维持性血液透析终末期肾病患者皮肤病变调查分析

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

目的调查进行维持性血液透析（maintenance hemodia1ysis，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、KTN、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。

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 fi＇om 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.