不同血液透析方式与腹膜透析对尿毒症皮肤瘙痒的疗效  

The effect of different dialysis modalities on pruritus in patients with uremia

作　　者：金东华[1] 石永兵[1] 沈华英[1] 施晓松[1] 张田杰[1] 冯胜[1] 李江鹏[1] 华胤[1] 

机构地区：[1]苏州大学附属第二医院血液透析中心,江苏省苏州215004

出　　处：《中华急诊医学杂志》2013年第10期1161-1166,共6页Chinese Journal of Emergency Medicine

基　　金：2010年苏州市科教兴卫青年科技项目（苏卫科20102318）

摘　　要：目的比较血液透析（HD）、血液透析联合血液透析滤过（HD＋HDF）及腹膜透析（PD）对尿毒症患者皮肤瘙痒症的疗效，探讨治疗尿毒症瘙痒症合适的透析方式。方法选择符合入选标准初发透析患者56例，其中HD为19例、HD＋HDF为17例、PD为20例，分别于首次透析前及透析第4、8周后记录皮肤瘙痒临床症状评分，检测血β2微球蛋白（β2-MG）及全段甲状旁腺素（iPTH），8周后观察患者皮肤瘙痒症疗效情况，对各组数据进行统计分析。评估3种透析方式对患者瘙痒症的疗效。结果（1）3组患者首次透析前的年龄、平均动脉压（MAP）、血肌酐（Cr）、血白蛋白（Alb）、血红蛋白（Hh）及iPTH、β2-MG等临床参数比较差异无统计学意义（P〉0．05）。（2）与本组首次透析前比较，HD组透析4、8周后的β2-MG、iPTH差异无统计学意义（P〉0．05）；HD＋HDF组透析4周后β2-MG水平由（17．15±4．27）mg／L降为（14．92±3．76）mg／L（t=1．616，P=0．126），iPTH水平由（827．81±227．43）ng／L降为（703．72±212．26）ng／L（t=1．646，P=0．119），8周后p2-MG水平降为（12．21±3．27）mg／L（t=3．787，P=0．002），iPTH水平降为（598．69±184．47）ng／L（t=3．229，P=0．0053）；PD组透析4周后β2-MG水平由（16．08±3．47）mg／L降为（14．21±4．01）mg／L（t=1．577，P=0．131），iPTH水平由（817．33±213．67）ng／L降为（692．29±214．54）ng／L（t=1．847，P=0．080），8周后B2-MG水平降为（11．90±2．89）mg／L（t=4．140，P=0．000），iVFH水平降为（567．22±156．32）ng／L（t=4．225，P=0．000）。8周后，HD＋HDF组及PD组β2-MG、iPTH水平明显低于HD组（P〈0．01）。（3）首次透析前3组皮肤瘙痒评分差异无统计学意义（P〉0．05）。与本组首次透析前比较，HD组透析4周后瘙痒评分由（22．05±3．98）分变为（21．75±4．37）分（t=0．221，P=0�Objective To study the effects of different dialysis modalities on pruritus in patients with uremia. Methods There were 19 hemodialysis （HD） patients, 17 hemodialysis combined with hemodiafiltration （ HD ＋ HDF） patients and 20 peritoneal dialysis （PD） patients enrolled in for study. All patients were suffering from skin pruritus. Plasma β2-microglobulin （β2-MG） and intact parathyroid hormone （iPTH） were measured by using radio immunoassay before and 4 weeks, 8 weeks after the iniliation of dialysis, and at the same time, scores of pruritus were recorded. The remission rate of itchiag was calculated 8 weeks after the beginning of dialysis. The biomarkers were compared among differen groups. Results There were no statistical differences in mean arterial pressure （MAP） , serum ereatinine （Cr）, serum albumin （All,）, hemoglobin （ Hb）, iPTH andβ2-MG among these three groups （all P 〉 0. 05 ）. There were significant changes in the levels of plasma β2 -MG and iPTH 8 weeks after the beginning of dialysis （all P 〈0. 01 ） , but no significant change 4 weeks after the beginning of dialysis in HDF and PD group （ all P 〉 0. 05）. There were no significant changes in the levels of plasma β2 -MG and iPTH 4 weeks and 8 weeks after the beginning of dialysis in HD group （ all P 〉 0.. 05）. There were significant changes in the scores of pruritus 4 weeks and 8 weeks after the beginning of dialysis in PD group and 8 weeks after the beginning of dialysis in HDF group （ all P 〈 0. 01 ）, but no significant change in HD group at every interval （all P 〉0. 05 ）. The remission rate of itching was 65.0% （13/20 cases） in PD group, 58.8% （ 10/17 cases） in HDF group, and 21.1% （4/19 eases） in HDF group. Conclusions PD and HDF can removeβ2-MG, iPTH and relieve pruritus efficiently, but HD can not removeβ2-MG, iPTH or relief itching efficiently.

关 键 词：血液透析 血液透析滤过 腹膜透析 尿毒症 瘙痒症 

分 类 号：R692.5[医药卫生—泌尿科学]