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目的比较4种血液净化方式对尿毒症周围神经病变的疗效。方法将108例尿毒症周围神经病变的维持性血透患者随机分为低通量血液透析(LFHD)28例、高通量血液透析(HFHD)27例、血液透析滤过(HDF)27例,血液透析联合血液灌流(HD+HP)26例。随访12周,比较治疗前、后血清肌酐(SCr)、甲状旁腺素(PTH)、β2微球蛋白(β2-MG)和感觉神经传导速度(SCV)的变化,分析PTH和β2-MG与SCV的相关性。结果 4组治疗前后的SCr均无统计学差异。与治疗前比较,治疗12周后,LFHD组PTH和β2-MG无明显改变,但HFHD组、HDF组和HD+HP组的PTH和β2-MG明显下降(P<0.05)。经12周治疗,HFHD组、HDF组、HD+HP组的SCV增加值明显高于LFHD组(P<0.05)。PTH和β2-MG分别与SCV有明显相关性(P<0.05)。结论HFHD、HDF、HD+HP等血液净化治疗方法均能有效清除PTH和β2-MG,且对治疗尿毒症周围神经病变有效;PTH和β2-MG在体内蓄积与尿毒症周围神经病变有关。
Objective To compare the efficacy of four blood purification methods on peripheral neuropathy of uremia. Methods A total of 108 patients with maintenance hemodialysis of uremic peripheral neuropathy were randomly divided into low-dose hemodialysis (HFHD) in 28 cases, high-throughput hemodialysis (HFHD) in 27 cases, hemodiafiltration (HDF) in 27 cases, Hemodialysis combined hemoperfusion (HD + HP) in 26 cases. The changes of serum creatinine (SCr), parathyroid hormone (PTH), β2 microglobulin (β2-MG) and sensory nerve conduction velocity (SCV) were compared before and after treatment for 12 weeks. SCV relevance. Results There was no significant difference in SCr between the 4 groups before and after treatment. PTH and β2-MG did not change significantly in LFHD group after 12 weeks of treatment, but PTH and β2-MG in HDHD group, HDF group and HD + HP group were significantly decreased compared with those before treatment (P <0.05). After 12 weeks treatment, the increase of SCV in HFHD, HDF and HD + HP groups was significantly higher than that in LFHD group (P <0.05). PTH and β2-MG were significantly associated with SCV (P <0.05). Conclusion The blood purification methods such as HFHD, HDF and HD + HP can effectively remove PTH and β2-MG, and are effective in treating peripheral neuropathy of uremia. Accumulation of PTH and β2-MG in the body is associated with uremic peripheral neuropathy.