Moriwaki K, Kanno Y, Nakamoto H, Okada H, Suzuki H
Department of Nephrology, Saitama Medical School, Japan.
Adv Perit Dial. 2000;16:308-12.
Polyneuropathy is one of the most frequent manifestations in chronic uremia. Among the factors related to polyneuropathy, vitamin B6 deficiency is well known. The exact prevalence of vitamin B6 deficiency related to neurological manifestations has not been previously reported. We studied vitamin B6 status, collected self-reported symptoms, and carried out full neurological examinations in 66 patients on chronic peritoneal dialysis. Vitamin B6 status was estimated by direct measurement of pyridoxal phosphate. In general, symptoms related to vitamin B6 deficiency are peripheral neuropathies, such as paresthesia, burning and painful dysesthesias, and thermal sensations. These symptoms were reported and assigned one of five grade scores. Of our 66 patients, 12 patients complained at least one sensory abnormality. The levels of vitamin B6 in the patients varied between 1.0 ng/mL and 30 ng/mL. Patients who complained of neurological symptoms owing to vitamin B6 deficiency were significantly older than the other patients. In analyzing the symptomatic cases before and after vitamin B6 supplementation, a significant correlation was seen between the level of vitamin B6 and symptoms. Within one month after initiation of oral vitamin B6 supplementations (30 mg daily), levels of pyridoxal phosphate rose, and sensory abnormalities improved in 8 of 12 patients. When peripheral neuropathy is suspected in elderly patients on chronic peritoneal dialysis, vitamin B6 deficiency should be taken into consideration as the cause. If vitamin B6 deficiency is appropriately treated by oral supplementation, sensory abnormalities can be eliminated.
多发性神经病是慢性尿毒症最常见的表现之一。在与多发性神经病相关的因素中，维生素B6缺乏是众所周知的。此前尚未报道与神经表现相关的维生素B6缺乏的确切患病率。我们研究了66例慢性腹膜透析患者的维生素B6状态，收集了自我报告的症状，并进行了全面的神经学检查。通过直接测量磷酸吡哆醛来评估维生素B6状态。一般来说，与维生素B6缺乏相关的症状是周围神经病变，如感觉异常、烧灼样疼痛和感觉异常，以及热感觉。这些症状被报告并给予五个等级分数之一。在我们的66例患者中，有12例患者至少抱怨有一种感觉异常。患者的维生素B6水平在1.0 ng/mL至30 ng/mL之间变化。因维生素B6缺乏而抱怨神经症状的患者明显比其他患者年龄大。在分析补充维生素B6前后的症状性病例时，发现维生素B6水平与症状之间存在显著相关性。在开始口服维生素B6补充剂（每日30 mg）后的一个月内，磷酸吡哆醛水平上升，12例患者中有8例感觉异常得到改善。当怀疑慢性腹膜透析的老年患者患有周围神经病变时，应考虑维生素B6缺乏作为病因。如果通过口服补充剂适当治疗维生素B6缺乏，感觉异常可以消除。
