左旋肉堿是一種類氨基酸物質(zhì)，廣泛存在于人體內(nèi)，尤其在心臟、肝臟和肌肉組織中。它的主要功能是幫助脂肪酸通過(guò)細(xì)胞內(nèi)的線粒體膜，從而轉(zhuǎn)化為能量。因此，左旋肉堿被認(rèn)為是促進(jìn)脂肪代謝和能量產(chǎn)生的關(guān)鍵物質(zhì)。它被廣泛用于運(yùn)動(dòng)補(bǔ)充劑、減脂和健康保健產(chǎn)品中。

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Changshou.com

左旋肉堿

(L-Carnitine)

左旋肉堿（L-Carnitine）是一種類氨基酸物質(zhì)，廣泛存在于人體內(nèi)，尤其在心臟、肝臟和肌肉組織中。它的主要功能是幫助脂肪酸通過(guò)細(xì)胞內(nèi)的線粒體膜，從而轉(zhuǎn)化為能量。因此，左旋肉堿被認(rèn)為是促進(jìn)脂肪代謝和能量產(chǎn)生的關(guān)鍵物質(zhì)。它被廣泛用于運(yùn)動(dòng)補(bǔ)充劑、減脂藥物和健康保健產(chǎn)品中。

什么是左旋肉堿？

左旋肉堿（L-Carnitine）是一種由賴氨酸和蛋氨酸在體內(nèi)合成的化合物[1,2]。它天然存在于我們的體內(nèi)，尤其是在肌肉組織中，也可以從食物中獲取，紅肉（如牛肉、豬肉） 是其主要膳食來(lái)源[3,4]，可以作為補(bǔ)充品服用。左旋肉堿可以乙?；梢阴?左旋肉堿（ALCAR），其與左旋肉堿相似，但能更有效地穿越血腦屏障[5]。

它在人體內(nèi)的核心生理功能是作為“運(yùn)輸車”，將長(zhǎng)鏈脂肪酸運(yùn)送到線粒體內(nèi)部進(jìn)行氧化，從而為身體產(chǎn)生能量[1,6]。因此，它對(duì)于維持細(xì)胞，特別是能量需求高的心肌和骨骼肌細(xì)胞的正常功能至關(guān)重要。

左旋肉堿：延壽證據(jù)等級(jí) D，為什么？

2020 年，《Aging》期刊發(fā)表的一項(xiàng)研究顯示，給線蟲喂養(yǎng) 50 mM的左旋肉堿，可以將線蟲的最大壽命延長(zhǎng) 28% [7]。

根據(jù)長(zhǎng)壽之家Changshou.com制定的《長(zhǎng)壽成分評(píng)級(jí)標(biāo)準(zhǔn)（2025 版）》，左旋肉堿的延壽證據(jù)等級(jí)為 D。

點(diǎn)擊查看長(zhǎng)壽之家Changshou.com《延壽天梯榜》。

補(bǔ)充左旋肉堿有什么好處？

 抗炎：一項(xiàng)隨機(jī)對(duì)照臨床試驗(yàn)招募了 254 名 2 型糖尿病患者，發(fā)現(xiàn)每天 2 克左旋肉堿+ 10 毫克西丁曲明（藥物）聯(lián)合治療，12 個(gè)月后與單獨(dú)用藥組相比，左旋肉堿組更快地改善了空腹血糖、餐后血糖、以及炎癥因子 TGF-α 和 C 反應(yīng)蛋白水平[8]。

一項(xiàng)隨機(jī)對(duì)照平行研究納入了 46 名活動(dòng)性類風(fēng)濕性關(guān)節(jié)炎患者，他們被平均隨機(jī)分配到組。一組僅接受傳統(tǒng) DMARDs 治療（甲氨蝶呤、來(lái)氟胺和羥氯喹），另一組接受 DMARDs 輔助 500 毫克左旋肉堿，持續(xù) 12 周，結(jié)果顯示左旋肉堿與 DMARDs 聯(lián)合使用，可以通過(guò)減輕系統(tǒng)性炎癥來(lái)改善類風(fēng)濕關(guān)節(jié)炎的臨床結(jié)局[18]。

改善運(yùn)動(dòng)表現(xiàn)、緩解疲勞：有多項(xiàng)臨床試驗(yàn)顯示，每天 2 克的左旋肉堿可以提高運(yùn)動(dòng)時(shí)的氧氣攝入量。降低血漿乳酸水平，從而改善了肌肉能量代謝，提升了運(yùn)動(dòng)表現(xiàn)[9-12]。而左旋肉堿補(bǔ)充劑還有助于減少運(yùn)動(dòng)引起的肌肉酸痛和肌肉損傷，促進(jìn)運(yùn)動(dòng)恢復(fù)[13]。

改善男性生殖能力：一項(xiàng)納入 50 項(xiàng)治療持續(xù)時(shí)間超過(guò) 12 周隨機(jī)對(duì)照試驗(yàn)的薈萃分析結(jié)果顯示，1–3 克/天的左旋肉堿或左旋乙酰肉堿可以提升男性精子的活動(dòng)性[14]。

另有一項(xiàng)隨機(jī)對(duì)照雙盲臨床試驗(yàn)招募了 40 名勃起功能障礙患者，被隨機(jī)分配口服丙酰左旋肉堿（2 克/天）加西地那非（藥物，每周兩次 50 毫克）、或單獨(dú)使用西地那非，治療 24 周后，結(jié)果發(fā)現(xiàn)前者比后者更加有效[15]。

改善女性生殖能力：同樣，左旋肉堿可以改善多囊卵巢綜合征（PCOS）女性的排卵和妊娠率。一項(xiàng)總樣本量為 835 參與者的薈萃分析結(jié)果顯示，肉堿能改善排卵率、臨床妊娠以及 PCOS 女性的胰島素抵抗和BMI（體質(zhì)指數(shù)）[16]。

改善代謝：大量的臨床研究表明，每天補(bǔ)充 1-3 克的左旋肉堿/乙酰左旋肉堿可以改善代謝，包括但不限于代謝綜合征的癥狀，如改善血壓，血糖，血脂（包括甘油三酯、總膽固醇、低密度脂蛋白膽固醇）等[19-24]。

減肥：一些薈萃分析還發(fā)現(xiàn)，補(bǔ)充左旋肉堿、乙酰左旋肉堿或丙酰左旋肉堿對(duì)減重有小范圍（約1公斤）的有益效果[32-34]。

降低偏頭痛發(fā)作頻率：一項(xiàng)隨機(jī)對(duì)照試驗(yàn)招募了 133 名偏頭痛患者，隨機(jī)分配到三個(gè)干預(yù)組：氧化鎂（500 毫克/天）、左旋肉堿（500 毫克/天）和氧化鎂+左旋肉堿（各 500 毫克/天）和一個(gè)對(duì)照組，補(bǔ)充 12 周，結(jié)果發(fā)現(xiàn)，每個(gè)干預(yù)組的偏頭痛發(fā)作頻率顯著降低[17]。但仍需大規(guī)模試驗(yàn)驗(yàn)證這一發(fā)現(xiàn)。

左旋肉堿的安全性與副作用

左旋肉堿可能引發(fā)的副作用，包括消化問(wèn)題、體味、癲癇發(fā)作、潛在心臟風(fēng)險(xiǎn)和過(guò)敏反應(yīng)[25-27]。

左旋肉堿補(bǔ)充劑的一個(gè)獨(dú)特副作用是“魚腥味”體味，這是由于汗液和尿液中的三甲胺的積累和排出引起的[25]。

左旋肉堿是如何發(fā)揮功能的？

左旋肉堿的作用機(jī)制尚不完全清楚。在肌肉等組織中，左旋肉堿被發(fā)現(xiàn)有助于將長(zhǎng)鏈脂肪酸“輸送”到線粒體中以產(chǎn)生能量[1,6]。進(jìn)一步證據(jù)表明，它可能通過(guò)增強(qiáng)抗氧化能力、保護(hù)細(xì)胞膜免受氧化應(yīng)激、減少炎癥以及提高一氧化氮水平來(lái)發(fā)揮潛在益處[28-31]。

左旋肉堿在國(guó)內(nèi)批準(zhǔn)現(xiàn)狀

目前在國(guó)內(nèi)，左旋肉堿已被批準(zhǔn)用于保健食品，作為健身、減肥的營(yíng)養(yǎng)補(bǔ)充劑使用。

哪些人群需慎用左旋肉堿？

孕婦、哺乳期女性：目前尚沒(méi)有足夠的證據(jù)支持來(lái)了解左旋肉堿在懷孕或哺乳期間大量使用左旋肉堿是否可以安全地用作藥物。為了安全起見(jiàn)，只需從食物中獲取即可。

兒童：尚缺乏安全性數(shù)據(jù)，同上。

肝腎疾病患者：肝腎疾病患者代謝功能受限，服用左旋肉堿可能加重肝腎負(fù)擔(dān)。

癲癇患者：有研究表明左旋肉堿有可能誘發(fā)癲癇發(fā)作。

過(guò)敏反應(yīng)：對(duì)肉堿類成分過(guò)敏的人，應(yīng)盡量避免服用。

劑量信息

通常左旋肉堿可以從飲食中充分獲取，身體也通常能夠產(chǎn)生足夠的左旋肉堿。

目前臨床實(shí)驗(yàn)中用的左旋肉堿的標(biāo)準(zhǔn)劑量為每天 500-2000 毫克，是相對(duì)安全的劑量。需注意，如果選擇服用乙酰左旋肉堿，則等效劑量高達(dá)約 2700 毫克/天，丙酰左旋肉堿的等效劑量高達(dá)約 2900 毫克/天。

首次服用建議從低劑量開(kāi)始，逐步觀察身體反應(yīng)，待身體適應(yīng)在逐步增加劑量。

參考資料：

[1] Johri, A. M. et al. Progression of atherosclerosis with carnitine supplementation: a randomized controlled trial in the metabolic syndrome. Nutrition & Metabolism 19, 26 (2022).

[2] Munji Choi, Seongmin Park, Myoungsook LeeL-Carnitine's Effect on the Biomarkers of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsNutrients.(2020 Sep 12)

[3] Ruggenenti P, Cattaneo D, Loriga G, Ledda F, Motterlini N, Gherardi G, Orisio S, Remuzzi GAmeliorating hypertension and insulin resistance in subjects at increased cardiovascular risk: effects of acetyl-L-carnitine therapyHypertension.(2009 Sep)

[4] Hadier M El-Sheikh, Sahar M El-Haggar, Tamer A ElbedewyComparative study to evaluate the effect of l-carnitine plus glimepiride versus glimepiride alone on insulin resistance in type 2 diabetic patientsDiabetes Metab Syndr.(Jan-Feb 2019)

[5] Fabio Galvano, Giovanni Li Volti, Michele Malaguarnera, Teresio Avitabile, Tijana Antic, Marco Vacante, Mariano MalaguarneraEffects of simvastatin and carnitine versus simvastatin on lipoprotein(a) and apoprotein(a) in type 2 diabetes mellitusExpert Opin Pharmacother.(2009 Aug)

[6] Giuseppe Derosa, Pamela Maffioli, Ilaria Ferrari, Angela D'Angelo, Elena Fogari, Ilaria Palumbo, Sabrina Randazzo, Arrigo F G CiceroComparison between orlistat plus l-carnitine and orlistat alone on inflammation parameters in obese diabetic patientsFundam Clin Pharmacol.(2011 Oct)

[7] Liu, D., Zeng, X., Li, L. & Ou, Z.-L. Carnitine promotes recovery from oxidative stress and extends lifespan in C. elegans. Aging 13, 813–830 (2020).

[8] Derosa, G. et al. Effects of combination of sibutramine and l-carnitine compared with sibutramine monotherapy on inflammatory parameters in diabetic patients. Metabolism 60, 421–429 (2010).

[9] Vecchiet, L. et al. Influence of L-carnitine administration on maximal physical exercise. European Journal of Applied Physiology 61, 486–490 (1990).

[10] Koozehchian, M. S. et al. Effects of nine weeks L-Carnitine supplementation on exercise performance, anaerobic power, and exercise-induced oxidative stress in resistance-trained males. Physical Activity and Nutrition 22, 7–19 (2018).

[11] Wall, B. T. et al. Chronic oral ingestion of l‐carnitine and carbohydrate increases muscle carnitine content and alters muscle fuel metabolism during exercise in humans. The Journal of Physiology 589, 963–973 (2011).

[12] Li, S. et al. Effects of acetyl‐L‐carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double‐blind, controlled trial. Journal of Diabetes Investigation 7, 777–785 (2016).

[13] Vecchio, M., Chiaramonte, R., Testa, G. & Pavone, V. Clinical Effects of L-Carnitine Supplementation on Physical Performance in Healthy Subjects, the Key to Success in Rehabilitation: A Systematic Review and Meta-Analysis from the Rehabilitation Point of View. Journal of Functional Morphology and Kinesiology 6, 93 (2021).

[14] Michaelsen, M. et al. The effect of dietary supplements on male infertility in terms of pregnancy, live birth, and sperm parameters: A Systematic Review and Meta-Analysis. Nutrients 17, 1710 (2025).

[15] Gentile, V., Vicini, P., Prigiotti, G., Koverech, A. & Di Silverio, F. Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes. Current Medical Research and Opinion 20, 1377–1384 (2004).

[16] Gong, Y. et al. Effects of carnitine on glucose and lipid metabolic profiles and fertility outcomes in women with polycystic ovary syndrome: A systematic review and meta‐analysis. Clinical Endocrinology 98, 682–691 (2023).

[17] Esfanjani, A. T. et al. The effects of magnesium, L-Carnitine, and concurrent Magnesium–L-Carnitine supplementation in migraine prophylaxis. Biological Trace Element Research 150, 42–48 (2012).

[18] Eldisouky, A. A., Hegazy, S. K. & Elghany, S. E. A. L-carnitine as a novel approach for pain and inflammation relief in rheumatoid arthritis. Inflammopharmacology 33, 6805–6811 (2025).

[19] Parvanova, A. et al. Blood pressure and metabolic effects of Acetyl-L-Carnitine in Type 2 diabetes: DIABASI randomized controlled trial. Journal of the Endocrine Society 2, 420–436 (2018).

[20] Gheysari, R. et al. The effects of L-carnitine supplementation on cardiovascular risk factors in participants with impaired glucose tolerance and diabetes: a systematic review and dose–response meta-analysis. Diabetology & Metabolic Syndrome 16, 185 (2024).

[21] Zamani, M. et al. The effects of L-carnitine supplementation on glycemic markers in adults: A systematic review and dose-response meta-analysis. Frontiers in Nutrition 9, 1082097 (2023).

[22] Molfino, A. et al. Caloric restriction and L‐Carnitine administration improves insulin sensitivity in patients with impaired glucose metabolism. Journal of Parenteral and Enteral Nutrition 34, 295–299 (2010).

[23] Florentin, M. et al. l‐Carnitine/Simvastatin Reduces Lipoprotein (a) Levels Compared with Simvastatin Monotherapy: A Randomized Double‐Blind Placebo‐Controlled Study. Lipids 52, 1–9 (2016).

[24] Malaguarnera, M. et al. l-Carnitine supplementation reduces oxidized LDL cholesterol in patients with diabetes. American Journal of Clinical Nutrition 89, 71–76 (2008).

[25] Rebouche, C.J. Kinetics, Pharmacokinetics, and Regulation of l-Carnitine and Acetyl-l-Carnitine Metabolism. Ann N Y Acad Sci 2004, 1033, 30–41

[26] Zeiler, F.A.; Sader, N.; Gillman, L.M.; West, M. Levocarnitine Induced Seizures in Patients on Valproic Acid: A Negative Systematic Review. Seizure 2016, 36, 36–39

[27] Koeth, R.A.; Wang, Z.; Levison, B.S.; Buffa, J.A.; Org, E.; Sheehy, B.T.; Britt, E.B.; Fu, X.; Wu, Y.; Li, L.; et al. Intestinal Microbiota Metabolism of L-Carnitine, a Nutrient in Red Meat, Promotes Atherosclerosis. Nat Med 2013, 19, 576–585

[28] Indiveri, C. et al. The mitochondrial carnitine/acylcarnitine carrier: Function, structure and physiopathology. Molecular Aspects of Medicine 32, 223–233 (2011).

[29] Reuter, S. E. & Evans, A. M. Carnitine and acylcarnitines. Clinical Pharmacokinetics 51, 553–572 (2012).

[30] Rebouche, C. J. Kinetics, Pharmacokinetics, and Regulation of l‐Carnitine and Acetyl‐l‐carnitine Metabolism. Annals of the New York Academy of Sciences 1033, 30–41 (2004).

[31] Pekala, J. et al. L-Carnitine - Metabolic functions and meaning in humans life. Current Drug Metabolism 12, 667–678 (2011).

[32] Talenezhad, N., Mohammadi, M., Ramezani-Jolfaie, N., Mozaffari-Khosravi, H. & Salehi-Abargouei, A. Effects of l-carnitine supplementation on weight loss and body composition: A systematic review and meta-analysis of 37 randomized controlled clinical trials with dose-response analysis. Clinical Nutrition ESPEN 37, 9–23 (2020).

[33] Askarpour, M. et al. Beneficial effects of l-carnitine supplementation for weight management in overweight and obese adults: An updated systematic review and dose-response meta-analysis of randomized controlled trials. Pharmacological Research 151, 104554 (2019).

[34] Pooyandjoo, M., Nouhi, M., Shab‐Bidar, S., Djafarian, K. & Olyaeemanesh, A. The effect of (L‐)carnitine on weight loss in adults: a systematic review and meta‐analysis of randomized controlled trials. Obesity Reviews 17, 970–976 (2016).

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