不同血液净化方式对终末期肾病周围神经病变的影响

目的探讨不同血液净化方式对终末期肾病(end-stage renal disease,ESRD)周围神经病变的疗效及治疗机制。方法将38例ESRD合并周围神经病变患者,随机分为血液透析(hemodialysis,HD)、血液透析灌流(hemodialysis+hemoperfusion,HD+HP)、腹膜透析(peritoneal dialysis,PD)3组,分别于血液净化前、血液净化4个月后观察患者临床症状改善情况、感觉神经传导速度.结果在症状改善方面:经平均Ridit分析,HD、HD+HP、PD均能有效改善ESRD周围神经病变症状(平均R值分别:R1=0.48,R2=0.41,R3=0.40,总R=0.50,95%CI分别:0.42～0.63,0.26～0.57,0.24～0.57,?2=7.359,P=0.025),两两比较发现PD组、HD+HP组均明显优于HD组(U=2.490,P=0.010;U=2.470,P=0.010),HD+HP组与PD组比较无显著差异性(U=0.070,P=0.946);感觉神经传导速度方面:经过4个月的治疗,HD组正中、胫前、腓总感觉神经传导速度较净化前增快,但比较无显著差异性(t=0.500,t=0.700,t=0.700,P>0.050);HD+HP组、PD组3条感觉神经传导速度均有显著改善(t=3.020,t=3.130,t=2.920;t=3.390,t=3.550,t=4.010,P<0.01),其改善程度显著优于HD组(t=5.560,t=5.230,t=4.580;t=5.030,t=4.610,t=5.570,P<0.01);PD组较HD+HP组3条感觉神经传导速度虽增快,但比较无显著差异性(t=1.530,t=1.140,t=0.980,P>0.05)。结论在改善ESRD周围神经病变疗效上PD和HD+HP疗效相当,均明显优于HD;周围神经病变的发生可能与尿毒症中、大分子毒素的潴留有关。

The influence of different blood purification profiles on the peripheral neuropathy in end-stage renal disease patients

Objective To evaluate the effect of different blood purification profiles on peripheral neuropathy and the curative mechanism in end-stage renal disease （ESRD） patients. Methods A total of 38 ESRD patients with peripheral neuropathy were randomly assigned to hemodialysis group （HD）, hemodialysis ＋ hemoperfusion group （HD＋HP） or peritoneal dialysis group （PD）. Changes of clinical symptoms, sensory nerve conduction velocity （SCV）, were respectively monitored in the patients before blood purifica-tion and after hemodialysis for 4 months, hemoperfusion for 4 months, or peritoneal dialysis for 4 months. Results By mean of Ridit analysis, clinical symptoms improved after blood purification than before in the HD, HD＋HP and PD groups （the mean R value： R1=0.48, R2=0.41, R3=0.40, respectively, and total R=0.50; 95% CI.：0.42～0.63, 0.26～0.57, 0.24～0.57, respectively; ？2=7.36, P=0.025）. The curative effect were significantly better in PD and HD＋HP groups than in HD group （U=2.490, P=0.010, and U=2.470, P=0.010, respectively）, but were statistically indifferent between PD group and HD＋HP group （U=0.070, P=0.946）. In HD group, SCV in median, anterior tibial, and common peroneal nerves became faster after the treatment for 4 months than before hemodialysis, but the differences were statistically insignificant （t=0.500, 0.700 and 0.700, respectively; P0.05）. In HD＋HP and PD groups, SCV in the 3 nerves improved significantly after the treatment （for HD＋HP group, t=3.02, 3.130 and 2.920, respectively; for PD group, t=3.390, 3.550 and 4.010, respectively; P0.01）, and the improvement was better in HD＋HP and PD groups than in HD group （for comparison of HD＋HP and HD groups： t=5.560, 5.230 and 4.58, respectively; for comparison of PD andHD groups： t=5.030, 4.61 and 5.570, respectively; P0.01）. Conclusion PD and HD＋HP are superior to HD for the treatment of uremic peripheral neuropathy in ESRD patients. The peripheral neuropathy may result from the large and middle toxic molecules accumulated in ESRD patients.