慢性腎不全患者のアキレス腱反射について

抄録

Achilles tendon reflex (ATR) was recorded in 30 patients with chronic renal failure by a modified Zawson's electromagnetic method described in the previous paper. The recorded curves were studied in relation to the changes in serum electrolytes and other biochemical components. The following conclusions were obtained. 1) Areflexia was found in 3 patients. One of them was diagnosed clinically as uremic neuropathy, whose sensory disturbances and areflexia were not improved after 6 months of maintenance dialysis. 2) Mean S-D (the interval from tapping point to the end of muscular contraction), S-C (reflex latency) and C-D (contraction phase) for 27 patients were 273±25, 78±15 and 193±24 msec, respectively. These intervals are significantly prolonged than those in the normal subjects (p<0.001 for each interval). 3) The prolongation of ATR-intervals was not correlated to the severity of the disease. 4) S-C was not improved by a single dialysis, what is suggestive of organic changes in nervous system. On the contrary, C-D was improved by a single dialysis, suggestive of functional nature of muscle disorders. 5) In the patients on maintenance dialysis, S-C was positively correlated to serum sodium and chloride content, and C-D to BUN and serum potassium content. In hyperkalemic patients administered with sodium cycle resin, improvement of C-D was associated After dialysis, improvement of C-D was seen with reduction of blood pH to the normal. No definite relationships were found between thyroid function and ATR-intervals in uremic patients. From these observations it is assumed that the neuromuscular function is under the direct influence of blood urea and serum electrolytes. 6) From the fact that the amplitude ratio (M-value as the ratio of contraction height to tapping height) is increased in uremia while it is diminished in diabetes, it seems likely that the causes of the neuropathy in the two diseases are not identical. 7) ATR estimation can be used as an aid to detect subclinical neuromuscular disorders in chronic renal failure and to know the metabolic changes in patients on dialysis.