牛痘疫苗接种家兔炎症皮肤提取物对维持性血液透析患者合并皮肤瘙痒症的治疗作用  

Clinical trial of neurotropin in the treatment of skin pruritus in maintenance hemodialysis patients

作　　者：熊艳 许传文 许琛 徐艳梅 XIONG Yan;XU Chuanwen;XU Chen;XU Yanmei(Department of Nephrology,Wuhan Fourth Hospital,Puai Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,Hubei,China)

机构地区：[1]武汉市第四医院,华中科技大学同济医学院附属普爱医院肾内科,湖北武汉430000

出　　处：《上海医学》2021年第1期26-30,共5页Shanghai Medical Journal

摘　　要：目的观察牛痘疫苗接种家兔炎症皮肤提取物对维持性血液透析(MHD)患者合并皮肤瘙痒症的临床疗效及其安全性,探讨尿毒症MHD患者合并皮肤瘙痒症的治疗方法。方法选择2017年10月—2018年10月在武汉市第四医院血液透析中心治疗,且合并皮肤瘙痒症超过8周的尿毒症患者50例。在充分透析、控制血压、控制钙磷代谢失调、改善贫血、因素控制等一般治疗的基础上,将患者随机分为2组。对照组(25例)予口服加巴喷丁胶囊4周,研究组(25例)给予牛痘疫苗接种家兔炎症皮肤提取物静脉注射2周+口服2周治疗。观察两组患者的皮肤瘙痒VAS评分、改良Duo评分、临床疗效,并观察患者治疗前后血清钙、磷、全段甲状旁腺激素(iPTH)、血β2-微球蛋白(β2-MG)、超敏CRP(hs-CRP)等指标的变化。结果研究组患者临床总有效率(88%)显著高于对照组(68%,P<0.05)。研究组患者治疗2和4周时的皮肤瘙痒VAS评分、改良Duo评分均显著低于对照组同时间点和本组治疗前(P值均<0.05)。治疗后4周,研究组和对照组患者的β2-MG、hs-CRP、血磷、iPTH、收缩压、舒张压较本组治疗前均显著下降(P值均<0.05),尿素清除指数(Kt/V)、血红蛋白均显著升高(P值均<0.05);血钙、血清肌酐(sCr)与本组治疗前的差异均无统计学意义(P值均>0.05)。治疗后4周,研究组患者β2-MG、hs-CRP、收缩压、舒张压均显著低于对照组(P值均<0.05)。研究组和对照组患者不良反应发生率的差异无统计学意义(8%比4%,P>0.05)。结论牛痘疫苗接种家兔炎症皮肤提取物可显著改善MHD合并皮肤瘙痒患者的临床症状,其疗效优于加巴喷丁胶囊,短期安全性良好,远期安全性有待于进一步验证。Objective To observe the clinical efficacy and safety of neurotropin in patients with maintenance hemodialysis(MHD)combined with pruritus.Methods Fifty patients with pruritus over 8 weeks who received MHD from October 2017 to October 2018 in the Hemodialysis Center of Wuhan Fourth Hospital were enrolled in this study.All the patients underwent general treatment such as dialysis,blood pressure control,correction of calcium-phosphorus metabolism disorders and anemia.Additionally,gabapentin capsules were orally given to the control group,and neurotropin was given to treatment group for 4 weeks.The pruritus VAS score,modified Duo score,and clinical efficacy were observed in the two groups,as well as serum calcium,inorganic phosphorus,intact parathyroid hormone(iPTH),β2-microglobulin(β2-MG),and high-sensitivity C-reactive protein(hs-CRP).Results The total clinical effective rate in the treatment group was significantly higher than that in the control group(88%vs.68%,P<0.05).The pruritus VAS score and modified Duo score in the treatment group 2 and 4 weeks after treatment were significantly lower than those in the control group and before treatment(all P<0.05).In both group,theβ2-MG,hs-CRP,serum phosphorus,iPTH,systolic blood pressure(SBP)and diastolic blood pressure(DBP)significantly were decreased,and urea clearance index(Kt/V),hemoglobin(Hb)were significantly increased 4 weeks after treatment(all P<0.05).Compared with those in control group,β2-MG,hs-CRP SBP,DBP decreased significantly in treatment group 4 weeks after treatment(all P<0.05).The incidences of adverse reaction were similar between the two groups(8%vs.4%,P>0.05).Conclusion Neurotropin can significantly improve the clinical symptoms of hemodialysis patients with pruritus,and the curative effect is better than gabapentin.It is safe and feasible in hemodialysis patients,but long-term observation is still needed.

关 键 词：牛痘疫苗接种家兔炎症皮肤提取物 加巴喷丁 血液透析 瘙痒症 

分 类 号：R692.5[医药卫生—泌尿科学] R758.31[医药卫生—外科学]