Improvement of Myocardial Fatty Acid Metabolism through L-Carnitine Administration to Chronic Hemodialysis Patients
Improvement of Myocardial Fatty Acid Metabolism through L-Carnitine Administration to Chronic Hemodialysis Patients
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慢性血液透析患者服用左旋肉碱改善心肌脂肪酸代谢
DOI：
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发表时间：
1999
影响因子：
4.2
通讯作者：
Takamichi Nakamura
中科院分区：
文献类型：
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作者：
T. Sakurabayashi;Yoshiji Takaesu;Susumu Haginoshita;T. Takeda;I. Aoike;S. Miyazaki;Y. Koda;Y. Yuasa;S. Sakai;Masashi Suzuki;Sachio Takahashi;Y. Hirasawa;Takamichi Nakamura
在长期血液透析合并危及生命的心脏损伤的患者中，对脂肪酸新陈代谢至关重要的肉碱浓度会显著降低。而L-卡尼汀的应用改善了这些患者的心功能。为了评估这种现象的潜在事件，我们使用了最近开发的技术，即123I标记的β-甲基-对碘苯基-十五烷酸(BMIPP)心肌闪烁成像，作为心肌脂肪酸代谢的测试。结果表明，11例慢性透析患者血浆游离肉碱浓度(19.2±6.5Mol/L)明显低于8例健康对照组(49.3±7.7Mol/μ，P<0.0001)。结果显示，11例慢性透析患者血浆游离肉碱浓度(19.2±6.5Mol/L)明显低于8例健康对照组(49.3±7.7Mol/L，P<0.0001)。BMIPP患者的心纵隔比(H/M)明显高于对照组(1.91±0.19vs.1.52±0.24，P<0.005)，洗净率低于对照组(17.2±6.0vs.22.8±4.2%，P<；0.05)。口服L肉碱1g/d，1个月和0.5g/d后，血清游离肉碱浓度升高至85.4±27.0moL/L(p<；0.0001)。H/M比值虽无明显变化(1.89±0.2)，但WOR增加到21.9±6.6%(p<；0.001)，与对照组相似。超声心动图显示左室舒张末期内径和左室短轴缩短率无明显变化。提示慢性血液透析患者存在肉碱缺乏症，其心肌脂肪酸代谢紊乱，补充L肉碱可改善心肌脂肪酸代谢。
The concentration of carnitine, which is essential to fatty acid metabolism, can decrease markedly in patients on long-term hemodialysis coincident with life-threatening cardiac damage. However, administration of L-carnitine improves the myocardial function of these patients. To evaluate the underlying events of this phenomenon, we used recently developed technology, 123I-labeled β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) myocardial scintigraphy, as a test of myocardial fatty acid metabolism. Our results showed that the free carnitine concentration (19.2 ± 6.5 μmol/l) was lower in 11 chronically dialyzed patients than in 8 healthy controls (49.3 ± 7.7 μmol/l, p < 0.0001). Additionally the heart to mediastinal ratio (H/M) of BMIPP was higher for these patients than for the controls (1.91 ± 0.19 vs. 1.52 ± 0.24, p < 0.005), and the patients’ washout rate (WOR) of BMIPP was lower (17.2 ± 6.0 vs. 22.8 ± 4.2%, p < 0.05). After L-carnitine was administered orally to the patients at doses of 1 g/day for 1 month and 0.5 g/day for the following month, the concentration of free carnitine in their sera increased to 85.4 ± 27.0 μmol/l (p < 0.0001). Although the H/M ratio did not change (1.89 ± 0.20) with this treatment, their WOR increased to 21.9 ± 6.6% (p < 0.001), similar to that of controls. The left ventricular end-diastolic dimension and left ventricular fractional shortening remained unchanged, as shown by echocardiography. The results presented here denote that a carnitine deficiency in chronically hemodialyzed patients disrupts their myocardial fatty acid metabolism, which is improved by L-carnitine supplementation.