中国血液净化

中国血液净化 ›› 2012, Vol. 11 ›› Issue (12): 661-663.doi: 10.3969/j.issn.1671-4091.2012.12.007

• 临床研究 • 上一篇    下一篇

不同血液净化方式对终末期肾病周围神经病变的影响

陈学勋1,陈宏书2,杨帅帅1,武文斌2   

  1. 1 潍坊医学院硕士研究生
    2 潍坊市益都中心医院
  • 收稿日期:2012-03-31 修回日期:2012-09-17 出版日期:2012-12-12 发布日期:2012-12-12
  • 通讯作者: 武文斌wuwenbin@medmail.com.cn E-mail:wuwenbin@medmail.com.cn

The influence of different blood purification profiles on the peripheral neuropathy in end-stage renal disease patients

  • Received:2012-03-31 Revised:2012-09-17 Online:2012-12-12 Published:2012-12-12

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摘要： 【摘要】目的探讨不同血液净化方式对终末期肾病(end-stage renal disease，ESRD)周围神经病变的疗效及治疗机制。方法 将38 例ESRD 合并周围神经病变患者，随机分为血液透析(hemodialysis，HD)、血液透析灌流(hemodialysis + hemoperfusion ，HD+HP)、腹膜透析(peritoneal dialysis ，PD)3 组，分别于血液净化前、血液净化4 个月后观察患者临床症状改善情况、感觉神经传导速度. 结果在症状改善方面：经平均Ridit 分析，HD、HD+HP、PD 均能有效改善ESRD 周围神经病变症状(平均R 值分别：R1=0.48，R2=0.41，R3=0.40，总R=0.50，95% CI 分别：0.42～0.63，0.26～0.57，0.24～0.57，χ2=7.359，P=0.025)，两两比较发现PD 组、HD+HP组均明显优于HD组(U=2.490，P=0.010；U=2.470，P=0.010)，HD+HP组与PD组比较无显著差异性(U=0.070，P=0.946)；感觉神经传导速度方面：经过4 个月的治疗, HD 组正中、胫前、腓总感觉神经传导速度较净化前增快，但比较无显著差异性(t=0.500，t=0.700，t=0.700，P＞0.050)；HD+HP组、PD组3 条感觉神经传导速度均有显著改善(t=3.020，t=3.130，t=2.920；t=3.390，t=3.550，t=4.010，P＜0.01)，其改善程度显著优于HD 组(t= 5.560, t=5.230，t=4.580；t=5.030，t=4.610，t=5.570，P＜0.01)；PD组较HD+HP组3条感觉神经传导速度虽增快，但比较无显著差异性(t=1.530，t=1.140, t=0.980，P＞0.05)。结论 在改善ESRD 周围神经病变疗效上PD和HD+HP疗效相当，均明显优于HD；周围神经病变的发生可能与尿毒症中、大分子毒素的潴留有关。

关键词: 血液灌流, 终末期肾脏病, 周围神经病变, 腹膜透析

Abstract: 【Abstract】 Objective To evaluate the effect of different blood purification profiles on peripheral neuropathy and the curative mechanism in end-stage renal disease (ESRD) patients. Methods A total of 38 ESRD patients with peripheral neuropathy were randomly assigned to hemodialysis group (HD), hemodialysis + hemoperfusion group (HD+HP) or peritoneal dialysis group (PD). Changes of clinical symptoms, sensory nerve conduction velocity (SCV), were respectively monitored in the patients before blood purification and after hemodialysis for 4 months, hemoperfusion for 4 months, or peritoneal dialysis for 4 months. Results By mean of Ridit analysis, clinical symptoms improved after blood purification than before in the HD, HD+HP and PD groups (the mean R value: R1=0.48, R2 =0.41, R3 =0.40, respectively, and total R =0.50; 95% CI.：0.42～0.63, 0.26～0.57, 0.24～0.57, respectively; χ2 =7.36, P=0.025). The curative effect were significantly better in PD and HD+HP groups than in HD group (U =2.490, P=0.010, and U=2.470, P=0.010, respectively), but were statistically indifferent between PD group and HD+HP group (U=0.070, P=0.946). In HD group, SCV in median, anterior tibial, and common peroneal nerves became faster after the treatment for 4 months than before hemodialysis, but the differences were statistically insignificant (t=0.500, 0.700 and 0.700, respectively; P＞0.05). In HD+HP and PD groups, SCV in the 3 nerves improved significantly after the treatment (for HD+HP group, t=3.02, 3.130 and 2.920, respectively; for PD group, t=3.390, 3.550 and 4.010, respectively; P＜0.01), and the improvement was better in HD+HP and PD groups than in HD group
(for comparison of HD+HP and HD groups: t=5.560, 5.230 and 4.58, respectively; for comparison of PD and HD groups: t=5.030, 4.61 and 5.570, respectively; P＜0.01). Conclusion PD and HD+HP are superior to HD for the treatment of uremic peripheral neuropathy in ESRD patients. The peripheral neuropathy may
result from the large and middle toxic molecules accumulated in ESRD patients.

Key words: Hemoperfusion, ESRD, Peripheral neuropathy, Peritoneal dialysis