Department of Nephrology, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010, USA.
Pediatr Nephrol. 2012 Aug;27(8):1381-7. doi: 10.1007/s00467-012-2144-6. Epub 2012 Mar 22.
Carnitine plays a key role in energy production in the myocardium. Carnitine deficiency commonly occurs in patients on chronic hemodialysis (HD) and may contribute to cardiomyopathy.
Carnitine levels and cardiac function of nine children on HD were assessed before and after 6 months of intravenous levocarnitine supplementation. Standard echocardiographic (ECHO) measures of left ventricular (LV) function as well as strain and strain rate analysis using novel speckle-tracking echocardiography were performed and the results compared to those of a control group of children on chronic HD.
Following carnitine supplementation, total (49.0 ± 1.67 vs. 298.0 ± 31.8 μmol/L) and free carnitine (29.0 ± 1.20 vs. 180.4 ± 19.2 μmol/L) increased (p < 0.0001), and the acyl:free (A:F) carnitine ratio improved (0.73 ± 0.04 vs. 0.65 ± 0.05; p = 0.02). There were no changes in standard ECHO measures of LV function, including end diastolic dimension, mass index, ejection fraction, and fractional shortening. There was significant (p = 0.017) improvement in the longitudinal strain rate (-1.48 ± 0.11 vs -1.91 ± 0.12) after carnitine supplementation in the study group. No improvements in LV function, strain, or strain rate occurred in controls.
Levocarnitine supplementation improved carnitine levels, the A:F ratio, and longitudinal strain rate in children on HD.
肉碱在心肌能量产生中起着关键作用。慢性血液透析（HD）患者常出现肉碱缺乏，可能导致心肌病。
评估了 9 名接受 HD 的儿童在静脉给予左卡尼汀补充 6 个月前后的肉碱水平和心脏功能。进行了标准超声心动图（ECHO）左心室（LV）功能测量以及使用新型斑点追踪超声心动图的应变和应变率分析，并将结果与接受慢性 HD 的儿童的对照组进行比较。
补充肉碱后，总（49.0±1.67 与 298.0±31.8 μmol/L）和游离肉碱（29.0±1.20 与 180.4±19.2 μmol/L）增加（p<0.0001），酰基：游离（A:F）肉碱比改善（0.73±0.04 与 0.65±0.05；p=0.02）。LV 功能的标准 ECHO 测量值没有变化，包括舒张末期内径、质量指数、射血分数和缩短分数。研究组补充肉碱后，纵向应变率（-1.48±0.11 与 -1.91±0.12）显著改善（p=0.017）。对照组的 LV 功能、应变或应变率均无改善。
左卡尼汀补充可改善 HD 儿童的肉碱水平、A:F 比值和纵向应变率。
