摘要
目的探讨左旋肉碱通过调控MAPK通路抑制维持性血液透析(MHD)患者体内炎症因子表达的机制。方法选择MHD患者120例,所有患者均采用自体动静脉内瘘为血管通路,血液透析时间均>3个月。按随机数字表法分为治疗组和对照组各60例。每次透析结束时,对照组从透析通路静脉端注射0.9%氯化钠注射液20 ml;治疗组注射100 g/L左旋肉碱20 ml,共3个月。观察治疗前后两组患者体力、精神状态、透析中肌肉痉挛临床症状情况。记录并比较外周血巨噬细胞M1/M2比例变化、外周血C-反应蛋白(CRP)、白介素-1(IL-1)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、IL-10和转化生长因子β(TGF-β)的变化。检测外周巨噬细胞MAPK、JNK及c-JUN基因表达,及外周巨噬细胞MAPK蛋白、JNK蛋白、c-JUN蛋白及其磷酸化情况。结果治疗组注射左旋肉碱治疗后与对照组进行比较,乏力、疲劳及肌肉痉挛现象发生率明显降低,差异有统计学意义(χ^2分别=13.32、15.25、11.37,P均<0.05);治疗后治疗组外周血巨噬细胞M1/M2比值比对照降低更加明显(t=4.39,P<0.05);治疗组治疗后血清中促炎性因子CRP、IL-1、IL-6及TNF-α水平较对照组更低,抗炎性因子IL-10及TGF-β水平较对照组更高(t分别=2.55、3.26、4.33、5.19、-3.89、-4.55,P均<0.05);治疗组患者治疗后外周巨噬细胞MAPK mRNA、JNK mRNA及c-JUN mRNA表达较对照组明显减弱(t分别=2.23、3.33、4.11,P均<0.05),MAPK、JNK、c-JUN蛋白及其磷酸化水平明显减弱,巨噬细胞c-JUN/MAPK信号通路受到抑制。结论左旋肉碱通过调控巨噬细胞MAPK通路减轻MHD患者体内微炎症症状。
Objective To explore the mechanism of levo-carnitine inhibiting the expression of inflammatory factors in maintenance hemodialysis(MHD)patients by regulating MAPK pathway.Methods A total of 120 patients with maintenance hemodialysis with autologous arteriovenous internal fistula as vascular access were selected,and the hemodialysis duration of all cases was longer than 3 months.According to random number table,120 cases were divided into treatment group and control group.At the end of dialysis,the control group was injected with 20ml normal saline.The treatment group was injected with 100g/L levo-carnitine 20ml.It lasts for three months.Before and after the treatment,the physical strength,mental state and the clinical situation of muscle spasm in dialysis were observed.The changes of M1/M2 ratio,C-reactive protein(CRP),interleukin-1(IL-1),interleukin-6(IL-6),TNF-α,IL-10 and TGF-βwere recorded and compared.The expression of MAPK,JNK and c-JUN in peripheral macrophages,MAPK,JNK and their phosphorylation,c-JUN and their phosphorylation were detected.Results After injection of levo-carnitine,the incidences of fatigue,fatigue and muscle spasm in the treatment group were significantly lower than those in the control group(χ^2=13.32,15.25,11.37,P<0.05),and the M1/M2 ratio of peripheral blood macrophages in the treatment group was significantly lower than that in the control group(t=4.39,P<0.05).After treatment,the serum levels of pro-inflammatory factors CRP,IL-1,IL-6 and TNF-αin the treatment group were lower than those in the control group,while the levels of anti-inflammatory factors IL-10 and TGF-βin the treatment group were higher than those in the control group(t=2.55,3.26,4.33,5.19,-3.89,-4.55,P<0.05).After treatment,the expressions of MAPK mRNA,JNK mRNA and c-JUN mRNA in peripheral macrophages in the treatment group were significantly lower than those in the control group(t=2.23,3.33,4.11,P<0.05)as well as the MAPK,JNK,c-JUN protein and their phosphorylation levels,and the c-JUN/MAPK signal pathway of macro
作者
姚书东
吴佳
罗文荣
YAO Shudong;WU Jia;LUO Wenrong(Department of Nephrology,Huzhou Hospital of Traditional Chinese Medicine,Zhejiang University of Traditional Chinese Medicine,Huzhou 313000,China)
出处
《全科医学临床与教育》
2020年第6期488-492,共5页
Clinical Education of General Practice
基金
公益性技术应用研究(一般)(2018GY35)。
