Carnitine abnormalities in patients with renal insufficiency. Pathophysiological and therapeutical aspects.
Carnitine abnormalities in patients with renal insufficiency. Pathophysiological and therapeutical aspects.
复制标题
肾功能不全患者的肉碱异常。
作者：
Christoph Wanner;W. H. Hörl
自从Böhmer等人[I]报道慢性血液透析(HD)治疗的终末期肾衰患者表现出肉碱代谢紊乱和肉碱缺乏症以来，L-肉碱疗法已引起尼泊尔社会学家的兴趣。近年来，许多研究人员试图证明外源性应用L肉碱可改善尿毒症诱导的亚病理改变。然而，在患有这种继发性肉碱缺乏症的患者中，关于补充L肉碱的益处的结果并不一致。方法学的进步为慢性尿毒症状态下肉碱代谢的机制提供了新的见解。本文着重介绍了肉碱代谢在各种肾功能不全中的研究现状，并着重介绍了L-卡尼汀疗法的作用。比女性更重要[9]。然而，如果慢性肾功能衰竭破坏了肾脏的结构和代谢的完整性，就有可能扰乱卡尼汀的生物合成或改变前体的器官分布调节。可排除血浆6-N-三甲基赖氨酸缺乏是尿毒症肉碱缺乏的潜在原因。HD患者透析前的三甲基赖氨酸浓度是正常人的四倍。在血液透析过程中，三甲基赖氨酸被大量去除，但透析后的数值仍高于正常[10]。
L-Carnitine therapy has become of interest for neph rologists, since Böhmer et al.[I] reported that patients with end-stage renal failure on chronic hemodialysis (HD) treatment display disturbed carnitine metabolism and carnitine deficiency. During recent years many re searchers have tried to demonstrate that exogenous ad ministration of L-carnitine improves uremia-induced subpathologies. However, inconsistent results about the benefits of L-carnitine supplementation have been re ported in patients suffering from this secondary form of carnitine deficiency. Advances in methodology gave new insights into the mechanism of carnitine metabolism in chronically uremic states. This review highlights the cur rent knowledge of carnitine metabolism in various forms of renal insufficiency and focuses particularly on the role of L-carnitine therapy. sine than females [9]. If, however, the structural and metabolic integrity of the kidneys is destroyed by chronic renal failure, a disturbance of the biosynthesis of carni tine or altered regulation of the organ distribution of the precursors could be possible. Deficiency of plasma 6-N-trimethyllysine as a potential cause of carnitine defi ciency in uremia could be ruled out. HD patients exhibit about fourfold higher predialysis concentrations of trimethyllysine than normal persons. Trimethyllysine is removed in great quantities during HD, but postdialysis values are still above normal [10],