甲钴胺联合血液透析治疗尿毒症患者周围神经病变的效果及对患者血清微炎症介质水平的影响

Clinical Efficacy of Mecobalamin Combined with Blood Purification in the Treatment of Uremia Patients with Peripheral Neuropathy and its Effect on the Serum Micro Inflammatory Mediators Levels

目的:探讨甲钴胺联合血液透析治疗尿毒症患者周围神经病变的效果及对患者血清微炎症介质水平的影响。方法:将86例合并周围神经病变的尿毒症患者随机分为观察组46例与对照组40例,两组均接受血液净化治疗,观察组同时加用甲钴胺治疗。比较两组治疗前后的血清C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6)及IL-8水平,肢体正中神经与腓浅神经的感觉神经传导速度(SCV)以及临床症状、体征改善情况。结果:治疗后,两组血清CRP、TNF-α、IL-6、IL-8水平均较治疗前明显下降(P<0.05),正中神经与腓总神经的SCV均较治疗前明显提高(P<0.05),且观察组血清CRP、TNF-α、IL-6、IL-8水平明显低于对照组(P<0.05),正中神经SCV显著高于对照组(P<0.05),四肢感觉减退、四肢远端麻木与烧灼感、不宁腿综合征、肢端疼痛的发生率明显低于对照组(P<0.05)。结论:甲钴胺联合血液透析对尿毒症性周围神经病变的疗效明显优于单用血液透析治疗,且可显著改善机体的微炎症状态。

Objective： To investigate the clinical efficacy of mecobalamin in the treatment of peripheral neuropathy and its effect on the micro inflammatory mediators of patients with uremia. Methods： 86 cases of patients with uremia combined with peripheral neu- ropathy were randomly divided into the observation group（46 cases） and the control group（40 eases）. Both groups received blood purifi- cation treatment, and the observation group were added mecobalamin. The levels of serum C-reactive protein （CRP）, tumor necrosis fac- tor-alpha （TNF-α）, interleukin-6 （IL-6） and IL-8, and sensory nerve conduction velocity （SCV） of the median nerve and superficial peroneal nerve in the extremities and improvement of clinical symptoms and signs were compared between the two groups before and after treatment. Results： After treatment, the levels of serum CRP, TNF-α, IL-6 and IL-8 of both groups were obviously decreased（P〈0.05）, the SCV of median nerve and the peroneal nerve of both groups were obvious higher than those before treatment （P〈0.05） and the serum CRP, TNF-α, IL-6, IL-8 levels of observation group were lower in the observation group than those of the control group （P〈0.05）. The median nerve SCV of observation group was significantly higher than that of the control group （P〈0.05）. The incidence of limb loss, numbness and burning sensation, restless legs syndrome and aeral pain of observation group were significantly lower than those of the control group （P〈0.05）. Conclusions： Meeobalamin combined with hemodialysis was better than hemodialysis in treatment of uremic pe- ripheral neuropathy, which could significantly improve the micro inflammatory state of patients.