| 特集名 | 透析とカルニチン | |
|---|---|---|
| 題名 | カルニチンと貧血 | |
| 発刊年月 | 2000年 02月 | |
| 著者 | 庭山 淳 | 東京女子医科大学附属第二病院内科 |
| 著者 | 佐中 孜 | 東京女子医科大学附属第二病院内科 |
| 【 要旨 】 | カルニチンは，筋肉組織中に発見された脂質代謝の補酵素で，肝臓で合成され，諸臓器に広く分布する．カルニチン，なかでもアシルカルニチンは，経口摂取，体内産生(肝，骨格筋など)により血液中に供給される．透析患者では，ほぼすべての患者において，透析療法の進行とともに減少する．これは透析療法に伴う喪失が原因であると推察される．腎性貧血に対するエリスロポエチン必要量は，血中総カルニチン濃度，遊離カルニチン濃度が低いほど増す．筆者らは，カルニチン欠乏が骨髄細胞を障害し，その結果として赤血球の産生が低下すると考え，カルニチン投与にてヘマトクリット上昇例を経験している．エリスロポエチン抵抗性貧血に対して，カルニチン投与は有効な治療と考えられる． | |
| Theme | Dialysis Therapy and Carnitine | |
|---|---|---|
| Title | Renal anemia and carnitine | |
| Author | Jun Niwayama | Department of Internal Medicine, Tokyo Women's Medical University Dai-ni Hospital |
| Author | Tsutomu Sanaka | Department of Internal Medicine, Tokyo Women's Medical University Dai-ni Hospital |
| [ Summary ] | Carnitine plays an important roll in heart and skeletal muscle energy metabolism, as a carrier of long-chain fatty acids into the mitochondria, for oxidation. Deficiencies in carnitine are not present before the institution of dialysis. These deficiencies might be due to excessive losses of carnitine during diclyss, decreased endogenous biosynthesis of carnitine, or decreased intake of meat and dairy products by the uremic patient. In patients undergoing hemodialysis, serum carnitine deficiencies were reduced as was the relation of serum total-carnitine levels (acylcarnitine estero) and maintenance rhEPO dosages. We suggested that deficiencies in carnitine levels were causing bone-morrow suppression. Trials of L-carnitine supplementation in patients with anemia of rhEPO resiatance, demonstrated increases in hematocrit. The results of this study suggest this L-carnitine substitution improves response to rhEPO treatment, also that rh-EPO dosages could be reduced by half, and that it is effective in patients with anemia associated with of rh-EPO resistance. |
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