Elisaf M, Bairaktari E, Katopodis K, Pappas M, Sferopoulos G, Tzallas C, Tsolas O, Siamopoulos K C
Department of Internal Medicine, Medical School, University of Ioannina, Greece.
Am J Nephrol. 1998;18(5):416-21. doi: 10.1159/000013386.
It has been reported that cumulative carnitine losses through dialysis membranes may worsen hyperlipidemia during long-term hemodialysis. However, carnitine supplementation has not shown a consistent beneficial response. We undertook the present study to determine if there is any hypolipidemic effect of L-carnitine on Greek dialysis patients in concert with the dialysate buffer composition (acetate or bicarbonate). A total of 28 patients (16 male, 12 female), mean age 43 years (range 21-61), with end-stage renal disease on maintenance hemodialysis for a mean period of 25 months (range 7-84) were studied. The dialysis schedule was 4 h, 3 times/week using cuprophane hollow-fiber dialyzers and acetate (n = 14) or bicarbonate (n = 14) dialysate. In all patients L-carnitine (5 mg/kg body weight) was infused intravenously 3 times/week at the end of each hemodialysis session. Blood samples for carnitine and lipid determinations were obtained before treatment, and 3 and 6 months following treatment. Even though L-carnitine did not modify most of the serum lipid levels, a significant decrease in serum triglycerides was evident in the whole group of patients (from 225 +/- 76 to 201 +/- 75 mg/dl, p = 0.03). Furthermore, L-carnitine could decrease serum triglycerides only in hypertriglyceridemic patients (from 260 +/- 64 to 226 +/- 82 mg/dl, p < 0.05). L-Carnitine resulted in a reduction of serum triglycerides in both patients on bicarbonate and on acetate dialysis, while there were no significant differences in the changes of lipid parameters after L-carnitine between the two groups of hemodialysis patients. We conclude that relatively low doses of L-carnitine supplementation could contribute to the management of some hypertriglyceridemic hemodialysis patients.
据报道，在长期血液透析过程中，通过透析膜累积的肉碱损失可能会使高脂血症恶化。然而，补充肉碱并未显示出一致的有益反应。我们进行了本研究，以确定左旋肉碱对希腊透析患者是否具有降血脂作用，以及是否与透析液缓冲液成分（醋酸盐或碳酸氢盐）有关。共研究了28例患者（16例男性，12例女性），平均年龄43岁（范围21 - 61岁），患有终末期肾病，维持性血液透析平均时间为25个月（范围7 - 84个月）。透析方案为每周3次，每次4小时，使用铜仿中空纤维透析器和醋酸盐（n = 14）或碳酸氢盐（n = 14）透析液。所有患者在每次血液透析结束时每周静脉输注3次左旋肉碱（5 mg/kg体重）。在治疗前以及治疗后3个月和6个月采集血液样本测定肉碱和血脂。尽管左旋肉碱并未改变大多数血清脂质水平，但整个患者组的血清甘油三酯明显降低（从225±76降至201±75 mg/dl，p = 0.03）。此外，左旋肉碱仅能降低高甘油三酯血症患者的血清甘油三酯（从260±64降至226±82 mg/dl，p < 0.05）。左旋肉碱使接受碳酸氢盐和醋酸盐透析的患者血清甘油三酯均降低，而两组血液透析患者在接受左旋肉碱治疗后脂质参数变化无显著差异。我们得出结论，相对低剂量补充左旋肉碱有助于管理一些高甘油三酯血症血液透析患者。
