采有不同方式的血液净化对长期维持血液透析患者皮肤瘙痒的疗效分析

目的探讨不同血液净化方法用于尿毒症皮肤瘙痒患者的可行性和效果。方法45例患者随机分为血液灌流串联血液透析组（HD＋HP）、血液透析滤过组（HDF）、血液透析组（HD）3组。记录首次透析前后及透析2、4周后血甲状旁腺激素（PTH）、补体（C3、C4）、白蛋白（Alb）、血小板（Plt）等的变化及皮肤瘙痒临床症状缓解情况，对各组指标进行比较。放射免疫法测定血清PTH水平。结果（1）HD＋HP组透析前与首次透析后及透析2、4周后患者的PTH比较差异有统计学意义（P〈0.05），皮肤瘙痒缓解率为86.67％（13／15）；（2）HDF组透析前与首次透析后及透析2周、4周后门H比较差异有统计学意义（P〈0.05和P〈0.01）；皮肤瘙痒缓解率为73.33％（11／15）；（3）HD组治疗前后盯H差异无统计学意义（P〉0.05）；皮肤瘙痒缓解率为13.33％（2／15）；（4）3组在不同阶段补体、血红蛋白含量、白蛋白、血小板计数等比较差异无统计学意义（P〉0.05）。结论血液灌流联合血液透析和血液透析滤过能有效地清除PTH，2者清除率差异无统计学意义（P〉0.05），能有效缓解皮肤瘙痒症状，血液透析滤过治疗无效者改用血液灌流串联血液透析治疗可能有效。

Analysis of the effect of blood purifcafion on cutaneous pruritus in long-term hemodialysis patients by different ways

Objective To investigate the effect of blood purifcafion on cutaneous pruritus in uraemia patients by different ways. Methods 45 patienst with uremic cutaneous pruritus were randomly divided into three groups ： hemodialysis ＋ hemoperfusion group （ HD ＋ HP）, hemodiafihration group （HDF）, hemodialysis group （HD） . Blood PTH, complement3（C3）, complement4（C4）, Alb, Pit and the improvement of cutaneous pruritus were observed before and after hemodialysis. Blood PTH was measured by radioimmunoassay. Results（1） The difference of serum PTH in （ HD ＋ HP） group before and after hemodialysis was significant（P〈0.05）. The improvement rate of cutaneous pruritus was 86.67% （ 13/15 cases） . （2） Serum PTH in HDF group was significantly different before and after hemodialysis （P 〈 0.05 and P 〈 0.01 ）. The improvement rate of cutane- ous pruritus was 73.33%（11/15 cases）. （3）While serum PTH in HD group did not change obviously（ P 〉 0.05 ）. The improvement rate of cutaneous pruritus was 86.67% （2/15 cases）. （4）C3, C4, Hb, Alb and Pit in 3 groups were not significantly different in various stages. Conclusion Hemoperfusion associated with hemodialysis can efectively clear PTH and improve cutaneous pruritus, while hemodialysis can not.