血液透析加血液灌流治疗终末期肾衰竭相关性皮肤瘙痒的临床研究

目的 探讨血液透析加血液灌流对终末期肾衰竭患者皮肤瘙痒的治疗效果和机制.方法将81例有不同程度皮肤瘙痒表现的终末期肾衰竭患者随机分为治疗组(血液透析加血液灌流,50例)和对照组(单纯血液透析,31例).治疗前及治疗24周后,分别检测所有患者血肌酐、尿素氮、血清总钙、血清磷、全段甲状旁腺素(iPIH)水平及皮肤瘙痒程度(视觉模拟评分,VAS).结果与治疗前比较,治疗组患者皮肤瘙痒改善明显(P<0.01),对照组无明显改善(P>0.05),两组比较差异有统计学意义(P<0.01);与治疗前比较,治疗组血清磷、iPTH明显降低(2.69±0.46)mmol/L比(0.98±0.39)mmol/L与(632.78±76.89)ng/L比(342.81±39.71)ng/L](P<0.01),对照组无明显下降(P>0.05),两组比较差异有统计学意义(P<0.01).结论血液透析加血液灌流能明显减轻终末期肾衰竭患者的皮肤瘙痒,而单纯血液透析则对其改善不明显,机制可能与血液透析加血液灌流联合治疗能较好清除患者体内致皮肤瘙痒的毒素有关.

A study of combined hemodialysis-hemoperfusion in treating patients with end-stage renal failure associated cutaneous pruritus

Objective To explore the efficacy and mechanism of combined hemodialysis-hemoperfusion in treating patients with end-stage renal failure associated cutaneous pruritus. Methods Eighty-one outpatients and inpatients with end-stage renal failure associated different degree of cutaneous pruritus were randomly divided into treatment group (combined hemoperfusion-hemodialysis, 50 cases) and control group (simple hemodialysis, 31 cases). At the pretreatment and 24 weeks posttreatment, all patients' serum creatinine, blood urea nitrogen, serum total calcium, serum phosphonium, serum intact parathyroid hormone and the intensity of cutaneous pruritus (visual analog scale,VAS) were determined detected. Results Compared with pretreatment, the intensity of cutaneous pruritus of patients in treatment group was obviously alleviated (P<0.01), but it was not alleviated in control group (P>0.05), there was significant difference between two groups (P<0.01). Compared with pretreatment, serum phosphonium and intact parathyroid hormone declined obviously in treatment group (2.69±0.46) mmol/L vs (0.98±0.39) mmol/L and (632.78±76.89) ng/L vs(342.81±39.71) ng/L] ((P<0.01), but did not decline obviously in control group (P>0.05), there was significant difference between two groups (P<0.01). Conclusions Combined hemodialysis-hemoperfusion can obviously alleviate the intensity of cutaneous pruritus of patients with end-stage renal failure, but simple hemodialysis can not alleviate it,its mechanism may be that it can clean the internal irritant toxin which leads to cutaneous pruritus well.