高通量血液透析联合阿法骨化醇冲击治疗肾衰竭持续皮肤瘙痒疗效观察

目的观察高通量血液透析（HFHD）联合阿法骨化醇冲击治疗肾衰竭持续皮肤瘙痒的疗效及作用。方法30例终末期肾衰竭行常规性血液透析患者,其中男性21例,女性9例;年龄18～84岁,平均年龄48岁。平均透析时间5.9年,均有程度不同瘙痒,按SergoD介绍的方法对瘙痒分级评分为（9.14±2.83）分。以上患者均使用聚砜膜F60血液滤过器行HFHD,每周2～3次。联合阿法骨化醇0.5μg/d×7d,用0.25μg/d维持、治疗4周,检测治疗前、后肾脏功能、K＋、Na＋、Cl-、Ca2＋、P3-、甲状旁腺激素（PTH）、白细胞介素（IL）-1β、IL-6、IL-8、肿瘤坏死因子（TNF）-α。结果30例患者治疗4周后瘙痒均有不同程度改善,SergoD评分为（3.13±1.81）分。HFHD后血尿素氮（BUN）、肌酐（Cr）、PTH、P3-明显下降,较透析前下降显著（P〈0.05）;联合阿法骨化醇冲击治疗4周后,PTH进一步下降。HFHD联合阿法骨化醇冲击治疗后IL-6下降较透析前下降显著（P〈0.05）,但透析后IL-8下降不明显（P〉0.05）。结论HFHD联合阿法骨化醇冲击治疗肾衰竭持续皮肤瘙痒疗效好,机制可能与清除PTH、P3-及IL-6有关。

Effect of high-flux hemodialysis combined alfacalcidol on continuous cutaneaus pruritus in renal failure

Objective To study the therapeutic effect of high-flux hemodialysis combined with alfacalcidol on continous cutancous pruritus in maintenance hemodialysis patients.Methods A total of 30 hemodialysis patients were enrolled,male 21,female 9;aged 18-84 years,mean age 48 years,their average duration of heomdialysis were 5.9 years.All patients had cutaneous pruritus and treated with Fresenius F60 polysulfone dialyzer and αD3（total therapeutic course of 4 weeks i.e.oral 0.5 μg/d × 7 d,then with maintenance dose 0.25 μg/d for 3 weeks）.Before and after the treatment,blood urea nitrogen（BUN）,creatinine（Cr）,potassium sodium,chloride,calcium,phosphorus,parathormone（PTH） were measured.At the same time,the levels of serum cytokines（IL-1β,IL-6,IL-8,TNF-α） were determined by radioimmunoassay,and the levels of cytokine in dialysate were also detected.After 2 weeks,all indexes were remeasured.Results The 30 patients with different grade cutaneous pruritus symptom,their effective rate was 40 %.They have been treated by high-flux hemodialysis combined with αD3.The cutaneous pruritus symptom was completely relieved after treatment.Compared with pretreatment parameters the posttreatment clearance of serum phosphorus,PTH was significantly decreased（P〈 0.05）,the level of serum IL-6 was significantly decreased（P 〉0.05）,but the serum IL-8 and TNF-α levels were not changed（P〈 0.05）.Conclusion High-flux hemodialysis combined with αD3 for treating continous cutaneous pruritus in maintenance hemodialysis patients can improve them more effectively.The possible mechanism may be correlated with the removing of middle molecular substances such as PTH,phosphorus and cytokine IL-6.