中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
17期
1319-1322
,共4页
蔡文利%苗书斋%王沛育%邢利
蔡文利%苗書齋%王沛育%邢利
채문리%묘서재%왕패육%형리
血液灌流%血液透析%周围神经病变%瘦素%内皮素
血液灌流%血液透析%週圍神經病變%瘦素%內皮素
혈액관류%혈액투석%주위신경병변%수소%내피소
Hemoperfusion%Hemodialysis%Peripheral neuropathy%Leptin%Endothelin-1
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.
目的 觀察血液灌流聯閤透析(HD+ HP)對尿毒癥患者週圍神經病變的治療效果,併探討其作用機製.方法 對2011年1月至2014年4月鄭州人民醫院血液淨化中心66例併髮週圍神經病變的血液透析患者,分為低通量HD組、高通量HD組和HP+ HD組,每組22例,觀察治療期結束後觀察對週圍神經病變的臨床效果,治療前後測定血清瘦素(leptin)及內皮素-1(ET-1),甲狀徬腺素(PTH)和β-2微毬蛋白(β-2MG)等指標,觀察治療前後感覺神經傳導速度(SCV)的變化.結果 經12週治療,HP+ HD組患者臨床癥狀改善明顯(有效率90.91％),高通量HD和低通量HD組僅小部分有效或基本無效(有效率分彆為31.82％和13.64％).HD+ HP組中leptin、ET-1和PTH、β-2MG治療前(分彆為37.7+3.6,98±16,719±112,79±10)較治療後(分彆為18.7±1.9,46±11,303±98,79±10)明顯降低,SCV明顯增加(P＜0.05),高通HD組和低通HD組治療前後各組指標變化差異無統計學意義(P＞0.05),相關分析提示leptin(r=-0.57)、ET-1(r=-0.47)和β-2MG(r=-0.56)和SCV呈負相關(P＜0.05),但PTH(r=-0.23)和SCV不相關(P＞0.05).結論 HP+ HD可以有效改善尿毒癥患者週圍神經病變臨床癥狀,可能與有效清除瞭leptin、ET-1和PTH、β-2MG等中大分子毒素有關.
목적 관찰혈액관류연합투석(HD+ HP)대뇨독증환자주위신경병변적치료효과,병탐토기작용궤제.방법 대2011년1월지2014년4월정주인민의원혈액정화중심66례병발주위신경병변적혈액투석환자,분위저통량HD조、고통량HD조화HP+ HD조,매조22례,관찰치료기결속후관찰대주위신경병변적림상효과,치료전후측정혈청수소(leptin)급내피소-1(ET-1),갑상방선소(PTH)화β-2미구단백(β-2MG)등지표,관찰치료전후감각신경전도속도(SCV)적변화.결과 경12주치료,HP+ HD조환자림상증상개선명현(유효솔90.91％),고통량HD화저통량HD조부소부분유효혹기본무효(유효솔분별위31.82％화13.64％).HD+ HP조중leptin、ET-1화PTH、β-2MG치료전(분별위37.7+3.6,98±16,719±112,79±10)교치료후(분별위18.7±1.9,46±11,303±98,79±10)명현강저,SCV명현증가(P＜0.05),고통HD조화저통HD조치료전후각조지표변화차이무통계학의의(P＞0.05),상관분석제시leptin(r=-0.57)、ET-1(r=-0.47)화β-2MG(r=-0.56)화SCV정부상관(P＜0.05),단PTH(r=-0.23)화SCV불상관(P＞0.05).결론 HP+ HD가이유효개선뇨독증환자주위신경병변림상증상,가능여유효청제료leptin、ET-1화PTH、β-2MG등중대분자독소유관.
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.
