血液灌流联合血液透析改善尿毒症患者周围神经病变疗效观察及机制研究

Efficacy and mechanism of hemoperfusion plus hemodialysis for peripheral neuropathy of uremic patients on maintenance hemodialysis

目的 观察血液灌流联合透析（HD＋ HP）对尿毒症患者周围神经病变的治疗效果,并探讨其作用机制.方法 对2011年1月至2014年4月郑州人民医院血液净化中心66例并发周围神经病变的血液透析患者,分为低通量HD组、高通量HD组和HP＋ HD组,每组22例,观察治疗期结束后观察对周围神经病变的临床效果,治疗前后测定血清瘦素（leptin）及内皮素-1（ET-1）,甲状旁腺素（PTH）和β-2微球蛋白（β-2MG）等指标,观察治疗前后感觉神经传导速度（SCV）的变化.结果 经12周治疗,HP＋ HD组患者临床症状改善明显（有效率90.91％）,高通量HD和低通量HD组仅小部分有效或基本无效（有效率分别为31.82％和13.64％）.HD＋ HP组中leptin、ET-1和PTH、β-2MG治疗前（分别为37.7±3.6,98±16,719±112,79±10）较治疗后（分别为18.7±1.9,46±11,303±98,79±10）明显降低,SCV明显增加（P＜0.05）,高通HD组和低通HD组治疗前后各组指标变化差异无统计学意义（P＞0.05）,相关分析提示leptin（r=-0.57）、ET-1（r=-0.47）和β-2MG（r=-0.56）和SCV呈负相关（P＜0.05）,但PTH（r=-0.23）和SCV不相关（P＞0.05）.结论 HP＋ HD可以有效改善尿毒症患者周围神经病变临床症状,可能与有效清除了leptin、ET-1和PTH、β-2MG等中大分子毒素有关.

Objective To explore the efficacy and mechanism of hemoperfusion （HP） plus hemodialysis （HD） for peripheral neuropathy of uremic patients on maintenance hemodialysis.Methods A total of 66 uremic patients on hemodialysis during January 2014 and April 2011 were assigned randomly into HP ＋ HD,low-flux HD and high-flux HD groups （n =22 each）.The serum levels of leptin,endothelin-1 （ET-1）,parathyroid hormone （PTH） and β-2 microglobulin were observed pre and post-treatment.And sensory conduction velocity （SCV） was detected simultaneously.Results After 12-week treatment,the clinical symptoms of group HP ＋ HD improved significantly with an effective rate of 90.91% while improvement was not obvious in groups high-flux and low-flux HD with effective rates of 31.82% and 13.64%.In HP ＋ HD group,the levels of leptin,ET-1,PTH and β-2MG decreased,sensory conduction velocity increased （P 〈 0.05） and clinical symptoms improved apparently.While in low-flux HD and highflux HD groups,leptin,ET-1,PTH and β-2MG had no decrease and SCV showed no improvement （P 〉 0.05）.Correlation analysis showed that the levels of leptin,ET-1 and β-2MG were negatively correlated with SCV（r =-0.57,r =-0.47,r =-0.56）.Yet PTH had no correlation with SCV （r=-0.23）.Conclusion Hemoperfusion plus hemodialysis may improve the clinical symptoms of peripheral neuropathy of uremic patients on maintenance hemodialysis.And it is probably due to the fact that HP ＋ HD effectively removes such plasma middle and macromolecular toxins as leptin,ET-1,PTH and β-2MG.