血液透析滤过对改善尿毒症患者周围神经病变的临床疗效观察  

The clinical efficacy of hemodiafiltration on peripheral neuropathy in uremic patients

作　　者：焦占峰[1] 张宜明[1] 马小芬[1] 李洋[1] 李相[1] JIAO Zhan-feng;ZHANG Yi-ming;MA Xiao-fen;LI Yang;LI Xiang(Department of Nephrology, The Affiliated Hospital of Jining Medical College, Jining 272029, China)

机构地区：[1]济宁医学院附属医院肾内科

出　　处：《中国血液净化》2019年第7期491-494,共4页Chinese Journal of Blood Purification

摘　　要：目的探究血液透析滤过对改善尿毒症患者周围神经病变的临疗床效。方法69 例维持性血液透析并有周围神经系统损害的患者,随机分为2 组,对照组给予常规血液透析(hemodialysis,HD)治疗,观察组给予血液透析滤过(hemodiafiltration,HDF)治疗,其中血液透析组35 例,血液透析滤过组34 例。观察治疗前后患者的周围神经病变症状,检测感觉神经传导速度(sensory nerve conductionvelocity,SCV)以及血清瘦素(leptin)、β2-微球蛋白(β2-microglobulin,β2-MG)和甲状旁腺素(parathormone,PTH)水平,对2 组的临床疗效进行比较。结果观察组患者周围神经病变消失或改善的有效率为91.18%,对照组有效率为28.57%,差异有统计学意义(χ^2=16.793,P=0.019);治疗后观察组瘦素、β2-MG、PTH 明显低于对照组(t 值分别为5.374,9.605,8.327;P 值分别为P<0.001,P<0.001,P<0.001);相关性分析表明β2-MG 分别与胫神经SCV、腓总神经SCV 呈负相关(r 值分别为-0.789,-0.832;P值分别为0.015,0.004);瘦素分别与胫神经SCV、腓总神经SCV 呈负相关(r 值分别为-0.819,-0.867;P 值分别为0.006,<0.001),但PTH 与胫神经SCV、腓总神经SCV 无明显相关性(r 值分别为-0.327,-0.359;P值分别为0.119,0.087)。结论血液透析滤过可以有效降低患者体内瘦素、β2-MG 及PTH 等水平,改善尿毒症患者的周围神经病变。Objective To explore the clinical efficacy of hemodiafiltration on peripheral neuropathy in uremic patients. Methods Sixty- nine maintenance hemodialysis patients complicated with peripheral neurological impairment were randomly assigned to the control group (n=35) in which patients were treated with conventional hemodialysis (HD), or the observation group (n=34) in which patients were treated with hemodiafiltration (HDF). The symptoms of peripheral neuropathy, sensory nerve conduction velocity (SCV), and serum leptin,β2-microglobulin (β2-MG) and parathyroid hormone (PTH) were observed before and after treatment, and the clinical effects were then compared between the two groups. Results The effectiveness rate of peripheral neuropathy symptoms, including disappearance or improvement of the symptoms, was 91.18% in the observation group and 28.57% in the control group (χ^2=16.793, P=0.019). After the treatment, serum leptin,β2-MG and PTH were significantly lower in the observation group than in the control group (t=5.374, 9.605 and 8.327 respectively;P<0.001, 0.001 and<0.001 respectively). Correlation analyses showed that β2- MG was negatively correlated with tibial nerve SCV and common peroneal nerve SCV (r=-0.789 and -0.832 respectively;P=0.015 and P=0.004 respectively);leptin was negatively correlated with tibial nerve SCV and common peroneal nerve SCV (r=-0.819 and -0.867 respectively;P=0.006 and P<0.001 respectively);PTH had no significant correlation with tibial nerve SCV and common peroneal nerve SCV (r=-0.327 and -0.359 respectively;P=0.119 and P=0.087 respectively). Conclusion Hemodiafiltration can effectively reduce leptin,β2-MG and PTH levels and improve peripheral neuropathy in uremic patients.

关 键 词：血液透析 血液透析滤过 尿毒症 周围神经病变 瘦素 

分 类 号：R459.5[医药卫生—治疗学]