左卡尼汀联合血液透析治疗尿毒症性周围神经病变的临床疗效观察  

Clinical efficacy of levocarnitine combined with hemodialysis in the treatment of uremic peripheral neuropathy

作　　者：赵璐杰[1] 李超林[2] 邱君[1] 王建萍[1] 杨文[1] 

机构地区：[1]烟台毓璜顶医院血液净化中心,烟台264000 [2]烟台毓璜顶医院内分泌科,烟台264000

出　　处：《中国血液净化》2013年第7期371-374,共4页Chinese Journal of Blood Purification

摘　　要：目的观察左卡尼汀与血液透析联合应用对尿毒症患者周围神经病变的疗效。方法将烟台毓璜顶医院门诊及住院的84例合并尿毒症性周围神经病变的血液透析患者随机分为常规血液透析对照组(HD,30例)、血液透析滤过治疗组(HDF,27例)、左卡尼汀联合血液透析治疗组(L-CN+HD,27例)。常规血液透析组行每周3次常规血液透析治疗;血液透析滤过组在每周两次常规血液透析的同时,接受每周1次血液透析滤过治疗;左卡尼汀治疗组在常规血液透析基础上给予左卡尼汀2.0g加入0.9%氯化钠溶液250ml静脉滴注,3次/周。治疗前、治疗后8周分别观察3组患者周围神经病变的临床症状及正中神经、胫神经、腓总神经的感觉神经传导速度(SCV)。结果 3组患者经过8周的充分透析治疗后,左卡尼汀联合血液透析组、血液透析滤过组治疗后肢端疼痛、感觉障碍、麻木感及不宁腿综合征等临床症状分别与对照组比较明显改善(χ2值=13.87,17.52,25.37,9.20;P<0.05);L-CN+HD、HDF组治疗后各感觉神经传导速度与治疗前比较有明显加快(t值L-CN+HD/HDF=10.1/12.3,12.7/13.4,16.8/18.1;P<0.05),治疗组各神经传导速度显著优于血液透析对照组(F值=25.63,32.83,22.5;P<0.01),而左卡尼汀联合血液透析组与血液透析滤过组治疗后感觉神经传导速度间比较差异无统计学意义(F值=0.613;P>0.05)。结论尿毒症性周围神经病变患者在常规HD治疗的同时联合左卡尼汀或进行血液透析滤过治疗均能有效地改善其周围神经病变。Objective To observe the effect ＇of levocarnitine combined with hemodialysis in the treatment of patients with uremic peripheral neuropathy. Methods Eighty-four patients with uremic peripheral neuropathy were randomly assigned to hemodialysis group （HD, n=30）, hemodiafiltration group （HDF, n=27）, or levocarnitine combined with hemodialysis group （L-CN＋HD, n=27）. Patients in HD group received regular hemodialysis thrice a week. Patients in HDF group received regular hemodialysis twice a week and hemodiafiltration once a week. Patients in L-CN＋HD group were given levocarnitine 2.0g dripped and intravenously thrice a week. Clinical symptoms and the sensory conduction velocity （SCV） of median nerve, tibial nerve and lateral popliteal nerve were observed in the three groups at baseline and after the treatment for 8 weeks. Results In HDF and L-CN＋HD groups after the treatment for 8 weeks, peripheral neuropathy symptoms of Pain in the extremities, Sensory disturbances, Numbness, Restless Legs Syndrom improved, as compared with HD group （χ2=13.87, 17.52, 25.37, 9.20; P〈 0.05）, and SCV of L-CN＋HD and HDF groups after the treatment became faster than that before treatment （t=-L-CN＋HD/ HDF=10.1/12.3, 12.7/13.4, 16.8/18.1; P〈0.05）, with wider range of SCV change in treatment group than in HD group （F=25.63, 32.83, 22.5; P〈0.01）. While the changes of SCV before and after the treatment for 8 weeks were statistically indifferent between HDF group and L-CN＋HD group （F=-0.613, P〉0.05）. Conclusions Both levocarnitine combined with hemodialysis and hemodiafiltration are effective for the treatment of patients with uremic peripheral neuropathy.

关 键 词：左卡尼汀 血液透析滤过 血液透析 尿毒症性周围神经病变 感觉神经传导速度 

分 类 号：R318.16[医药卫生—生物医学工程]