凝结芽孢杆菌对尿毒症瘙痒症的治疗价值临床研究  

Clinical study of bacillus coagulans for pruritus in uremia patients

作　　者：姜书宁[1] 沙婷婷[1] Jiang Shuning Sha Tingting.(Department of Nephrology, the Second Affiliated Hospital of Dalian Medical University, Dalian 116021, China)

机构地区：[1]大连医科大学附属第二医院肾内科,116021

出　　处：《中国医师进修杂志》2017年第6期535-538,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨尿毒症维持性血液透析患者合并瘙痒症的临床特点及通过凝结芽孢杆菌改善肠道菌群对其的治疗价值.方法 收集312例维持性血液透析患者的临床资料,对尿毒症瘙痒症发病率、临床表现、相关因素进行综合分析.在充分透析的基础上,将40例常用止痒方法无效且微炎性反应指标升高的瘙痒症患者按随机数字表法分为两组,每组20例,试验组给予凝结芽孢杆菌口服,对照组给予维生素E治疗,比较两组瘙痒程度减轻状况.结果 312例患者中,无瘙痒158例,轻度瘙痒56例,中度瘙痒68例,重度瘙痒30例.按瘙痒发生的程度分组,各组血尿素氮、血肌酐、血钙、铁蛋白水平比较差异均无统计学意义（P〉0.05）;血磷、钙磷乘积、免疫反应性甲状旁腺激素（iPTH）、C反应蛋白（CRP）、白细胞介素（IL）-1、IL-6水平均随瘙痒程度的加重而升高,差异有统计学意义（P〈0.05）.Logistic回归分析显示,CRP、IL-6、iPTH是维持性血液透析患者皮肤瘙痒的危险因素（P〈0.01或〈0.05）.试验组中度、重度患者治疗后VAS评分显著降低,与治疗前比较差异有统计学意义（P〈0.05）.对照组治疗前后CRP、IL-1及IL-6水平比较差异无统计学意义（P〉0.05）.试验组治疗后CRP、IL-1及IL-6水平显著下降,与治疗前比较差异有统计学意义（P〈0.05）.结论 尿毒症瘙痒症患者在充分透析的基础上,给予凝结芽孢杆菌调节肠道菌群,能减轻体内微炎性反应状态,有助于缓解瘙痒症状.Objective To investigate the clinical characterastics of uremia pruritus and the value of treatment by bacillus coagulans. Methods The clinical data of 312 patients with maintenance hemodialysis were collected. The incidence rate, clinical manifestation and correlation factors of uremia pruritus were analyzed. Then, 40 refractory pruritus patients were divides into 2 groups by random digits table, with 20 patients in each group. The patients in experiment group were treated by bacillus coagulans, and the patients in control group were given vitamin E. The relieve of pruritus in two groups was compared. Results In 312 patients, 158 patients didn′t have pruritus, 56 patients had mild pruritus, 68 patients had moderate pruritus , and 30 patients had severe pruritus. The levels of urea nitrogen, creatinine, calcium, ferroprotein in different degree of pruritus patients had no significant differences （P〉0.05）, but the levels of phosphorus, calcium-phosphorus product, immunoreactive parathyroid hormone （iPTH）, C reactive protein （CRP）, interleukin （IL）-1 and IL-6 increased with the severity of pruritus （P〈0.05）. Logistic regression analysis showed that the levels of CRP, IL-6, iPTH were risk factors for pruritus （P〈0.01 or 〈0.05）. The VAS scores of moderate and severe pruritus patients in experiment group after treatment were significantly decreased compared with that before treatment （P〈0.05）. The levels of CRP, IL-1 and IL-6 before and after treatment in control group had no significant differences （P〉0.05）. The levels of CRP, IL-1 and IL-6 after treatment in experiment group significantly decreased （P〈0.05）. The rate of pruritus was very high , and there was markedly positive correlation between pruritus and serium inorganic phosphorus、iPTH and CRP. Bacillus coagulans can alleviate pruritus. Conclusions On the basis of maintenance hemodialysis, bacillus coagulans can regulate the intestinal flora, alleviate inflammatory reaction, and help to release the symptom o

关 键 词：尿毒症 瘙痒症 凝结芽孢杆菌 微炎性反应 

分 类 号：R692.5[医药卫生—泌尿科学]