尿毒症脑病腹膜透析前后神经胶质纤维酸性蛋白变化与影像学评价

目的 通过检测腹膜透析前后血清神经胶质纤维酸性蛋白（glial fibrillary acidic potein,GFAP）水平的变化联合头颅磁共振（MRI）影像学比较评估腹膜透析治疗尿毒症脑病（uremic encephalopathy,UE）的疗效和预后.方法 将未进行过透析治疗的慢性肾功能衰竭（chronic renalfailure,CRF）患者按有无中枢神经系统异常分为UE组和尿毒症对照组,并选择来自同期门诊健康体检的人群作为健康对照组.UE组和尿毒症对照组在腹膜透析治疗前及治疗后1周、2周、4周分别测定血清GFAP水平和行头颅MRI检查.结果 治疗前,UE组血清GFAP水平高于尿毒症对照组和健康对照组（均P＜0.01）;UE组中检出MRI异常信号灶的患者占18/38（47.4％）,尿毒症对照组中检出MRI异常信号灶的患者占2/40（5％）,2组比较差异具有统计学意义（P＜0.01）.随着腹膜透析的进行,UE组血清GFAP水平逐渐下降,头颅MRI异常信号逐渐减轻.至治疗后4周,UE组血清GFAP水平基本降至正常水平,大部分患者中枢神经系统损害的症状完全消失,仅有5例患者遗留有轻度的认知功能减退,5例中其中4例（占10.5％）患者遗留有长T1长T2信号.结论 血清GFAP水平联合头颅MRI影像学比较可以作为临床上评估UE患者神经系统损害程度及透析治疗的疗效和预后的有效手段之一.

Change of glial fibers acidic protein and the imaging evaluation in the patients with uremic encephalopathy before and after peritoneal dialysis

Objective To evaluate the curative effect and prognosis of peritoneal dialysis in the patients with uremic encephalopathy （UE） by detecting the change of serum glial fibrillary acidic po- tein （GFAP） level and MRI imaging of head before and after peritoneal dialysis. Methods The pa- tients with chronic renal failure without dialysis were divided into UE group and uremia control group. The health check-up volunteers served as healthy control group. In UE group and uremia control group serum level of GFAP was determined and head MRI examination was done before and on the 1st, 2nd and 4th week after peritoneal dialysis. Results Before treatment, the serum GFAP level in UE group was higher than in uremia control group and healthy control group （P0. 01）. There were 18 cases of abnormal MRI signal detection in UE group （18/38, 47. 40/oo）, and 2 cases in uremia con- trol group （2/40, 5 %）. With peritoneal dialysis, the level of serum GFAP was gradually declined and the abnormal MRI signal gradually reduced. At 4th week after treatment, the serum GFAP level in UE group was nearly normal and the damage symptoms of central nervous system disappeared in the majority of patients of UE group. Only 5 patients had mild cognitive decline, including four of five pa- tients （10. 5%） with long Tl-long T2 signals. Conclusions The changes of serum GFAP level com- bined with MRI imaging of head could be used effectively as a clinical assessment of nerve damage de-gree, the curative effect and prognosis of dialysis in UE.