硫代硫酸钠治疗维持性血液透析患者皮肤瘙痒的疗效和安全性分析  

The efficacy and safety of sodium thiosulfate in the treatment of pruritus in maintenance hemodialysis patients

作　　者：鲍宏达[1] 简桂花[1] 郭永平 刘琨[3] 张黎明 王应灯[5] 余晨[6] 邹建洲[7] 张蕾[7] 张冉 范秋灵 陈舜杰 马骏[11] 王筱霞[12] 王秦 汪年松[1] 蒋更如[14] BAO Hong-da;JIAN Gui-hua;GUO Yong-ping;LIU Kun;ZHANG Li-ming;WANG Ying-deng;YU Chen;ZOU Jian-zhou;ZHANG Lei;ZHANG Ran;FAN Qiu-ling;CHEN Shun-jie;MA Jun;WANGXiao-xia;WANG Qin;WANG Nian-song;JIANG Geng-ru(Department of Nephrology,Shanghai Sixth People’s Hospital,Shanghai 200233,China;Department of Nephrology,Shanghai Sixth People’s Hospital East Campus,Shanghai 201306,China;Department of Nephrology,Jinshan Branch,Shanghai Sixth People's Hospital,Shanghai 201500,China;Department of Nephrology,Zhabei Central Hospital,Jing'an District,Shanghai 200070,China;Department of Nephrology,Shanghai Ninth People’s Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China;Department of Nephrology,Tongji Hospital,Shanghai 200065,China;Department of Nephrology,Wusong Hospital,Zhongshan Hospital,Fudan University,Shanghai 200940,China;Department of Nephrology,Shanghai Tianyou Hospital,Shanghai 200331,China;Department of Nephrology,Shanghai First People's Hospital,Shanghai 200080,China;Department of Nephrology,Shanghai Fourth People’s Hospital,Shanghai 200434,China;Department of Nephrology,Shanghai Jing'an District Central Hospital,Shanghai 200040,China;Department of Nephrology,Shanghai Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200336,China;Department of Nephrology,Shanghai Fengxian District Central Hospital,Shanghai 201499,China;Department of Nephrology,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海市第六人民医院肾内科,上海200233 [2]上海市第六人民医院东院肾内科,上海201306 [3]上海市第六人民医院金山分院肾内科,上海201500 [4]上海市静安区闸北中心医院肾内科,上海200070 [5]上海交通大学医学院附属第九人民医院肾内科,上海200011 [6]上海市同济医院肾内科,上海200065 [7]复旦大学附属中山医院吴淞医院肾内科,上海200940 [8]上海天佑医院肾内科,上海200331 [9]上海市第一人民医院肾内科,上海200080 [10]上海市第四人民医院肾内科,上海200434 [11]上海市静安区中心医院肾内科,上海200040 [12]上海交通大学医学院附属同仁医院肾内科,上海200336 [13]上海市奉贤区中心医院肾内科,上海201499 [14]上海交通大学医学院附属新华医院肾内科,上海200092

出　　处：《中国血液净化》2025年第1期35-39,共5页Chinese Journal of Blood Purification

摘　　要：目的观察和比较不同硫代硫酸钠剂量在维持性血液透析患者皮肤瘙痒治疗中的临床疗效和安全性。方法纳入2020年1月—2022年12月上海市13家综合性医院的维持性血液透析伴有皮肤瘙痒的患者,按随机数字表法分为3组:组1给予1.92g的硫代硫酸钠,组2给予3.20g的硫代硫酸钠,组3给予4.48g的硫代硫酸钠治疗。3组治疗时间均为8周,观察和比较不同硫代硫酸钠剂量在维持性血液透析患者皮肤瘙痒治疗中的临床疗效和安全性,包括瘙痒评分、生化指标、治疗效果和不良反应等。结果共纳入226例患者。治疗8周后,组1(n=72)、2(n=79)、3(n=75)的患者5D瘙痒评分分别从(18.6±1.91)、(19.0±2.80)、(19.6±3.64)分降至(12.8±3.03)、(11.3±3.40)、(10.9±3.75)分。治疗8周后与治疗前5D瘙痒评分的差值,3组间差异有统计学意义(F=2.735,P=0.046),两两比较显示组3的5D瘙痒评分下降幅度大于组1(差值为-1.352,95%CI:-2.645~-0.060,P=0.041)。观察期内,所有患者未出现过敏、皮疹及血压下降等不良反应。多因素分析结果显示:与组1相比,组3的5D瘙痒评分斜率β=-1.650(95%CI:-3.046~-0.253,P=0.021)。结论硫代硫酸钠治疗可明显缓解血液透析患者皮肤瘙痒症状。随剂量增加,效果加强,无明显不良反应,安全有效。Objective To observe and compare the efficacy and safety of different doses of sodium thio-sulfate for the treatment of pruritus in maintenance hemodialysis(MHD)patients.Methods A total of 126 MHD patients with pruritus from 11 general hospitals in Shanghai during January 2020 to December 2022 were included in this study.They were randomly divided into three groups.The dose of sodium thiosulfate was 1.92g in group 1,3.20g in group 2,and 4.48g in group 3.The treatment period lasted 8 weeks.Clinical effects and safety including pruritus score,biochemical indicators and adverse reactions were observed and compared between the groups.Results Compared with the pruritus scores 5 days before the treatment and 8 weeks after the treatment,the decreases of pruritus score were 18.6±1.91 to 12.8±3.03,19.0±2.80 to 11.3±3.40 and 19.6±3.64 to 10.9±3.75 in group 1(n=72),2(n=79)and 3(n=75)respectively;the extent of decrease were statistical-ly significant among the 3 groups(F=2.735,P=0.046),and the extent of score decrease was greater in group 3 than in group 1(score difference=-1.352,95%CI:-2.645~-0.060,P=0.041).No adverse reactions such as al-lergic reactions,rash and hypotension were found during the observation period.Multivariate analysis showed that compared with group 1 the slope of pruritus score 5 days before the treatment and 8 weeks after the treat-ment in group 3 showedβ=-1.650(95%CI:-3.046~-0.253,P=0.021).Conclusion Sodium thiosulfate can effectively relieve the pruritus symptoms in MHD patients,and the effect is enhanced with increase of the dose.No obvious adverse reactions were found.This treatment is therefore safe and effective.

关 键 词：血液透析 瘙痒 硫代硫酸钠 治疗 

分 类 号：R459.5[医药卫生—治疗学]