维持性血液透析终末期肾病患者皮肤病变调查分析

目的　调查进行维持性血液透析（maintenance hemodialysis, MHD）的终末期肾脏病患者皮肤病变的发病情况和病变特点，探讨其危险因素。方法　对181例MHD的终末期肾病患者进行皮肤体检；收集其临床和生化资料，分析皮肤病变的患病率，病变类型及其危险因素。结果　 ①181例患者中161例（88.95％）存在不同种类的皮肤病变，其中38例（23.60％）存在1种皮肤病变，52例（32.30％）有2种，40例（24.84％）有3种、26例（16.15％）有4种、5例（3.11％）有5种。②最常见是皮肤干燥（128/181， 77.72％），其次是瘙痒（101/181，55.80％）、脱屑（73/181，40.33％）和色素沉着（70/181，38.67％）。其他有皮肤苍白（6/181，3.31％）、瘀斑（4/181，2.21％）、指（趾）干性坏疽（3/181，1.66％）、足部溃疡（2/181，1.10％）、甲纵裂（1/181，0.55％）。③皮肤病变组患者的透析龄、超滤量、血磷、钙磷乘积、甲状旁腺激素、超敏C-反应蛋白（Hs-CRP）水平，乙肝、丙肝病毒标志物阳性率明显高于无皮肤病变组；而血红蛋白、血清尿素清除指数（Kt/V）明显低于无皮肤病变组。④Logistic回归分析结果显示，透析龄、KT/V、血钙磷乘积、血甲状旁腺激素、高敏C反应蛋白（Hs-CRP）和丙肝病毒标志物阳性是MHD患者发生皮肤病变的独立危险因素。结论MHD的终末期肾病患者皮肤病变的患病率高，以皮肤干燥症和皮肤瘙痒最常见。透析龄、KT/V、血钙磷乘积、血甲状旁腺激素、Hs-CRP和丙肝病毒标志物阳性是MHD终末期肾病患者发生皮肤病变的独立危险因素。

Skin abnormality and its risk factors in patients with chronic renal failure on maintenance hemodialysis

Objective To investigate the prevalence and risk factors of skin abnormality in patients with chronic renal failure （CRF） on maintenance hemodialysis. Methods One hundred and eighty-one patients with CRF on maintenance hemodialysis were examined for skin abnormality. The following data were collected from patients: age, gender, ultrafiltration volume, urea clearing index （Kt/V）, blood pressure, levels of hemoglobin, serum albumin, lipid, calcium phosphorus product and parathyroid hormone, etc. Results Skin abnormalities were observed in 88.95% of these patients. Among them, 23.60% had one kind of abnormality, 32.30% had two, 24.84% had three, 16.15% had four, and 3.11% had five. The most common manifestation was xerosis （77.72％, 128/181）, followed by pruritus （55.80％, 101/181）, epidermal desquamation （40.33％, 73/181） and cutaneous pigmentation （38.67％, 70/181）. Other cutaneous disorders included skin pallor （3.31％, 6/181）, ecchymosis （2.21％, 4/181）, mummification necrosis of digits（1.10%, 2/181）, foot ulcer （1.66％, 3/181）, onychorrhexis （0.55％, 1/181,）. The levels of dialysis duration, ultrafiltration volume, serum phosphonium, calcium phosphonium product, serum parathyroid hormone, high sensitivity C-reactive protein, positivity rate of hepatitis B virus and hepatitis C virus markers were significantly higher in the hemodialysis patients with skin abnormalities than in those without, while the levels of hemoglobin and Kt/V were significantly lower in the hemodialysis patients with skin abnormalities than in those without. As shown by logistic regressive analysis, the levels of dialysis duration, Kt/V, serum calcium phorsphorum product, serum parathyroid hormone, high sensitivity C-reactive protein, and the presence of hepatitis C virus were the independent risk factors for the occurrence of skin abnormalities in hemodialysis patients. Conclusions There is a high prevalence of skin abnormality in patients with CRF on maintenance hemodialysis, and, xerosis and pruritus are the most common skin abnormalities.