血液透析联合血液灌流对尿毒症自主神经病变的影响

Influence of hemodialysis combined with hemoperfusion on uremic autonomic neuropathy

目的：研究血液透析联合血液灌流（HDP）对尿毒症患者自主神经病变的改善效果与机制。方法选择本院2013年5月-2014年5月收治的尿毒症患者60例，随机分为两组，观察组给予HDP治疗，对照组给予血液透析治疗。分别于治疗前及治疗12周后检测交感神经皮肤反应各指标、甲状旁腺素（PTH）及β2-微球蛋白（β2-MG）水平；分析PTH及β2-MG与交感神经皮肤反应各指标相关性。结果观察组治疗后上下肢潜伏期均有明显下降，上下肢波幅均有明显上升，差异有统计学意义（P〈0.05）；对照组无明显变化（P〉0.05）。观察组治疗后PTH及β2-MG均有明显下降，差异有统计学意义（P〈0.05）；对照组无明显变化（P〉0.05）。 PTH及β2-MG均与上下肢潜伏期呈正相关而与上下肢波幅呈负相关，差异有统计学意义（P〈0.05）。结论 HDP能明显改善尿毒症患者的自主神经病变，这可能与其能有效清除PTH及β2-MG有关。

Objective To study the improvement effect and mechanism of hemodialysis combined with hemoperfusion （HDP）on uremic autonomic neuropathy. Methods 60 patients with uremia in our hospital from May 2013 to May 2014 were selected and randomly divided into two groups,the observation group was treated with HDP,the control group was treated with hemodialysis.Sympathetic skin response of each index,parathyroid hormone（PTH） andβ2-microglobulin（β2-MG） level before treatment and treatment after 12 weeks was respectively checked;correlation on PTH and β2-MG and sympathetic skin response indexes were analyzed. Results After treatment,the latency of upper and lower limb in obser-vation group was significantly decreased respectively,upper and lower extremity amplitude in observation group was sig-nificantly increased respectively,with significant difference （P〈0.05）;The control group had no significant difference （P〉0.05）.The PTH andβ2-MG was decreased significantly respectively in observation group,with significant difference （P〈0.05）;The control group had no significant difference （P〉0.05）.The PTH andβ2-MG were positively associated with the upper and lower extremity latency and negatively correlated with the amplitude of upper and lower limb,with significant difference （P〈0.05）. Conclusion HDP can obviously improve uremic patients with autonomic neuropathy,which may be related to effectively remove PTH andβ2-MG.