血液净化方式对尿毒症周围神经病变的疗效  

The outcomes of blood purification in treatment of uremic peripheral neuropathy

作　　者：高民[1] 汤日宁[1] 马坤岭[1] 刘必成[1] 张留平[1] 王越[1] 杨金芳[1] 刘宏[1] 黄海泉[1] 

机构地区：[1]东南大学附属中大医院肾脏病科,江苏省210009

出　　处：《江苏医药》2012年第23期2806-2809,共4页Jiangsu Medical Journal

基　　金：江苏省自然科学基金(BK2011603)

摘　　要：目的比较4种血液净化方式对尿毒症周围神经病变的疗效。方法将108例尿毒症周围神经病变的维持性血透患者随机分为低通量血液透析(LFHD)28例、高通量血液透析(HFHD)27例、血液透析滤过(HDF)27例,血液透析联合血液灌流(HD+HP)26例。随访12周,比较治疗前、后血清肌酐(SCr)、甲状旁腺素(PTH)、β2微球蛋白(β2-MG)和感觉神经传导速度(SCV)的变化,分析PTH和β2-MG与SCV的相关性。结果 4组治疗前后的SCr均无统计学差异。与治疗前比较,治疗12周后,LFHD组PTH和β2-MG无明显改变,但HFHD组、HDF组和HD+HP组的PTH和β2-MG明显下降(P<0.05)。经12周治疗,HFHD组、HDF组、HD+HP组的SCV增加值明显高于LFHD组(P<0.05)。PTH和β2-MG分别与SCV有明显相关性(P<0.05)。结论HFHD、HDF、HD+HP等血液净化治疗方法均能有效清除PTH和β2-MG,且对治疗尿毒症周围神经病变有效;PTH和β2-MG在体内蓄积与尿毒症周围神经病变有关。Objective To compare the outcomes of four kinds of blood purification in the treatment of uremic peripheral neuropathy in the patients undergoing maintenance hemodialysis（MHD）.Methods A total of 108 MHD patients with uremic peripheral neuropathy received low-flux hemodialysis（group LFHD,28 cases）,high-flux hemodialysis（group HFHD,27 cases）,hemodiafiltration（group HDF,27 cases） or hemodialysis combined with hemoperfusion（group HD＋HP,26 cases）.The patients were followed up for 12 weeks.Serum creatinine（SCr）,parathyroid hormone（PTH）,beta-2 microglobulin（β2-MG）,sensory nerve conduction velocity（SCV） were measured before and after blood purification treatment.The correlation between PTH,β2-MG and SCV was analyzed,respectively.Results There was no significant difference in SCr before and after treatment in 4 groups.Compared to before,after treatment for 12 weeks,PTH and β2-MG in group LFHD were not significantly changed,but PTH and β2-MG in groups of HFHD,HDF and HD＋HP were significantly decreased（P0.05）.After treatment for 12 weeks,the increase of SCV was greater in groups of HFHD,HDF and HD＋HP than that in group LFHD（P0.05）.PTH and β2-MG were closely correlated to SCV（P0.05）.Conclusion HFHD,HDF and HD＋HP can effectively clear PTH and β2-MG in blood and treat the uremic peripheral neuropathy.The uremic peripheral neuropathy is associated with the accumulation of serum PTH and β2-MG.

关 键 词：血液净化 尿毒症周围神经病变 

分 类 号：R692[医药卫生—泌尿科学]