血液灌流联合血液透析和单纯血液透析对患者皮肤瘙痒疗效的比较研究  

Study on the effect of hemoperfusion combined with hemodialysis compared with that of hemodialysis alone on patients with uremic pruritus

作　　者：李悦[1] 曲巍[1] 秦丽丽 郑晓庆 杜银科[1] 姚丽[1] LI Yue;QU Wei;QIN Li-li;ZHENG Xiao-qing;DU Yin-ke;YAO Li(Department of Nephrology,the First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院肾脏内科,辽宁沈阳110001

出　　处：《中国实用内科杂志》2024年第12期1032-1038,共7页Chinese Journal of Practical Internal Medicine

基　　金：辽宁省中央引导地方科技发展资金计划项目(2024JH6/100800028)。

摘　　要：目的对比血液灌流联合血液透析和单纯血液透析对透析患者皮肤瘙痒的缓解程度。方法回顾性分析中国医科大学附属第一医院肾脏内科2022年1月至2024年1月行规律血液透析且伴有皮肤瘙痒的60例患者临床资料。根据随访期间是否行血液灌流治疗分为血液透析组(HD组:未行血液灌流,30例)和血液灌流组(HP+HD组:血液灌流次数≥1次/月,30例)。对比观察起始节点和透析治疗6个月后血清尿素氮(BUN)、肌酐(SCr)、钙离子、磷离子、全段甲状旁腺激素(iPTH)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的数值变化以及通过视觉模拟量表评分(VAS)变化评估患者皮肤瘙痒缓解情况。结果采用两种透析方式治疗6个月后,HP+HD组缓解皮肤瘙痒总有效率(90.00%)高于HD组(53.33%),差异有统计学意义(P<0.05);HP+HD组VAS评分[3(3,5)]低于HD组[4.5(4,6)],差异有统计学意义(P<0.05);两组患者血清BUN、SCr、钙离子、磷离子差异均无统计学意义(P>0.05),但HP+HD组iPTH水平(52.83±8.24)pmol/L低于HD组(59.77±8.81)pmol/L;HP+HD组CRP水平(8.61±2.74)mg/L低于HD组(10.35±3.11)mg/L,HP+HD组TNF-α水平(12.41±3.16)ng/L低于HD组(14.21±4.72)ng/L,HP+HD组IL-6水平(11.16±3.30)ng/L低于HD组(14.28±5.59)ng/L,差异均有统计学意义(P<0.05),且相关性分析结果显示皮肤瘙痒VAS评分分别与CRP水平、TNF-α水平、iPTH水平呈正相关。结论血液透析联合血液灌流相比于单纯血液透析能够更好地清除iPTH、炎症因子(CRP、TNF-α、IL-6),从而更有效地缓解透析患者的皮肤瘙痒问题,是治疗维持性HD皮肤瘙痒的有效措施。Objective To compare the effect of hemoperfusion combined with hemodialysis on relieving uremic pruritus withthat of hemodialysis alone in dialysis patients.Methods The clinical data of 60 patients with uremic pruritus were retrospectively analyzed,who received regular hemodialysis in the Department of Nephrology of China Medical University from Jan.2022 to Jan.2024,and they were divided into a hemodialysis group(HD group,no hemoperfusion,30 cases)and a hemoperfusion group(HP+HD group,hemoperfusion≥1 time/month,30 cases)based on whether they received hemoperfusion during the follow-up.Compare and observe the changes in serum urea nitrogen(BUN),creatinine(SCr),calcium,phosphorus,intact parathyroid hormone(iPTH),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)at the starting point and after 6 months of dialysis treatment,and evaluate the relief of uremic pruritus in patients through changes in visual analog scale(VAS)scores.Results After 6 months of treatment with two dialysis methods,the HP+HD group showed a significantly higher effective rate in relieving uremic pruritus(90.00%)than the HD group(53.33%),with a statistically significant difference(P<0.05).The VAS scores of the HP+HD group[3(3,5)]were lower than those of the HD group[4.5(4,6)],and the difference was statistically significant(P<0.05).There was no significant difference in serum BUN,SCr,calcium,or phosphorus between the two groups of patients(P>0.05),but the iPTH level in the HP+HD group[(52.83±8.24)pmol/L]was lower than that in the HD group[(59.77±8.81)pmol/L],the CRP level in the HP+HD group[(8.61±2.74)mg/L]was lower than that in the HD group[(10.35±3.11)mg/L],the TNF-αlevel in the HP+HD group[(12.41±3.16)ng/L]was lower than that in the HD group[(14.21±4.72)ng/L],and the IL-6 level in the HP+HD group[(11.16±3.30)ng/L]was lower than that in the HD group[(14.28±5.59)ng/L],all the differences being statistically significant(P<0.05).The correlation analysis results showed that the VAS score for uremic pruritus

关 键 词：血液灌流 血液透析 皮肤瘙痒 全段甲状旁腺激素 炎症因子 

分 类 号：R459.5[医药卫生—治疗学]