α-硫辛酸联合高通量血液透析对糖尿病血液透析患者周围神经病变的临床疗效观察

Clinical effect of alpha-lipoic acid plus high flux hemodialysis on peripheral neuropathy in patients with diabetic hemodialysis

目的探讨α-硫辛酸联合高通量血液透析对糖尿病血液透析患者周围神经病变的临床疗效。方法选取2016年7月至2019年7月于湖北省天门市第一人民医院行血液透析治疗的糖尿病合并有周围神经病变患者60例。采用简单随机法将患者分成对照组和观察组。对照组每周3次行常规血液透析,每次4 h,同时口服α-硫辛酸胶囊,每次1粒,每日3次;观察组每周3次行高通量血液透析治疗,每次4 h,亦服用α-硫辛酸胶囊,每次1粒,每日3次。两组均治疗12周。比较对照组和观察组治疗前及治疗后患者的临床症状(肢端疼痛、麻木感、不宁腿综合征)改善情况,比较两组患者治疗前后血清中丙二醛、晚期蛋白氧化产物、全段甲状旁腺素、β2-微球蛋白等指标变化情况,比较两组患者治疗前后外周神经(正中神经、腓总神经和胫神经)的感觉传导速度变化情况。结果治疗12周后,对照组和观察组患者临床症状和神经感觉传导速度都较治疗前明显改善(P<0.05),观察组较对照组改善更为明显(P<0.05)。治疗后观察组患者血清中丙二醛、晚期蛋白氧化产物、全段甲状旁腺素、β2-微球蛋白水平较对照组明显降低(P<0.05)。结论α-硫辛酸联合高通量血液透析可以更好地改善糖尿病血液透析患者周围神经病变。

Objective To explore the clinical effect of alpha-lipoic acid plus high flux hemodialysis on diabetics with peripheral neuropathy.Methods A total of 60 patients with diabetic hemodialysis and peripheral neuropathy were selected from 2016 to 2019.They were randomly divided into control and observation groups.Control group received routine hemodialysis 3 times a week,4 hours each time and took alpha-lipoic acid capsule,1 capsule each time,3 times daily;observation group was offered high flux hemodialysis treatment 3 times a week,4 hours each time and also took alpha-lipoic acid capsule(same as control group).Both groups were for 12 weeks.The clinical symptoms(limb pain,numbness&restless leg syndrome),serum levels of oxidative stress index[malondialdehyde(MDA)&advanced protein oxidation products(AOPP)]and of serum parathyroid hormone(iPTH),β2-microglobulin and peripheral nerves,sensory conduction velocity(median nerve,common peroneal nerve&tibial nerve)were compared between two groups before and after 12 weeks.Results After 12 weeks of treatment,clinical symptoms,oxidative stress parameters and nerve sensory conduction velocity markedly improved in both groups(P<0.05)and the improvement was more obvious in observation group than that in control group(P<0.05).After dialysis,the levels of parathyroid hormone andβ2-microglobulin were significantly lower in observation group than those in control group(P<0.05).Conclusions Alpha-lipoic acid plus high flux hemodialysis can improve peripheral neuropathy in diabetic hemodialysis patients.