终末期肾病患者金刚烷胺引起的药物性脑病血液透析灌流的研究

Research of Hemodialysis Perfusion Treatment in Patients with End-stage Renal Disease and Amantadine Encephalopathy Caused by Drug

目的探讨和分析对终末期肾病伴金刚烷胺药物性脑病患者应用血液透析(hemodialysis,HD)联合血液灌流(hemoperfusion,HP)(HP+HD)治疗的临床效果及价值。方法选取2007-09/2013-09月在秦皇岛地区各透析室治疗的终末期肾病患者52例为研究对象,均伴金刚烷胺药物性脑病,随机分成研究组及对照组,分别行HP+HD和HD治疗,用LC-MS(liquid chromatograph-mass spectrometer)法测定血液透析前后的血浆金刚烷胺水平,并观察精神神经系统症状改善情况及生活质量改善情况。结果透析前,血浆中金刚烷胺检测水平及生活质量评分对比差异均不明显(P>0.05),透析治疗后,研究组金刚烷胺水平下降幅度明显较对照组低,药物性脑病治疗有效率明显较对照组高,生活质量评分均较对照组改善优良,对比差异显著(P<0.05)。结论 HP+HD治疗终末期肾病患者金刚烷胺引起的药物性脑病的效果显著,能明显降低血浆中金刚烷胺水平,改善患者药物性脑病精神症状及生活质量,有临床上推广价值。

Objective To explore the clinical effect and value of hemodialysis perfusion（HP ＋ HD）in the treatment of end-stage renal disease patients with drug amantadine encephalopathy.Methods Fifty-two patients with end-stage renal disease were selected to treated in Qinhuangdao area every dialysis room in September 2007 to September 2013,and the patients also suffered drug amantadine encephalopathy who were randomly divided into the research group and the control group.Both group were given HP＋HD and hemodialysis（HD）treatment respectively.The plasma level of amantadine was determined before and after hemodialysis treatnment by LC-MS.The improvement of the nervous system symptoms and the quality of life were observed.Results Before the dialysis,the contrast differences in scores of amantadine in plasma level and quality of life were not significant（P〉0.05）.After the dialysis therapy,the amantadine level of the research group decreased obviously lower than that of the control group,the effectiveness of drug encephalopathy treatment in the research group was significantly higher than that of the control group,and the improvement in score of quality of life was better than the contral group.The difference was significant（P〈0.05）.Conclusion The effect of HP＋HD treatment for patients with end-stage renal disease and amantadine encephalopathy caused by drug is obvious.It can decrease the plasma level of amantadine significantly and improve the mental symptoms of patients with drug encephalopathy and the quality of life,which is worth clinical promotion.