不同血液净化方法治疗尿毒症并发皮肤瘙痒的临床观察

Clinical observation of different blood purification therapeutics in the treatment of uremia pruritus

目的比较不同血液净化方法治疗尿毒症并发皮肤瘙痒的临床疗效。方法55例有不同程度皮肤瘙痒的血透患者随机分为血液灌流串联血液透析组(HPHD)、高通量透析组(HPD)、血液透析组(HD)3组。记录首次透析前后及透析2、4周后血肌酐(SCr)、尿素氮(BUN)、甲状旁腺激素、血浆清蛋白、补体等的变化及皮肤瘙痒临床症状缓解情况,对各组指标进行比较;放射免疫法测定血清PTH水平。结果3种治疗方式均可使PTH降低,其中HPHD和HPD组首次透析后、治疗2周与4周后患者PTH的血浓度较首次透析前差异均有显著性意义(P<0.05);两组间首次透析后、治疗2周与4周后患者PTH的血浓度比较差异无显著性意义(P>0.05);但两组与HD组比较,差异均有显著性意义(P<0.05)。3组在不同阶段补体、血红蛋白含量、清蛋白、血小板计数等比较差异无显著性。结论血液灌流联合血液透析和高通量透析能有效地清除PTH,从而有效缓解皮肤瘙痒症状,是治疗肾移植术后并发皮肤瘙痒行之有效的方法。

Objective To compare the therapeutic effects of different blood purification therapeutics in the treatment of uremia pruritus. Methods Fifty-five uremia pruritus patients were randomly selected and divided into three groups： hemopefusion-hemodialysis （HPH-D） group, high plus dialysis （HPD） group and hemodialysi （HD） group.Patients in HPHD received therapy of hemopeffusion and HD,others in HPD received HPD,and the rest received HD.The changes of parathyroid hormone（PTH）, complement（C3,C4）,albumin（Alb）,platelet（Plt） level and the relief of pruritus were recorded pre and post dialysis, 2 weeks and 4 weeks after the beginning of dialysis.The parameters were compared among different groups.The PTH level was examined with radioimmunoassay. Results There were significant differences （P〈0.05） of PTH levels among pre and post dialysis,and 2 weeks and 4 weeks after the beginning of dialysis in HPHD group. The remission rate of itching was 83.33%（15/ 18 cases）. There were significant differences （P〈0.05） of the PTH levels among post dialysis,2 weeks and 4 weeks after the beginning of dialysis in HPD group.The remission rate of itching was 72.22%（13/18 cases）.There was no significant difference （P〉0.05） of PTH level pre and post dialysis in HD group. There was no significant difference of the levels of PTH,C3, C4,Alb and Pit among the different dialysis phase. Conclusion HPHD and HPD can eliminate PTH effectively, they can relief skin pruritus efficiently.