| Objective: To use the sympathetic skin response (SSR) testing to evaluate the efficiency of different blood purification methods on uremic autonomic dysfunction (AD),and to provide testimony for looking for effective blood purification methods on uremic AD.Methods: 115 patients with AD who need long-term hemodialysis were collected and divided into the general hemodialysis(HD) treatment group (51 cases),hemodiafiltration(HDF) treatment group (30 cases), hemodialysis +hemoperfusion(HD+HP) treatment group (22 cases) and peritoneal dialysis(PD) treatment group (12 cases).Respectively,we detected the four treatment groups'SSR and the corresponding blood parathyroid hormone (PTH) levels before treatment and 3 months after treatment to compare the efficacy of the four blood purification methods on uremic AD.Results: The SSR of 35 cases of the 115 patients couldn′t be introducted.And of these 35 patients,23 cases′lower extremities were neither be introducted,nor the other cases′upper and lower extremities.The remaining 80 cases were manifested as prolongation of the latency(Lat) and reduction of peak-peak amplitude(Amp).After treatments,the SSR′s improvement rates of the patients whose SSR couldn′t be introducted were 11.76%,66.67%,100%,100% respectively in HD treatment group,HDF treatment group,HD+HPtreatment group and PD treatment group.In the HD group,there was no significant difference in the change of the upper and lower extremities Lat of SSR,Amp and PTH after 3 month-treatment(P>0.05). In HDF group,HD+HP group and PD group,the Lat was shorter than that before treatment ,and the Amp was increased significantly(P<0.01),PTH levels also decreased significantly after treatment(P<0.01). Through analysis of variance,we found out that the change of Lat and Amp of the HD+HP and PD group was more significantly than that of the HD and HDF group(P<0.01). There is no significant difference in the change of Lat and Amp between the HD+HP and PD groups (P>0.05). But, the lat of HDF group shortened more significantly than that in the HD group,the Amp increased as well(P<0.01). The levels of blood PTH in the HD+HP and PD group decreased much more than those in the HD and HDF group after treatment(P<0.01),but there is no significant difference in the drop of PTH between the two groups(P>0.05). The PTH of HDF group decreased more significantly than that of HD group(P<0.01).The mean of the 150 cases′PTH was 1642.06±844.15pmol/l.The mean of PTH of the 35 patients whose SSR couldn′t be introducted was 2609.49±599.27pmol/l,and the other 80 cases′mean of PTH was 1218.81±526.79pmol/l.The PTH level of the two group has significant contrast(P<0.01).There is a significant correlation between PTH level and SSR(P<0.01).Conclusion: The SSR can be an objective method in evaluating different blood purification treatment on uremic AD.HD+HP and PD can improve the SSR of uraemic patients with AD effectively, HDF can improve partly and HD can not improve absolutely,which may be related to the efficiency of clearance of the macromolecular and middle molecule uraemic toxinum. Uremic patients′PTH was relevant with SSR extremely,which prompts PTH level is one of the factors which could lead to uremic AD. |
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