连续多次HDF与HD＋HP对尿毒症皮肤瘙痒的疗效比较

目的观察连续多次血液透析滤过（cmHDF）与血液透析加血液灌流（HD＋HP）治疗尿毒症皮肤瘙痒的临床效果。方法选择尿毒症合并严重皮肤瘙痒的维持性血液透析患者20例，随机分为两组，cmHDF组应用血液透析滤过常规方法（on-lineHDF），3次／w，4h／次；HD＋HP组采用每周2次常规透析加1次常规灌流，连续2W为1个疗程。治疗结束后，观察皮肤瘙痒缓解程度，并检测两组治疗前后血清P3＋、β2-MG、CRP水平。结果cmHDF组治疗结束时全部患者均完全缓解，缓解率达100％；HD＋HP组治疗结束时，仅有3例完全缓解，3例部分缓解，缓解率60％，两组比较有显著性差异（P〈0．01）。治疗后两组血清P3＋、β2-MG、CRP均下降，但cmHDF组比HD＋HP组下降更显著（P〈0．01）。结论cmHDF治疗尿毒症皮肤瘙痒，效果明显优于HD＋HP，与cmHDF清除血液中、大分子尿毒素物质有关。

Comparison of curative effects between continuous multiple HDP and HD plus HP on uremic skin pruritus

Objective To observe the clinical effects of continuous multiple hemodiafihration （cmHDF） and hemodialysis plus hemoperfusion （HD ＋ HP） on uremic skin pruritus. Methods Twenty patients with uremia combined with skin pruritus and receiving maintenance hemodialysis were randomly divided into two groups, i.e. cmHDF group and HD ＋ HP group. The cmHDF group received hemodialysis filtration method （on - line HDF） 3 times a week and 4 hours at a time; the HD ＋ HP group received conventional dialysis twice a week and routine perfusion once a week. Continuous two weeks were a course of treatment. After the treatment, the relieving degree of skin itch of both groups was evaluated, and the levels of serum p3＋ , β2- MG, and CRP in the two groups were detected before and after the treatment. Results At the end of the treatment, patients in the cmHDF group were all relieved, and the remission rate was 100%. Only 3 cases in the HD ＋ HP group were completely remitted, while other 3 ones were partially remitted, and the remission rate was 60%. There were significant differences of remission rate between the two groups （ P 〈 0. 01 ）. After the treatment, the levels of serum p3＋ , β2- MG, and CRP all decreased significantly in both groups, but the decreasing degree in the cmHDF group was significantly higher than that in the HD ＋ HP group （P 〈 0. 01 ）. Conclusion For the treatment of uremic skin pruritus, cmHDF has superior curative effects to that of HD ＋ HP, which is due to the clearance of medium and large molecular uremic toxin substances in the blood.