尿毒症血液透析患者周围神经病的发生率及影响因素分析

Occurrence and risk factors of uremia peripheral neuropathy in hemodialysis patients

目的探讨尿毒症性周围神经病的发生率以及影响因素。方法收集解放军第455医院2011年1月至2012年12月386例维持性血液透析治疗的尿毒症患者,据其是否存在周围神经病变分成病变组(196例)与对照组(190例)。对比2组患者临床特征和血液检查结果,解析其与尿毒症性周围神经病发生的相关性。结果结果显示,在尿毒症性周围神经病变组患者透析龄、血清C反应蛋白(C-reactive protein,CRP)、血清甲状旁腺素(parathyroid hormone,PTH)、尿素氮(BUN)、空腹血糖含量显著上升,而前白蛋白(prealbumin,PA)、白蛋白(albnmin,Alb)、血红蛋白(hemoglobin,Hb)浓度明显下降。结果提示,尿毒症性周围神经病的发生与CRP、PTH、BUN、空腹血糖含量的表达正相关,同时与透析频率、PA、Alb、Hb的表达负相关。纳入的两组患者性别、年龄、吸烟史、饮酒史、血压无显著差异,对比结果显示两组是否有周围神经病的发生与小分子物质如血肌酐(SCr)、血浆胆固醇、三酰甘油、血钾、血钙、血钠、血磷均无显著差异(P>0.05)。结论尿毒症性周围神经病的发生可能与CRP、PTH、PA、Alb、Hb的表达量相关,但是它们是如何参与尿毒症性周围神经病的发生、发展有待进一步的探索。

Objective To investigate the occurrence and risk factors of uremic peripheral neuropathy. Methods 386 cases of uremia undergoing hemodialysis treatment were collected in our hospital from January 2011 to December 2012. According to the existence of uremic peripheral neuropathy,they were divided into the lesion group（ 190 cases） and non-lesion group（ 196 cases）. To investigate the relationship between the clinical features,several blood indicators of the patients and the existence of uremic peripheral neuropathy,we tested all the sera of the 386 patients and made a detailed comparison subsequently. Results Our results found that the expression of dialysis age,C-reactive protein,PTH proteins,BUN,and GLU2＋ were positively correlated with the existence of uremic peripheral neuropathy. However,the expression of dialysis frequency,pre-albumin,albumin,and hemoglobin had a negative correlation with the existence of uremic peripheral neuropathy. There were no significant differences between the two groups in sex,age,smoking history,drinking history,blood pressure. Results it show that the two groups whether occurrence of perpheralne uropathy with small mole cules such as SCr,CHO,TG,potassium,calcium,serum sodium,blood phosphorus had no signifi cant difference（ P 〉0. 05）. Conclusions The occurrence of uremic peripheral neuropathy might be related to dialysis age and the expression of C-reactive protein,PTH,pre-albumin,albumin and hemoglobin. Our follow-up study might aim to explore the mechanisms of these proteins in the development of uremic peripheral neuropathy.