| Objective:1.To investigate the incidence of peripheral neuropathy in patients with uremia maintenance hemodialysis;2.Study on risk factors of peripheral neuropathy in patients with uremia maintenance hemodialysis;3.Setting up a risk scoring system of uremia peripheral neuropathy in hemodialysis patients;4.To verify the risk scoring system of uremia maintenance dialysis patients.Methods:1.Patients in the Department of Nephrology of Neijiang Second People's Hospital had a serum creatinine greater than 707umol/L and lasted for more than 3 months and regular maintenance hemodialysis was at least 2 times a week,and the dialysis time lasted for more than 3 months;2.Peripheral neuropathy was determined according to the patient's symptoms,signs,and laboratory tests.The peripheral neuropathy occurred in the lesion group,and the rest of the patients entered the control group.3.All patients were examined by electromyography:peroneal nerve,tibial nerve,sural nerve,superficial peroneal nerve,and median nerve.The measurement includes the amplitude,the conduction velocity,the end latency,and the distance of the end.4.The study was approved by the ethics committee,and the patient volunteered to join the study and signed an informed consent.5.SPSS 17.0 was used for statistical analysis.The single factor was tested by x 2,and the multiple factors were analyzed by Logistic regression.The discriminative ability of the risk prediction and scoring system is evaluated by the ROC curve.The non parametric Bootstrap method was used to verify the internal crowd validation.Results:1.There were 163 patients who met the requirements of the experiment.Among them the minimum age was 18 years,the maximum was 80 years,and the average was 50.17 years old;There were 75 men and 88 women;the highest height was 180 centimeters,the lowest was 145 centimeters,and the average was 161.1 centimeters.There were 38 people with a history of smoking and 125 people without a history of smoking.The primary disease was 134 patients(82.20%)with chronic nephritis,23 patients(14.11%)with hypertensive nephropathy,6 polycystic kidney(3.68%),5 of gouty nephropathy(3.07%)and 1 cavernous kidney(0.61%).There were 88 cases(53.99%)in the pathological group and 75 cases(46.01%)in the control group.95.45%(84/88)of the cases were diagnosed by electromyography in the pathological group.4 patients were diagnosed with peripheral neuropathy through typical clinical symptoms and signs and excluding possible diseases.2.The primary disease in the pathological group was mainly chronic nephritis,accounting for 81.81%(72/88),and the control group was 82.67%(62/75).Other primary diseases include hypertensive nephropathy,polycystic kidney,etc.There was no significant difference in the difference between the two groups(P>0.05).There were 45.45%(40/88)men and 54.55%(48/88)women in the lesion group,46.47%(3 5/75)men and 53.33%(40/75)women in the control group.There was no difference in gender statistics between the two groups(P>0.05).Patients with past smoking history or smoking(excluding secondhand smoke)were 29.55%(26/88)in the lesion group and 16%(12/75)in the control group.The difference between the two groups was statistically significant(P<0.05).The frequency of dialysis was 27.27%(24/88)in two times per week in the lesion group,16%(12/75)in the control group,and 72.72%(64/88)in three times a week in the lesion group,84%(63/75)in the contol group.There was no statistical difference of patients' dialysis frequency between the two groups(P>0.05).In the lesion group,42.5%were treated with HD+HP or HDF,and 36%in the control group.There was no statistical difference between the two groups.The length of dialysis was 12 months as the critical value.and 80.68%(71/88)patients in the pathological group had more than 12 months dialysis,and 30.67%(23/75)in the control group.There was significant statistical difference between the two groups(P<0.01).The age of 60 was a demarcation point,and the senile patient was over 60 years old.The elderly patients in the lesion group accounted for 39.77%(35/88)and 25.33%(19/75)in the control group,and there was no significant difference between the two groups(P>0.05).The height of the patients in the lesion group and the control group was 1.62±0.07m and 1.60±0.07m.The patients over 160cm were 63.64%(56/88)and 46.67%(35/75)in the control group,and the two groups were statistically different(P<0.05).The average weight of the lesion group and the control group was 51.45±7.67kg and 51.88±8.52kg respectively.The weighe of 50 kilograms was the critical value.The patients with less than 50kg were 53.41%(47/88)and 48%(36/75)in the control group(36/75),and there was no statistical difference between the two groups(P>0.05).The levels of C reactive protein,parathyroid hormone,beta 2-microglobulin and vitamin B12 in the lesion group were significantly different from those in the control group.The P values were 0.032,0.010,0 and 0.035,respectively.There was a significant difference between parathyroid hormone and beta 2-microglobulin.4.Logistic multi factor regression analysis,regression model fit well,P=0.309.Smoking and vitamin B12 were excluded by multivariate analysis.5 risk factors were screened out:height,C reactive protein,parathyroid hormone,total dialysis duration and beta 2-microglobulin.5.The ORRF scoring system:The OR value was assigned to the risk factors(four to five homes in rounding),risk the risk factors of the corresponding value named ORRF scoring system(RF was the abbreviation of the risk factor,which was assigned by OR,so it was named ORRF).4 points higher than 160cm and zero point less than 160cm;C reactive protein was up to four point and normal was zero,For parathyroid hormone was up to 9 points and normal was zero,The duration of dialysis for more than 12 months was 29 points and the value was zero for less than 12 months,The increase of beta 2-microglobulin was 4 points and the normal value was zero.The scoring system was statistically analyzed by the ROC evaluation system:the area under the curve was 0.876(95%CI,0.826-0.926),and the standard was 0.026,P<0.01.When Z=35,the sensitivity=0.761,the specificity=0.787.At a critical point of 35 points,the patients were divided into low risk(less than 35 points)and high risk(higher than 35 points).There were 80 patients at high risk,and 83 at low risk.Peripheral neuropathy accounted for 80%(64/80)in high-risk patients,and peripheral neuropathy accounted for 25.30%(21/83)in low risk patients.The difference between two groups was statistically significant(P<0.05).The area of ROC curve under non parametric Bootstrap sampling was 0.899(95%CI,0.854-0.945),and the standard was 0.023,P<0.01.The two methods mentioned above all show that the ORRF scoring system has a better division.6.BRF scoring system:Assign a value based on the ? value,named the BRF scoring system(RF was the abbreviation of the risk factor,which was assigned by?,so it was named BRF).1 points higher than 160cm,1 points for C reactive protein,2 points for parathyroid hormone,3 points for longer than 12 months,and 1 points for beta 2-microglobulin.The area under the ROC curve is 0.881(95%CI,0.832-0.931),and the standard is 0.025,P<0.01.AS the results of the BRF scoring system were similar to the results of ORRF,the BRF scoring system was no longer verified.Conclusion:1.Univariate analysis showed that smoking,height,C reactive protein,parathyroid hormone,total dialysis duration,beta 2-microglobulin and vitamin B12 were potential risk factors for peripheral neuropathy in uremic maintenance hemodialysis patients.2.Multivariate Logistic regression analysis showed that height,C reactive protein,parathyroid hormone,total dialysis duration and beta 2-microglobulin were independent risk factors for peripheral neuropathy in uremic maintenance hemodialysis patients.3.The ORRF and BRF scoring system for the risk factors of peripheral neuropathy in patients with uremia maintenance hemodialysis were established and verified by the differentiation of the scoring system. |
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