Nishimura T, Suga T, Takemura F, Nomoto Y, Sakai H
Department of Internal Medicine, Tokai University Oiso Hospital, Japan.
Tokai J Exp Clin Med. 1997 May;22(2):45-51.
Eight hemodialysis (HD) patients with convulsions of unknown cause were monitored for serum levels of uremic toxins such as methylguanidine(MG), and polymorphonuclear leukocyte elastase (PMNE). Twenty HD patients without convulsions served as controls. In the convulsion group, MG and PMNE were high. In 2 patients, convulsions subsided after daily hemodiafiltration (HDF). Although PMNE was thought to be a mediator of injury in the present series, no significant correlation was found between PMNE and either neutrophil numbers or endotoxin levels. PMNE may indicate the over production of cytokines not associated with serious infection or septicemia. In patients with renal failure and complications of unknown cause, intensified dialysis therapy such as frequent HDF may be useful when combined with treatment of the underlying disease producing the toxins. PMNE measurement is useful in assessing the uremia caused by high cytokine levels and, together with methylguanidin (MG) serum levels, can indicate the severity of the convulsion.
对8例病因不明惊厥的血液透析（HD）患者监测了血清中尿毒症毒素水平，如甲基胍（MG）和多形核白细胞弹性蛋白酶（PMNE）。20例无惊厥的HD患者作为对照。惊厥组中，MG和PMNE水平较高。2例患者在每日进行血液透析滤过（HDF）后惊厥缓解。尽管在本系列研究中PMNE被认为是损伤的介质，但未发现PMNE与中性粒细胞数量或内毒素水平之间存在显著相关性。PMNE可能提示细胞因子过度产生，而与严重感染或败血症无关。在病因不明的肾衰竭及并发症患者中，强化透析治疗，如频繁进行HDF，与产生毒素的基础疾病治疗联合应用时可能有效。PMNE检测有助于评估高细胞因子水平所致的尿毒症，并且与甲基胍（MG）血清水平一起可提示惊厥的严重程度。
