不同血液净化方式改善尿毒症血液透析患者不宁腿综合征的临床研究  

Clinical study on the improvement of restless legs syndrome in uremic patients treated with different hemodialysis methods

作　　者：王彤[1] 涂阳科[1] 安文文[1] 刘颖[1] 张文玉[1] 

机构地区：[1]天津市第一中心医院,天津300050

出　　处：《中国血液净化》2009年第3期155-157,共3页Chinese Journal of Blood Purification

摘　　要：目的研究常规血液透析(CHD)、在线血液透析滤过(on-line HDF)、血液透析联合血液灌流(HD+HP)的中分子清除及不宁腿综合征(RLS)的改善情况。方法根据国际不宁腿综合征委员会(IRLSSG)的诊断标准,对患有RLS的尿毒症血液透析患者的严重程度进行评分,选择评分较高的患者30例,随机分为3组,每组10例。A组(每周CHD3次),B组(每周CHD2次,on-line HDF1次),C组(每周CHD2次,HD+HP1次),疗程为3月。观察患者甲状旁腺激素(iPTH)、β2微球蛋白(β2-MG)、RLS评分的变化。结果①三组治疗前后比较RLS评分之间差异有统计学意义,每两组之间相比RLS评分下降均有统计学意义,C组下降最明显,B组其次;②A组与B组、A组与C组之间的iPTH、β2-MG下降有统计学意义,A组治疗前后、B组与C组比较iPTH、β2-MG下降无统计学意义。结论三种不同血液净化方式均能改善尿毒症血液透析患者RLS症状,HD+HP疗效最好,on-line HDF其次。CHD对iPTH、β2-MG的清除无明显效果,on-line HDF与HD+HP对中分子的清除相比无统计学意义。Objective To explore the effects of conventional hemodialysis （CHD）, on-line hemodiafiltration （on-line HDF） and hemodialysis plus hemoperfusion （HD＋HP） on clearance of medial molecular size substances and on improvement of restless legs syndrome （RLS）. Methods The severity of RLS was graded following the diagnostic criteria of International Restless Legs Syndrome Study Group （IRLSSG） in patients with renal replacement therapy. Thirty cases with higher score were randomly and equally assigned to 3 treatment groups： A group （CHD 3 times/ week）, B group （CHD twice/week, and on-line HDF once/week）, and C group （CHD twice/week and HD＋HP once/ week）. The treatment lasted for 3 months. Serum iPTH and β2-microglobulin （β2-MG） were examined, and the change of RLS score was monitored. Results The changes of RLS score before and after the treatment were significant different among the 3 groups. Comparison of the scores showed that the decrease of score was significant between 2 groups, with the most remarkable decrease in C group followed by B group. The decrease of serum iPTH and β2- MG was significant in group A as compared with that in groups B and C, but was insignificant in group B as compared with that in group C. The decrease also showed no difference before and after the treatment in group A. Conclusion RLS in the patients can be improved by the 3 blood purification methods we used, among which HD＋HP is most effective, followed by on-line HDF. CHD is no useful for the clearance of iPTH and β2-MG. On-line HDF and HD＋HP have the same effect on clearance of medial molecular size substances.

关 键 词：尿毒症 血液灌流 不宁腿综合征 

分 类 号：R459.5[医药卫生—治疗学]