Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan.
Intern Med. 2021;60(22):3533-3542. doi: 10.2169/internalmedicine.7175-21. Epub 2021 Nov 15.
Objective In the present study, we prospectively examined the efficacy of levocarnitine in relieving symptoms of fatigue in patients with cirrhosis but without overt hepatic encephalopathy. Methods Twenty-one cirrhotic patients who were able to undergo fatigue symptom evaluations at our institution were enrolled. A total of 12 cirrhotic patients underwent levocarnitine treatment (1,200-1,800 mg/day), while 9 did not undergo levocarnitine treatment. As primary endpoints, we investigated whether or not levocarnitine treatment exerted any beneficial effects by assessing the symptoms of fatigue [8-item Short-Form Health Survey (SF-8) and Fisk Fatigue Severity Score (FFSS)] at baseline and three months after treatment. Furthermore, as exploratory secondary endpoints, we investigated whether or not levocarnitine treatment exerted ameliorative effects on oxidative stress by assessing the serum thioredoxin (TRX) and urinary 8-hydroxydeoxyguanosine (8-OHdG) levels. Results The median age of the patients was 73 years old. Three men and 18 women were categorized by their Child-Pugh class (A and B in 14 and 7 patients, respectively). There were no significant differences in the clinical laboratory values between the two groups. The FFSS and SF-8 scores were significantly improved in the patients with cirrhosis who underwent levocarnitine treatment (p<0.01) but not in those who did not undergo levocarnitine treatment. Furthermore, three months after levocarnitine treatment, the serum carnitine concentrations were significantly increased, and the serum thioredoxin levels were decreased in the patients with cirrhosis who underwent levocarnitine treatment (p<0.05). Conclusion These results suggest that levocarnitine treatment may relieve symptoms of fatigue in cirrhotic patients by reducing oxidative stress.
在本研究中，我们前瞻性地研究了左卡尼汀缓解无显性肝性脑病的肝硬化患者疲劳症状的疗效。
本研究共纳入 21 名在我院能够进行疲劳症状评估的肝硬化患者。其中 12 名肝硬化患者接受左卡尼汀治疗（1200-1800mg/天），9 名未接受左卡尼汀治疗。作为主要终点，我们通过评估基线和治疗后 3 个月的疲劳症状[8 项简短健康调查（SF-8）和 Fisk 疲劳严重程度评分（FFSS）]，来研究左卡尼汀治疗是否有任何有益效果。此外，作为探索性次要终点，我们通过评估血清硫氧还蛋白（TRX）和尿 8-羟基脱氧鸟苷（8-OHdG）水平，来研究左卡尼汀治疗是否对氧化应激有改善作用。
患者的中位年龄为 73 岁。根据 Child-Pugh 分级，3 名男性和 18 名女性患者分别为 A 级和 B 级（14 名和 7 名患者）。两组患者的临床实验室值无显著差异。接受左卡尼汀治疗的肝硬化患者的 FFSS 和 SF-8 评分显著改善（p<0.01），而未接受左卡尼汀治疗的患者则无显著改善。此外，接受左卡尼汀治疗 3 个月后，肝硬化患者的血清肉碱浓度显著升高，血清硫氧还蛋白水平降低（p<0.05）。
这些结果表明，左卡尼汀治疗可能通过减轻氧化应激缓解肝硬化患者的疲劳症状。
