高通量血液透析治疗终末期肾病伴金刚烷胺药物性脑病的研究

Application of high-flux hemodialysis in treatment of end-stage renal disease complicated with amantadine-induced encephalopathy

目的探讨采用高通量血液透析技术治疗终末期肾病伴金刚烷胺药物性脑病患者的疗效。方法将52例终末期肾病伴金刚烷胺药物性脑病患者分为低通量组及高通量组,分别给予低通量和高通量血液透析治疗,比较两组治疗前、后血清金刚烷胺水平的变化情况及神经症状的改善情况。结果治疗前,两组血清金刚烷胺水平比较差异无统计学意义,分别为(1.73±0.22)mg/L、(1.75±0.23)mg/L(P>0.05);但治疗2周后,高通量组血清金刚烷胺水平为(1.55±0.12)mg/L,低于低通量组的(1.67±0.15)mg/L,比较差异有统计学意义(P<0.05)。低通量组谵语、幻听、记忆力衰退的改善率分别为18%、15%、9%,高通量组的分别为50%、54%和50%,两组上述3种症状的改善率比较差异均具统计学意义(P<0.05)。结论高通量血液透析能明显降低终末期肾病伴金刚烷胺药物性脑病患者血清金刚烷胺水平,改善患者神经症状。

Objective To evaluate the clinical efficacy of high-flux hemodialysis technique in the treatment of end-stage renal disease complicated with amantadine-induced encephalopathy. Methods Fifty- two patients diagnosed with end-stage renal disease complicated with amantadine-induced encephalopathy were divided into the low-flux and high-flux groups. Patients in two groups underwent low- and high-flux hemodialy- sis, respectively. The changes of serum amantadine and the alleviation of neurological symptoms were statisti- cally compared between two groups before and after treatment. Results Before treatment, the serum levels of amantadine did not significantly differ between two groups [ （ 1.73 ＋ 0. 22） mg/L vs. （ 1.75 ＋ 0. 23 ） mg/L, P 〉 O. 05 ] ; at 2 weeks after treatment, the serum level of amantadine in the high-flux group declined to （ 1.55 ± 0. 12） mg/L, significantly lower compared with （ 1.67 ± 0. 15） mg/L in the low-flux group （P 〈 0. 05 ）. The improvement rates of delirious speech, auditory hallucination and the failure of memory were 18%, 15% and 9% in the low-flux group, significantly lower than 50% , 54% and 50% in the high-flux group, respectively （P 〈 0.05 ）. Conclusions High-flux hemodialysis can significantly reduce the serum level of amantadine and improve neurological symptoms in patients suffering from end-stage renal disease complicated with amantadine- induced eucephalopathy.