Cardioprotective Effects Of L-carnitine In Maintenance Hemodialysis Patients

Background Cardiovascular disease(CVD)is the main cause of death in end-stage renal disease(ESRD)patients,especially in maintenance hemodialysis(MHD)patients.In recent years,the relationship between abnormal energy metabolism of cardiomyocytes and concurrent CVD in MHD patients has become a hotspot in basic and clinical research at home and abroad.Studies have confirmed that myocardial cell energy metabolism disorders are associated with CVD,especially in patients with heart failure,and this phenomenon is associated with progressive fatty acid oxidation [1].L-carnitine(L-CN)is an important cofactor in the metabolism of fatty acids in human body.Its main function is to transport long-chain fatty acids into the mitochondrial endoplasmic reticulum,promote its oxidative decomposition,and provide enough for the body tissues and organs.Adenotriphos(ATP)is a key controlling factor in oxidative metabolism and energy transport of cardiomyocytes.Since the introduction of L-CN,more and more experts and scholars have a broad understanding of its biological characteristics and physiological effects,but for L-CN in MHD patients with CVD in cardiac function and structure,renal anemia,microinflammation The clinical therapeutic effects of status and nutritional status have rarely been reported.Objective To observe the effects of L-CN on cardiac structure,function and non-traditional risk factors of cardiovascular disease in patients with MHD complicated with CVD: renal anemia,serum nutritional status,inflammatory factor levels;clinical application of L-CN to improve hemodialysis-related complications value.Method A total of 60 patients with ESRD combined with CVD who underwent regular dialysis treatment(3 times a week,4 hours each)for more than 6 months in the Department of Blood Purification,Tai’an Central Hospital from February 2017 to June 2018.They were randomly divided into treatment group and control group,30 cases in each group.All patients underwent conventional treatment with ESRD complicated with CVD(such as controlling blood pressure,diuresis,improving renal anemia,correcting calcium and phosphorus metabolic disorders,cardiac strengthening,etc.).The treatment group was treated with L-CN on the basis of conventional treatment.Immediately after the end of each hemodialysis,1.0 ml of L-CN saline was added intravenously 20 ml,and the control group was given intravenous saline 20 ml,and the two groups were closely Observed for 3 months.Comparison of cardiac function improvement criteria,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diamete(LVEDD),and left ventricular end-systolic diameter(LVEDS),hemoglobin(HB),red blood cell(RBC),hematocrit(Hct),total protein(TP),albumin(AIbu),anterior white Protein(Prealbumin,ALP),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α).The level of change ofhe above indexes was analyzed by SPSS25.0 software.The t-test and x2 test were used to compare the changes of the above indexes between before and after treatment and between the two groups(P<0.05).Result 1.After 3 months of treatment,the cardiac function of the two groups(New York Heart Association NYHA classification)was significantly improved,and the total effective rate of the two groups was significantly different(P<0.05).2.After 3 months of treatment,the cardiac ultrasound index of the treatment group: left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVEDS)was significantly smaller than before treatment,left ventricular ejection fraction(LVEF)compared with before treatment There was a significant increase(P<0.05),and the difference was statistically significant.However,compared with the control group,the improvement of the above indicators in the treatment group was more significant,and the difference was statistically significant(P<0.05).3.After 3 months of treatment,the anemia indicators of the two groups: hemoglobin(HB),red blood cells(RBC),and hematocrit(Hct)were higher than those before treatment(P<0.05);The control group was more significant,and the difference was statistically significant(P<0.05).4.After 3 months of treatment,the nutritional status of the two groups: total protein(TP),albumin(AIb),prealbumin(ALP)were higher than before treatment(P<0.05);The height was more obvious than the control group,and the difference was statistically significant(P<0.05).5.After 3 months of treatment,the microinflammation status indicators of the two groups: high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)were different degrees.The difference was statistically significant(p<0.05);however,the degree of reduction in the treatment group was significantly better than that in the control group,and the difference was statistically significant(P<0.05).6.During the use of L-CN,two patients(6.67%)in the treatment group developed nausea and vomiting,which was quickly relieved after symptomatic treatment.The remaining patients did not have new symptoms associated with L-CN medication.Statistical significance(P>0.05).Conclusion 1.L-CN can significantly improve the heart structure and function of patients with MHD complicated with CVD,effectively correct renal anemia,improve malnutrition and micro-inflammatory state,reduce the risk of CVD,and have cardioprotective effects.2.Exogenous L-CN has fewer adverse reactions,better clinical tolerance,and has important clinical application value.