血液透析联合血液灌流及依达拉奉对尿毒症RLS患者外周血清中毒素水平、临床症状及睡眠质量的影响

摘要 目的：探讨高通量血液透析（HFD）联合血液灌流（HP）及依达拉奉对尿毒症不宁腿综合征（RLS）患者外周血清中毒素水平、临床症状、睡眠质量、负性情绪的影响。方法：选择2018年2月至2019年12月我院肾内科收治的174例尿毒症RLS患者，采用随机数字表法将患者分为三组。常规血液透析（HD）组（58例）采用常规血液透析治疗，联合A组（58例）采用HFD联合HP治疗，联合B组（58例）采用HFD联合HP及依达拉奉治疗。观察三组治疗前后肾功能尿素氮（BUN）、血肌酐（SCr）、尿白蛋白排泄率（UAER）]、血清毒素甲状旁腺激素（PTH）、硫酸吲哚酚（IS）、硫酸对甲酚（PCS）]水平、RLS评分、睡眠质量、负性情绪以及不良反应的差异。结果：三组治疗后血清BUN、SCr、UAER、PTH、IS、PCS水平、RLS评分、匹兹堡睡眠质量指数（PSQI）评分、汉密尔顿焦虑量表（HAMA)评分、汉密尔顿抑郁量表（HAMD）评分均有所下降（P＜0.05）。联合B组、联合A组治疗后血清BUN、SCr、UAER、PTH、IS、PCS水平低于HD组（P＜0.05），联合B组、联合A组上述指标比较无统计学差异（P＞0.05）。联合B组治疗后RLS评分、PSQI评分、HAMA评分、HAMD评分均低于联合A组和HD组（P＜0.05），联合A组低于HD组（P＜0.05）。三组治疗期间不良反应发生率比较无统计学差异（P＞0.05）。结论：HFD联合HP及依达拉奉可改善尿毒症RLS患者的临床症状和肾功能，可降低血清毒素水平，并改善睡眠质量和负性情绪。

Effects of Hemodialysis Combined with Hemoperfusion and Edaravone on the Levels of Toxins in Peripheral Blood, Clinical Symptoms and Sleep Quality in Patients with Restless Leg Syndrome

ABSTRACT Objective: To investigate the effects of high-flux hemodialysis (HFD) combined with hemoperfusion (HP) and Edaravone on the levels of toxins, clinical signs and symptoms, sleep quality and negative emotions of patients with uremia restless legs syndrome (RLS). Methods: 174 patients with uremia RLS admitted to the hemodialysis center of our hospital from February 2018 to December 2019 were selected, and the patients were divided into three groups by random number table method. The Routine hemodialysis (HD) group (58 cases) was treated with conventional hemodialysis, the joint group A (58 cases) was treated with HFD combined HP, and the joint group B (58 cases) was treated with HFD combined HP and Edaravone. The differences in renal functionurea nitrogen (BUN),serum creatinine (SCr), urinary albumin excretion rate (UAER)], serum toxin parathyroid hormone (PTH), indoxyl sulphate (IS), pcresyl sulphate (PCS)]levels, RLS score, sleep quality, negative emotions and adverse reactions in three groups were observed before and after treatment. Results: The levels of serum BUN, SCr, UAER, PTH, IS, PCS, RLS score, Pittsburgh sleep quality index (PSQI) score, Hamilton anxiety scale (HAMA) score and Hamilton depression scale (HAMD) score all decreased after treatment in three groups (P<0.05). The levels of serum BUN, SCr, UAER, PTH, IS, PCS in the joint group A and the joint group B were lower than those of the HD group after treatment (P<0.05), and there was no statistical difference between the joint group A and the joint group B (P>0.05). After treatment, RLS score, PSQI score, HAMA score and HAMD score in the joint group B were all lower than those in the joint group A and the HD group (P<0.05), while those in the joint group A were lower than those in the HD group (P<0.05). There was no significant difference in the incidence of adverse reactions in the three groups (P>0.05). Conclusion: HFD combined with HP and edaravone can improve the clinical symptoms and renal function of uremic RLS patients, reduce serum toxin level, and improve sleep quality and negative emotions.