Effect of low doses of L-carnitine on the response to recombinant human erythropoietin in hemodialyzed children: about two cases.
Effect of low doses of L-carnitine on the response to recombinant human erythropoietin in hemodialyzed children: about two cases.
复制标题
低剂量左旋肉碱对血液透析儿童重组人促红细胞生成素反应的影响：约2例。
作者：
E. Bérard;A. Iordache
亲爱的先生，我们怀着极大的兴趣阅读了Koostra等人的文章。[1]在您最近一期的评论中。这些作者指出，对重组人促红细胞生成素(RhEPO)有抵抗力的成年血液透析患者的卡米丁水平较低。自从tro-vato等人的研究以来。1982年，不同作者报道了大剂量L·卡尼汀(20 mg/kg/d)对血液透析患者贫血的影响[3-6]。透析患者中存在与低水平肌胺结合的心肌炎以及治疗后心肌炎下降的可能性已被广泛讨论[7]。1990年，我们观察了2名13岁和15岁的儿童，分别进行了2.5年和3年的血液透析，尽管接受了超过12个月的重组人促红细胞生成素治疗，剂量高达240-360U/kg/周，但红细胞压积在20-23%之间(铁、维生素B12和叶酸水平正常，没有甲状旁腺功能亢进症)。此外，这些患者在超声检查中心脏收缩能力差，并严重疲劳。它们的卡米丁水平(用分光光度法[8]测量)很低(表1)。在Wanner和Hörl[7]和
E. Bérard, MD, Department of Pediatrics, Hôpital de Cimiez, 4, avenue Reine Victoria, BP179, F-06003 Nice Cedex (France) Dear Sir, We read with great interest the article of Kooistra et al. [1] in a recent issue of your review. These authors noted that adult hemodialyzed patients who are resistant to recombinant human erythropoietin (rhEPO) have low camitine levels. Since the studies of Tro-vato et al. in 1982 [2], different authors have shown the effect of high doses of L·carnitine (20^0 mg/kg/day) on anemia in dialyzed patients [3-6]. The existence of myocarditis bound to low levels of camitine in dialyzed people and the possibility of its decline after treatment have been widely discussed [7]. In 1990, we observed 2 children, 13 and 15 years old, hemodialyzed for 2.5 and 3 years, who, in spite of treatment by rhEPO over 12 months at doses as high as 240-360 U/kg/ week, had hematocrit between 20 and 23% (with normal levels of iron, vitamin B12 and folic acid, and no hyperparathyroidism). In addition, these patients suffered from bad cardiac contractility at ultrasonic examinations and severe tiredness. Their camitine levels (measured by a spectrophotometric method [8]) were low (table 1). Following the recommandation of Wanner and Hörl [7] and