【摘要】目的探讨不同血液净化方式对终末期肾病(end-stage renal disease，ESRD)周围神经病变的疗效及治疗机制。方法 将38 例ESRD 合并周围神经病变患者，随机分为血液透析(hemodialysis，HD)、血液透析灌流(hemodialysis + hemoperfusion ，HD+HP)、腹膜透析(peritoneal dialysis ，PD)3 组，分别于血液净化前、血液净化4 个月后观察患者临床症状改善情况、感觉神经传导速度. 结果在症状改善方面：经平均Ridit 分析，HD、HD+HP、PD 均能有效改善ESRD 周围神经病变症状(平均R 值分别：R1=0.48，R2=0.41，R3=0.40，总R=0.50，95% CI 分别：0.42～0.63，0.26～0.57，0.24～0.57，χ2=7.359，P=0.025)，两两比较发现PD 组、HD+HP组均明显优于HD组(U=2.490，P=0.010；U=2.470，P=0.010)，HD+HP组与PD组比较无显著差异性(U=0.070，P=0.946)；感觉神经传导速度方面：经过4 个月的治疗, HD 组正中、胫前、腓总感觉神经传导速度较净化前增快，但比较无显著差异性(t=0.500，t=0.700，t=0.700，P＞0.050)；HD+HP组、PD组3 条感觉神经传导速度均有显著改善(t=3.020，t=3.130，t=2.920；t=3.390，t=3.550，t=4.010，P＜0.01)，其改善程度显著优于HD 组(t= 5.560, t=5.230，t=4.580；t=5.030，t=4.610，t=5.570，P＜0.01)；PD组较HD+HP组3条感觉神经传导速度虽增快，但比较无显著差异性(t=1.530，t=1.140, t=0.980，P＞0.05)。结论 在改善ESRD 周围神经病变疗效上PD和HD+HP疗效相当，均明显优于HD；周围神经病变的发生可能与尿毒症中、大分子毒素的潴留有关。

【Abstract】 Objective To evaluate the effect of different blood purification profiles on peripheral neuropathy and the curative mechanism in end-stage renal disease (ESRD) patients. Methods A total of 38 ESRD patients with peripheral neuropathy were randomly assigned to hemodialysis group (HD), hemodialysis + hemoperfusion group (HD+HP) or peritoneal dialysis group (PD). Changes of clinical symptoms, sensory nerve conduction velocity (SCV), were respectively monitored in the patients before blood purification and after hemodialysis for 4 months, hemoperfusion for 4 months, or peritoneal dialysis for 4 months. Results By mean of Ridit analysis, clinical symptoms improved after blood purification than before in the HD, HD+HP and PD groups (the mean R value: R1=0.48, R2 =0.41, R3 =0.40, respectively, and total R =0.50; 95% CI.：0.42～0.63, 0.26～0.57, 0.24～0.57, respectively; χ2 =7.36, P=0.025). The curative effect were significantly better in PD and HD+HP groups than in HD group (U =2.490, P=0.010, and U=2.470, P=0.010, respectively), but were statistically indifferent between PD group and HD+HP group (U=0.070, P=0.946). In HD group, SCV in median, anterior tibial, and common peroneal nerves became faster after the treatment for 4 months than before hemodialysis, but the differences were statistically insignificant (t=0.500, 0.700 and 0.700, respectively; P＞0.05). In HD+HP and PD groups, SCV in the 3 nerves improved significantly after the treatment (for HD+HP group, t=3.02, 3.130 and 2.920, respectively; for PD group, t=3.390, 3.550 and 4.010, respectively; P＜0.01), and the improvement was better in HD+HP and PD groups than in HD group
(for comparison of HD+HP and HD groups: t=5.560, 5.230 and 4.58, respectively; for comparison of PD and HD groups: t=5.030, 4.61 and 5.570, respectively; P＜0.01). Conclusion PD and HD+HP are superior to HD for the treatment of uremic peripheral neuropathy in ESRD patients. The peripheral neuropathy may
result from the large and middle toxic molecules accumulated in ESRD patients.