摘要
Abstract
Objective To investigate the effect of different doses of L-carnitine on the cardiac function in patients with refractory secondary hyperparathyroidism (R-SHPT).Methods We enrolled 43 cases of R-SHPT who needed to undergo the selective parathyroidectomy (PTX) in Aerospace Center Hospital between 2013 and 2016 and divided them into high-dose group (n =22) and conventional-dose group (n =21) by the random number table.The high-dose group received 2-week intravenous injection of 2 g L-carnitine diluted in 20 ml 0.9％ sodium chloride solution,once daily,the total amount of L-carnitine used was 28 g.The conventional-dose group received intravenous injection of 1 g L-carnitine diluted in 20 ml 0.9％ sodium chloride solution at the end of every hemodialysis (three times a week) for two weeks,and the total amount of L-carnitine used was 6 g.The brain natriuretic peptide (BNP),cardiac troponin Ⅰ (cTnI) and left ventricular end-diastolic dimension (LVEDD),interventricular septal thickness at end-diastole (IVSdT),left ventricular posterior wall thickness at end-diastole (LVPWdT),left ventricular ejection fraction (LVEF),and mitral ratio of peak early to late diastolic filling velocity (E/A) were measured in all the patients before and after treatment.Results Before treatment,the values of BNP,cTnI,LVEDD,IVSdT,LVPWdT,LVEF and E/A did not differ significantly between the two groups (P ＞ 0.05).After treatment,the values of LVEF and E/A in the two groups were similar (P ＞ 0.05),but the values of BNP,cTnI,LVEDD,IVSdT and LVPWdT in the conventional-dose group were much higher than those in the high-dose group (P ＜ 0.05);the values of LVEF and E/A in the conventional-dose group did not change significantly as compared with those measured before treatment (P ＞ 0.05),while those of BNP,cTnI,LVEDD,IVSdT and LVPWdT were obviously lower compared with those measured before treatment (P ＜ 0.05);the values of BNP,cTnI,LVEDD,IVSdT and LVPWdT were much lower and those of LVEF and E/A were much higher in the high-dose group compared with those measured before treatment (P ＜ 0.05);the high -dose group had higher proportion of patients meeting the requirements of PTX than the conventional-dose group [63.6％ (14/22) vs.28.6％ (6/21),x2 =5.31,P =0.021].Conclusion High dose of L-carnitine treatment for patients with R-SHPT is better in the aspects of promoting heart function recovery and improving left ventricular remodeling,which could create better opportunity for the patient who would receive PTX.关键词
甲状旁腺功能亢进症,继发性/肾透析/左旋肉毒碱/心肌损伤/心脏结构和功能Key words
Hyperparathyroidism, secondary/Renal dialysis/L-carnitine/Myocardial injury/Cardiac structure and function分类
医药卫生
