摘要
目的通过电生理测试结果评估持续腹膜透析(PD)或血液透析(HD)的慢性肾功能衰竭患者周围神经病的发生率,并根据残余肾功能判断透析方式对周围神经功能的影响。方法将131例慢性肾功能衰竭患者按透析方式分为HD组(n=73)和PD组(n=58)。根据透析治疗期间肌电图的结果分别将HD组、PD组各分为MN亚组和非MN亚组。采用德国Medelec Shaphire 2MED仪对每例患者的正中神经、尺神经、腓总神经和胫神经的神经传导速度(NCV)进行电生理测定,感觉神经检测包括波幅、潜伏期和传导速度;运动神经检测则包括复合肌肉动作电位的波幅、潜伏期和传导速度。电生理检测发现至少2条神经异常结果可诊断为多发性神经病。在透析开始后的第1、6、12、18、24月检测每位患者的残余肾功能。结果 131例患者中在观察末期有78例存在感觉障碍。78例患者经肌电图检查诊断为MN者77例,其中HD组中MN患者44例(60.3%),PD组中MN患者33例(56.9%),2组比较差异无统计学意义(P>0.05)。透析治疗初期HD组中的MN亚组、非MN亚组,PD组中的MN亚组、非MN亚组对残余肾功能(RRF)变化进行多重比较,差异均无统计学意义(均P>0.05)。随着透析的进行,第12、24个月2种透析组的MN亚组RRF显著下降(P<0.05),非MN亚组RRF比较差异无统计学意义(P>0.05)。结论 MN在慢性肾衰患者中是常见的并发症,发生率与治疗方法无明显关系;PD或HD治疗不能阻止慢性肾功能衰竭患者周围神经病变的发生。残留肾功能在保护慢性肾功能衰竭患者周围神经功能方面起了重要的作用。
Objectives To assess the incidence of peripheral neuropathy using electrophysiological recording in chronic renal failure patients treated with continuous ambulatory peritoneal dialysis（CAPD） or maintenance hemodialysis（HD）,and to investigate the effects of different patterns of dialysis on peripheral nerve function according to residual renal function.Methods A total of 131 chronic renal failure patients were treated with HD（HD group,n=73） or CAPD（PD group,n=58）.Each of the two groups was further divided into MN subgroup and non-MN subgroup according to electrophysiological results.Electrophysiological testing was performed using Medelec Shaphire 2ME equipment for nerve conduction velocity（NCV） of bilateral ulnar nerves,median nerves,tibial nerves and fibular nerves.Electrophysiological indexes included the amplitude of evoked response,latency and NCV in sensory nerves,and the amplitude of compound muscle action potential,latency and NCV in motor nerves.Polyneuropathy was diagnosed if abnormal electrophysiological results were found in at least two nerves.Residual renal function was detected at 1,6,12,18 and 24 months after initiation of dialysis.Results Seventy-seven patients were diagnosed with polyneuropathy,and there were no significant differences in the incidence between HD patients（44 patients,60.3%） and CAPD patients（33 patients,56.9%）（P0.05）.In the early period after initiation of dialysis,the changes in RRF were not significantly different among the four subgroups（P0.05）.With the conduct of dialysis,RRF obviously decreased at 12 and 24 months in MN subgroups（P0.05）,but RRF had no significant changes in non-MN subgroups（P0.05）.Conclusion Polyneuropathy is a common complication in patients with chronic renal failure and the incidence is not associated with treatment methods.PD or HD can not prevent the occurrence of peripheral neuropathy in uremia patients.Residual renal function plays an important role in protecting peripheral nerve function in chronic renal f
出处
《实用临床医学（江西）》
CAS
2012年第1期10-12,15,共4页
Practical Clinical Medicine
关键词
腹膜透析
血液透析
慢性肾功能衰竭
多发性神经病
肌电图
残余肾功能
peritoneal dialysis
hemodialysis
chronic renal failure
peripheral neuropathy
electromyogram
residual renal function
