.: ORİJİNAL ARAŞTIRMA
The Influence of L-Carnitine in the Complex Treatment of Patients with Renal Dysfunction Who Have Synchronous Chronic Coronary Artery Disease and Prostate Adenocarcinoma
Eş Zamanlı Kronik Koroner Arter Hastalığı ve Prostat Adenokarsinoması Olan Renal Disfonksiyonlu Hastaların Kompleks Tedavisinde L-Karnitinin Etkisi
Turkiye Klinikleri J Med Sci. 2019;39(4):381-8
doi: 10.5336/medsci.2019-65452
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: The aim of the study is to evaluate the effect of L-Carnitine on the dynamics of inflammation, insulin resistance (IR), functional status of kidneys in the complex therapy of patients with coronary heart disease (CHD) in combination with prostate adenocarcinoma and renal dysfunction. Material and Methods: Forty two men with prostate adenocarcinoma and coronary heart disease were enrolled. The patients were randomly and blindly divided into 2 groups: Group I patients were treated with L-Carnitine in addition to standard treatment; Group II patients received only conventional treatment. Standard laboratory blood tests, lipid profile, glucose, renal and liver function tests, serum C-reactive protein (CRP), insulin, testosterone levels, echocardiographic examination were performed for all patients at baseline and after 10 days of treatment. Results:Median level of HOMA index was 3.1 [1.9; 4.8] mg/ml. Insulin resistance was established in 54.8% patients of Group I and 40% patients of control group (p<0.05). In Group I, the mean insulin index and HOMA index decreased by 15.4% (p=0.001) and 19.2% (p=0.003), respectively. The supplementation of L-Carnitine in standard therapy contributed to a significant decrease in serum creatinine level and an increase in the level of glomerular filtration rate (GFR) in Group I patients (p<0.05). Conclusion: The supplementation of L-Carnitine in the complex therapy of patients with coronary artery disease in combination with prostate adenocarcinoma contributes to a significant decrease in insulin resistance, improves the functional state of kidneys.
Keywords: Insulin resistance; carnitine; coronary disease; prostatic neoplasms
Objective: The aim of the study is to evaluate the effect of L-Carnitine on the dynamics of inflammation, insulin resistance (IR), functional status of kidneys in the complex therapy of patients with coronary heart disease (CHD) in combination with prostate adenocarcinoma and renal dysfunction. Material and Methods: Forty two men with prostate adenocarcinoma and coronary heart disease were enrolled. The patients were randomly and blindly divided into 2 groups: Group I patients were treated with L-Carnitine in addition to standard treatment; Group II patients received only conventional treatment. Standard laboratory blood tests, lipid profile, glucose, renal and liver function tests, serum C-reactive protein (CRP), insulin, testosterone levels, echocardiographic examination were performed for all patients at baseline and after 10 days of treatment. Results:Median level of HOMA index was 3.1 [1.9; 4.8] mg/ml. Insulin resistance was established in 54.8% patients of Group I and 40% patients of control group (p<0.05). In Group I, the mean insulin index and HOMA index decreased by 15.4% (p=0.001) and 19.2% (p=0.003), respectively. The supplementation of L-Carnitine in standard therapy contributed to a significant decrease in serum creatinine level and an increase in the level of glomerular filtration rate (GFR) in Group I patients (p<0.05). Conclusion: The supplementation of L-Carnitine in the complex therapy of patients with coronary artery disease in combination with prostate adenocarcinoma contributes to a significant decrease in insulin resistance, improves the functional state of kidneys.
Keywords: Insulin resistance; carnitine; coronary disease; prostatic neoplasms
ÖZET
Amaç: Bu çalışmanın amacı koroner kalp hastalığı (KKH) olan hastalarda prostat adeno karsinomu ve böbrek fonksiyon bozukluğu bulunması durumunda tedavide böbreklerin fonksiyonel durumu, inflamasyon dinamikleri ve insülin direnci (IR) üzerinde L-Karnitinin etkisini değerlendirmektir. Gereç ve Yöntemler: Prostat adenokarsinomu ve koroner kalp hastalığı olan 42 erkek alındı. Hastalar randomize ve kör olarak 2 gruba ayrıldı: Grup I hastaları standart tedaviye ek olarak L-Karnitin ile tedavi edildi; Grup II hastalar sadece geleneksel tedavi aldı. Bütün hastalar için standart laboratuvar kan testleri, lipid profili, glukoz, böbrek ve karaciğer fonksiyon testleri, serum C-reaktif protein (CRP), insülin, testosteron düzeyleri, ekokardiyografik inceleme bazal olarak ve 10 günlük tedavi sonrasında yapıldı. Bulgular: Ortanca HOMA indeksi seviyesi 3,1 [1,9; 4,8] mg/ml. İnsülin rezistansı açılımı Grup I'de %54,8, kontrol grubunda% 40 hastada saptandı (p<0,05). Grup I'de ortanca insülin indeksi ve HOMA indeksi sırasıyla% 15,4 (p=0,001) ve %19,2 (p=0,003) azaldı. L-Karnitinin standart tedaviye eklenmesi, Grup I hastalarında serum kreatinin seviyesinde anlamlı bir düşüşe ve glomerül filtrasyon hızında bir artışa neden oldu (p<0,05). Sonuç: Koroner arter hastalığı olan hastaların prostat adenokarsinomu ile kombinasyon halinde kompleks tedavisinde L-Karnitin takviyesi, insülin direncinde önemli bir düşüşe neden olur, böbreklerin fonksiyonel durumunu iyileştirir.
Anahtar Kelimeler: İnsülin direnci; karnitin; koroner hastalığı; prostatik neoplazmalar
Amaç: Bu çalışmanın amacı koroner kalp hastalığı (KKH) olan hastalarda prostat adeno karsinomu ve böbrek fonksiyon bozukluğu bulunması durumunda tedavide böbreklerin fonksiyonel durumu, inflamasyon dinamikleri ve insülin direnci (IR) üzerinde L-Karnitinin etkisini değerlendirmektir. Gereç ve Yöntemler: Prostat adenokarsinomu ve koroner kalp hastalığı olan 42 erkek alındı. Hastalar randomize ve kör olarak 2 gruba ayrıldı: Grup I hastaları standart tedaviye ek olarak L-Karnitin ile tedavi edildi; Grup II hastalar sadece geleneksel tedavi aldı. Bütün hastalar için standart laboratuvar kan testleri, lipid profili, glukoz, böbrek ve karaciğer fonksiyon testleri, serum C-reaktif protein (CRP), insülin, testosteron düzeyleri, ekokardiyografik inceleme bazal olarak ve 10 günlük tedavi sonrasında yapıldı. Bulgular: Ortanca HOMA indeksi seviyesi 3,1 [1,9; 4,8] mg/ml. İnsülin rezistansı açılımı Grup I'de %54,8, kontrol grubunda% 40 hastada saptandı (p<0,05). Grup I'de ortanca insülin indeksi ve HOMA indeksi sırasıyla% 15,4 (p=0,001) ve %19,2 (p=0,003) azaldı. L-Karnitinin standart tedaviye eklenmesi, Grup I hastalarında serum kreatinin seviyesinde anlamlı bir düşüşe ve glomerül filtrasyon hızında bir artışa neden oldu (p<0,05). Sonuç: Koroner arter hastalığı olan hastaların prostat adenokarsinomu ile kombinasyon halinde kompleks tedavisinde L-Karnitin takviyesi, insülin direncinde önemli bir düşüşe neden olur, böbreklerin fonksiyonel durumunu iyileştirir.
Anahtar Kelimeler: İnsülin direnci; karnitin; koroner hastalığı; prostatik neoplazmalar
REFERANSLAR:
- DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics 2014. CA Cancer J Clin. 2014;64(4):252-71. [Crossref] [PubMed]
- Epstein MM, Edgren G, Rider JR, Mucci LA, Adami HO. Temporal trends in cause of death among Swedish and US men with prostate cancer. J Natl Cancer Inst. 2012;104(17): 1335-42. [Crossref] [PubMed] [PMC]
- Conteduca V, Di Lorenzo G, Tartarone A, Aieta M. The cardiovascular risk of gonadotropin releasing hormone agonists in men with prostate cancer: an unresolved controversy. Crit Rev Oncol Hematol. 2013;86(1):42-51. [Crossref] [PubMed]
- Nguyen PL, Alibhai SM, Basaria S, D'Amico AV, Kantoff PW, Keating NL, et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol. 2015;67(5):825-36. [Crossref] [PubMed]
- Albertsen PC, Klotz L, Tombal B, Grady J, Olesen TK, Nilsson J. Cardiovascular morbidity associated with gonadotropin releasing hormone agonists and an antagonist. Eur Urol. 2014;65(3):565-73. [Crossref] [PubMed]
- Zamorano JL, Lancellotti P, Rodriguez Mu-oz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(36):2768-801. [Crossref] [PubMed]
- Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, HillegeHL. Renal impairment, worsening renal function, and outcome in patients withheart failure: an updated meta-analysis. Eur Heart J. 2014;35(7):455-69. [Crossref] [PubMed]
- Christensson A, Savage C, Sjoberg DD, Cronin AM, O'Brien MF, Lowrance W, et al. Association of cancer with moderately impaired renal function at baseline in a large, representative, population-based cohort followed for up to 30 years. Int J Cancer. 2013;133(6):1452-8. [Crossref] [PubMed] [PMC]
- Foster DW. The role of the carnitine system in human metabolism. Ann N Y Acad Sci. 2004;1033:1-16. [Crossref] [PubMed]
- Xu Y, Jiang W, Chen G, Zhu W, Ding W, Ge Z, et al. L-carnitine treatment of insulin resistance: a systematic review and meta-analysis. Adv Clin Exp Med. 2017;26(2):333-8. [Crossref] [PubMed]
- Calo LA, Vertolli U, Davis PA, Savica V. L carnitine in hemodialysis patients. Hemodial Int. 2012;16(3):428-34. [Crossref] [PubMed]
- Wang ZY, Liu YY, Liu GH, Lu HB, Mao CY. l-carnitine and heart disease. Life Sci. 2018;194:88-97. [Crossref] [PubMed]
- Kim J. The effects of acetyl L-carnitine treatment on cognitive and memory function in epileptic patients under antiepileptic medication. J Neur Sci. 2015;357(1):150-1. [Crossref]
- Song X, Qu H, Yang Z, Rong J, Cai W, Zhou H. Efficacy and safety of l-carnitine treatment for chronic heart failure: a meta-analysis of randomized controlled trials. Biomed Res Int. 2017;2017:6274854. [Crossref] [PubMed] [PMC]
- Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-61.
- Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia. 1985;28(7):412-9. [Crossref] [PubMed]
- Sahebkar A. Effect of L-carnitine supplementation on circulating C-reactive protein levels: a systematic review and meta-analysis. J Med Biochem. 2015;34(2):151-9. [Crossref] [PubMed] [PMC]
- Fu L, Huang M, Chen S. Primary carnitine deficiency and cardiomyopathy. Korean Circ J. 2013;43(12):785-92. [Crossref] [PubMed] [PMC]
- Xu Y, Jiang W, Chen G, Zhu W, Ding W, Ge Z, et al. L-carnitine treatment of insulin resistance: a systematic review and meta-analysis. Adv Clin Exp Med. 2017;26(2):333-8. [Crossref] [PubMed]
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