[1]张文吉,赵瑛瑛,张宛哲.左卡尼汀联合自动腹膜透析治疗老年糖尿病肾病疗效观察[J].新乡医学院学报,2022,39(9):865-870.[doi:10.7683/xxyxyxb.2022.09.014]
　ZHANG Wenji,ZHAO Yingying,ZHANG Wanzhe.Efficacy of levocarnitine combined with automatic peritoneal dialysis in the treatment of elderly patients with diabetic nephropathy[J].Journal of Xinxiang Medical University,2022,39(9):865-870.[doi:10.7683/xxyxyxb.2022.09.014]
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左卡尼汀联合自动腹膜透析治疗老年糖尿病肾病疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年9
页码:
865-870
栏目:
临床研究
出版日期:
2022-09-05

文章信息/Info

Title:
Efficacy of levocarnitine combined with automatic peritoneal dialysis in the treatment of elderly patients with diabetic nephropathy
作者:
张文吉; 赵瑛瑛; 张宛哲
（郑州大学第二附属医院肾病风湿免疫科，河南　郑州　450014）
Author(s):
ZHANG Wenji; ZHAO Yingying; ZHANG Wanzhe
(Department of Nephrology,Rheumatology and Immunology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,Henan Province,China)
关键词:
左卡尼汀; 自动腹膜透析; 糖尿病肾病; 炎症微环境; 红细胞免疫功能
Keywords:
levocarnitine; automated peritoneal dialysis; diabetic nephropathy; inflammatory microenvironment; red blood cell immune function
分类号:
R459.5
DOI:
10.7683/xxyxyxb.2022.09.014
文献标志码:
A
摘要:
目的　探讨左卡尼汀联合自动腹膜透析治疗老年糖尿病肾病（DN）的临床疗效及对患者肾血流状态、肾功能、营养状况、微炎症、红细胞（RBC）免疫功能的影响。方法　选择2017年6月至2021年1月郑州大学第二附属医院收治的92例老年DN患者为研究对象，根据治疗方法将患者分为对照组和观察组，每组46例。所有患者给予常规治疗，包括降血糖、控制血压、纠正酸碱平衡紊乱、控制饮食等。在常规治疗基础上，对照组患者给予自动腹膜透析，每次持续透析8~10 h，每周4次，连续治疗3个月。在对照组治疗基础上，观察组患者给予左卡尼汀1 g，口服，每日2次，连续治疗3个月。治疗后，评估2组患者的临床疗效，并计算总有效率。分别于治疗前后，使用彩色多普勒超声系统检测2组患者的肾血流参数，包括肾内段动脉舒张末期血流速度（EDV）、收缩期峰值血流速度（PSV）、搏动指数（PI）、阻力指数（RI）。分别于治疗前后，收集2组患者空腹肘静脉血3 mL，使用全自动生物化学分析仪测定患者血尿素氮（BUN）、血肌酐（Scr）、血红蛋白（Hb）及白蛋白（Alb）水平；采用双抗体夹心酶联免疫吸附试验测定患者血清白细胞介素-6（IL-6）、超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）水平；采用酵母花环试验测定患者空腹静脉血中红细胞免疫复合物花环率（RBC-ICR）、红细胞C3b受体花环率（RBC-C3bRR）、CD35＋RBC百分比。分别于治疗前后，使用皮褶计测量患者肱三头肌皮褶厚度（TSF）；留取患者24 h尿液，使用尿微量蛋白检测仪测定患者24 h尿蛋白定量（24 h UP）。结果　观察组和对照组患者的治疗总有效率分别为93.48%（43/46）、76.09%（35/46）；观察组患者的治疗总有效率显著高于对照组（χ2=4.130,P<0.05）。2组患者治疗后的肾内段动脉EDV、PSV显著高于治疗前，PI、RI显著低于治疗前（P<0.05）；治疗后，观察组患者的肾内段动脉PI、RI显著低于对照组，EDV、PSV显著高于对照组（P<0.05）。2组患者治疗后的BUN、Scr水平及24 h UP均显著低于治疗前（P<0.05）；治疗后，观察组患者的BUN、Scr水平及24 h UP均显著低于对照组（P<0.05）。2组患者治疗后的血清Hb、Alb水平及TSF均显著高于治疗前（P<0.05）；治疗后，观察组患者的血清Hb、Alb水平及TSF均显著高于对照组（P<0.05）。2组患者治疗后的血清IL-6、hs-CRP、TNF-α水平均显著低于治疗前（P<0.05）；治疗后，观察组患者的血清IL-6、hs-CRP、TNF-α水平均显著低于对照组（P<0.05）。2组患者治疗后的RBC-ICR显著低于治疗前，RBC-C3bRR、CD35＋RBC百分比显著高于治疗前（P<0.05）；治疗后，观察组患者的RBC-ICR显著低于对照组，RBC-C3bRR、CD35＋RBC百分比显著高于对照组（P<0.05）。结论　左卡尼汀联合自动腹膜透析治疗可有效改善老年DN患者微炎症反应状态，提高RBC免疫功能，纠正营养不良，改善肾功能及肾血流状态。
Abstract:
Objective　To investigate the clinical curative effect of levocarnitine combined with automatic peritoneal dialysis in the treatment of elderly patients with diabetic nephropathy (DN) and the effect on the renal blood flow status,renal function,nutritional status,microinflammation and immune function of red blood cell (RBC) of patients.Methods　A total of 92 elderly DN patients admitted to the Second Affiliated Hospital of Zhengzhou University from June 2017 to January 2021 were selected as the research subjects.The patients were divided into the control group and the observation group according to the treatment method,with 46 cases in each group.All patients were given conventional treatment,including hypoglycemia,blood pressure control,correction of acid-base balance disorder and diet control.On the basis of conventional treatment,the patients in the control group were given automatic peritoneal dialysis for 8-10 hours each time with continuous dialysis,4 times a week for 3 months.On the basis of the treatment of the control group,the patients in the observation group were given levocarnitine 1 g orally,twice daily for 3 months.After treatment,the clinical efficacy of patients in the two groups was assessed and the total effective rate was calculated.Before and after treatment,the renal blood flow parameters,including end diastolic velocity (EDV),peak systolic velocity (PSV),pulse index (PI) and resistance index (RI) were measured by colour Doppler ultrasound system.Before and after treatment,3 mL of fasting elbow venous blood of patients in the two groups was collected,and the levels of blood urea nitrogen (BUN),serum creatinine (Scr),hemoglobin (Hb) and Alb (albumin) of patients in the two groups were determined by the automatic biochemical analyzer.The serum levels of interleukin-6 (IL-6),hypersensitive C-reactive protein (hs-CRP) and tumour necrosis factor-α (TNF-α) of patients were determined by double antibody sandwich enzyme-linked immunosorbent assay；the red blood cell-immune complex rosette rate (RBC-ICR),red blood cell-C3b receptor rosette rate (RBC-C3bRR) and CD35+ RBC percentage in fasting venous blood of patients were detected by Yeast rosette test.Before and after treatment,the triceps skinfold thickness (TSF) was measured by skinfold meter;24-hour urine was collected,and the 24-hour urine protein (24 h UP) quantification was measured by urine microprotein detector.Results　The total effective rates of patients in the observation group and the control group were 93.48% (43/46) and 76.09% (35/46),respectively;the total effective rate of patients in the observation group was significantly higher than that in the control group (χ2=4.130,P<0.05).The EDV and PSV in the intrarenal segment artery of patients in the two groups after treatment were significantly higher than those before treatment (P<0.05);after treatment,the PI and RI in the intrarenal segment artery of patients in the observation group were significantly lower than those in the control group,and the EDV and PSV were significantly higher than those in the control group (P<0.05).The levels of BUN,Scr and 24 h UP of patients in the two groups after treatment were significantly lower than those before treatment (P<0.05);after treatment,the levels of BUN,Scr and 24 h UP of patients in the observation group were significantly lower than those in the control group (P<0.05).The Hb,Alb levels in serum and TSF of patients in the two groups after treatment were significantly higher than those before treatment (P<0.05);after treatment,the Hb,Alb levels in serum and TSF of patients in the observation group were significantly higher than those in the control group (P<0.05).The levels of serum IL-6,hs-CRP and TNF-α of patients in the two groups after treatment were significantly lower than those before treatment (P<0.05);after treatment,the levels of serum IL-6,hs-CRP and TNF-α of patients in the observation group were significantly lower than those in the control group (P<0.05).The RBC-ICR of patients in the two groups after treatment was significantly lower than that before treatment,and the RBC-C3bRR,the percentage of CD35+RBC were significantly higher than those before treatment (P<0.05);after treatment,the RBC-ICR of patients in the observation group was significantly lower than that in the control group,and the RBC-C3bRR,the percentage of CD35+RBC of patients in the observation group were significantly higher than those in the control group (P<0.05).Conclusion　Levocarnitine combined with automatic peritoneal dialysis in the treatment of elderly patients with DN can effectively improve the patient′s micro-inflammatory response state,improve RBC immune function,correct malnutrition,and improve renal function and renal blood flow.

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更新日期/Last Update: 2022-09-05