血液净化治疗尿毒症皮肤瘙痒的效果分析

目的探讨不同血液净化方式治疗尿毒症皮肤瘙痒的疗效并分析其可能的机制。方法54例尿毒症皮肤瘙痒患者,分为三组,血液灌流联合血液透析（HP＋HD）组18例;高通量血液透析（HPD）组18例;常规血液透析（HD）组18例。共治疗2个月,治疗前后用放射免疫法测定血液甲状旁腺激素（PTH）的水平。结果HP＋HD组和HPD组治疗前后皮肤瘙痒症状均有明显改善（P〈0.01）,但两组间疗效无统计学意义（P〉0.05）。HD组治疗前后无统计学意义（P〉0.05）。HP＋HD组和HPD组治疗前后血浆PTH下降有统计学意义（P〈0.05）,且两组间疗效无统计学意义（P〉0.05）。HD组治疗前后血浆PTH变化无统计学意义（P〉0.05）。结论血液灌流联合血液透析和高通量透析治疗尿毒症皮肤瘙痒疗效确切、可靠,而常规血液透析不能缓解尿毒症皮肤瘙痒症状。

A clinical study of blood purification on uremic pruritus in maintenance hemodialysis patients

Objective To study the feasibility and effect of different blood purification methods on uremic pruritus in patients undergoing hemodialysis.Methods Fifty-four Patients with uremic pruritus were randomly divided into three groups：hemoperfusion plus hemodialysis group （HD＋HP）,high-flux dialysis group （HPD） and convenient hemodialysis group （HD）.The patients in HD＋HP group received therapy of hemoperfusion and convenient hemodialysis,those in HPD and HD received high-flux dialysis and convenient hemodialysis twice a week,respectively.The changes of parathyroid hormone （PTH） and score of skin pruritus pre-therapy and post-treatment were respectively observed for two months.Results There were significant differences of score of skin pruritus （P0.01） and PTH level （P0.05） among pre and post-treatment in HP＋HD group and HPD group,while no significant differences （P0.05） in HD group,and there was no significant differences between HP＋HD group and HPD group.Conclusion HP＋HD and HPD on uremic pruritus are effective.