不同血液透析方式与腹膜透析对尿毒症皮肤瘙痒的疗效
불동혈액투석방식여복막투석대뇨독증피부소양적료효
The effect of different dialysis modalities on pruritus in patients with uremia
  • 万方数据
    中华急诊医学杂志 중화급진의학잡지
    CHINESE JOURNAL OF EMERGENCY MEDICINE
    2013年 10期 1161-1166 ,共6页

    金东华%石永兵%沈华英%施晓松%张田杰%冯胜%李江鹏%华胤

    금동화%석영병%침화영%시효송%장전걸%풍성%리강붕%화윤

    血液透析%血液透析滤过%腹膜透析%尿毒症%瘙痒症 血液透析%血液透析濾過%腹膜透析%尿毒癥%瘙癢癥
    혈액투석%혈액투석려과%복막투석%뇨독증%소양증
    Hemodialysis%Hemodiafiltration%Peritoneal dialysis%Uremia%Cutaneous pruritus
    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(Hb)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β2-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β2-MG水平降为(11.90±2.89) mg/L (t=4.140,P=0.000),iPTH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 =0.827),8周后变为(23.78 ±5.58)分(t=1.100,P=0.286)；HD+ HDF组透析4周后瘙痒评分由(19.94±4.81)分降为(15.91 ±4.03)分(t=2.648,P=0.018),8周后降为(12.04±4.74)分(t=4.823,P=0.000)；PD组透析4周后瘙痒评分由(20.15 ±4.91)分降为(14.35±3.42)分(t=4.335,P=0.000),8周后降为(10.37 ±3.35)分(t=7.358,P=0.000)；8周后,HD+ HDF组及PD组瘙痒评分明显低于HD组(P＜0.01)；治疗8周后,PD组瘙痒症缓解率为65.0％(13/20例),HD+ HDF组为58.8％(10/17例),HD组为21.1％(4/19例).PD组缓解率明显优于HD组(x2=7.653,P=0.006),HD+ HDF组优于HD组(x2=5.386,P=0.020),PD组虽略优于HD+ HDF组,但无统计学意义(x2=0.141,P=0.699)结论 PD及HD+ HDF能部分清除尿毒症患者血清β2-MG、iPTH等中分子毒素,明显缓解皮肤瘙痒症状,而HD清除中分子毒素及缓解皮肤瘙痒较差,HD治疗无效者改PD或HD+ HDF治疗可能有效.
    목적 비교혈액투석(HD)、혈액투석연합혈액투석려과(HD+ HDF)급복막투석(PD)대뇨독증환자피부소양증적료효,탐토치료뇨독증소양증합괄적투석방식.방법 선택부합입선표준초발투석환자56례,기중HD위19례、HD+ HDF위17례、PD위20례,분별우수차투석전급투석제4、8주후기록피부소양림상증상평분,검측혈β2미구단백(β2-MG)급전단갑상방선소(iPTH),8주후관찰환자피부소양증료효정황,대각조수거진행통계분석.평고3충투석방식대환자소양증적료효.결과 (1)3조환자수차투석전적년령、평균동맥압(MAP)、혈기항(Cr)、혈백단백(Alb)、혈홍단백(Hb)급iPTH、β2-MG등림상삼수비교차이무통계학의의(P＞0.05).(2)여본조수차투석전비교,HD조투석4、8주후적β2-MG、iPTH차이무통계학의의(P＞0.05)；HD+ HDF조투석4주후β2-MG수평유(17.15 ±4.27) mg/L강위(14.92±3.76) mg/L(t=1.616,P=0.126),iPTH수평유(827.81±227.43)ng/L강위(703.72±212.26) ng/L (t=1.646,P=0.119),8주후β2-MG수평강위(12.21 ±3.27) mg/L (t=3.787,P =0.002),iPTH수평강위(598.69±184.47) ng/L(t=3.229,P=0.0053)；PD조투석4주후β2-MG수평유(16.08±3.47) mg/L강위(14.21 ±4.01) mg/L (t=1.577,P=0.131),iPTH수평유(817.33 ±213.67) ng/L강위(692.29 ±214.54) ng/L(t=1.847,P=0.080),8주후β2-MG수평강위(11.90±2.89) mg/L (t=4.140,P=0.000),iPTH수평강위(567.22±156.32)ng/L(t=4.225,P=0.000).8주후,HD+ HDF조급PD조β2-MG、iPTH수평명현저우HD조(P＜0.01).(3)수차투석전3조피부소양평분차이무통계학의의(P＞0.05).여본조수차투석전비교,HD조투석4주후소양평분유(22.05 ±3.98)분변위(21.75 ±4.37)분(t=0.221,P =0.827),8주후변위(23.78 ±5.58)분(t=1.100,P=0.286)；HD+ HDF조투석4주후소양평분유(19.94±4.81)분강위(15.91 ±4.03)분(t=2.648,P=0.018),8주후강위(12.04±4.74)분(t=4.823,P=0.000)；PD조투석4주후소양평분유(20.15 ±4.91)분강위(14.35±3.42)분(t=4.335,P=0.000),8주후강위(10.37 ±3.35)분(t=7.358,P=0.000)；8주후,HD+ HDF조급PD조소양평분명현저우HD조(P＜0.01)；치료8주후,PD조소양증완해솔위65.0％(13/20례),HD+ HDF조위58.8％(10/17례),HD조위21.1％(4/19례).PD조완해솔명현우우HD조(x2=7.653,P=0.006),HD+ HDF조우우HD조(x2=5.386,P=0.020),PD조수략우우HD+ HDF조,단무통계학의의(x2=0.141,P=0.699)결론 PD급HD+ HDF능부분청제뇨독증환자혈청β2-MG、iPTH등중분자독소,명현완해피부소양증상,이HD청제중분자독소급완해피부소양교차,HD치료무효자개PD혹HD+ HDF치료가능유효.
    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 initiation of dialysis,and at the same time,scores of pruritus were recorded.The remission rate of itching was calculated 8 weeks after the beginning of dialysis.The biomarkers were compared among differ(en) groups.Results There were no statistical differences in mean arterial pressure (MAP),serum creatinine (Cr),serum albumin (Alb),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 ＜ O.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 cases) 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.
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