05). The incidence of complications during dialysis in the observation group was lower than that in the control group ［3.8%(2/53) vs 15.1%(8/53)］(P=0.046). Conclusion Levocarnitine combined with MHD treatment in patients with CKD can better improve the inflammatory state, reduce the cardiac load, and reduce the incidence of dialysis-related complications.