维持性血液透析患者尿毒症性皮肤瘙痒临床综合分析

Clinical analysis of uremic pruritus in patients maintaining hemodialysis

目的:探讨尿毒症性皮肤瘙痒(UP)在维持性血液透析患者中的发生状况、发病机制及与预后的关系.方法:通过可视模拟评分法(VAS)调查我院238例维持性血液透析患者UP的发生状况,收集患者稳定的血压、红细胞压积、血钙、血磷、甲状旁腺激素(iPTH)、Kt/V、C反应蛋白(CRP)等临床指标,应用多元逐步回归分析了解UP积分与各临床指标的关系,通过3a的随访了解UP与患者预后的关系.结果:238例患者中有132例合并UP,其中轻度瘙痒53例(22.2%),中度瘙痒59例(24.8%),重度瘙痒20例(8.4%).31例为局限性皮肤瘙痒(23.5%),101例为广泛性皮肤瘙痒(76.5%).多元回归分析显示UP积分与血清iPTH、钙磷乘积和红细胞压积显著相关(P分别<0.01,0.01和0.05),而与年龄、性别、透析时间、血压、血清尿素氮、肌酐、血尿酸、血白蛋白、转铁蛋白、血钙、血磷、Kt/V和CRP水平无关.Kaplan-meier分析显示,UP与患者预后无关.结论:维持性血透患者UP的严重程度与稳定的血清iPTH水平、血钙磷乘积和红细胞压积显著相关,而与年龄、性别、透析时间等其它临床指标无关,UP不能作为判断预后的标志.

AIM：To investigate the prevalence,mechanism and prognostic significance of uremic pruritus （UP） in chronic hemodialysis patients. METHODS：Totally 238 adult hemodialysis patients were included in this study and followed up for 3 years. The frequency and the intensity of UP were evaluated using visual analogue scale （VAS） in all the patients. The relationship between VAS scores and stable clinical or laboratory data was analyzed by multiple linear regression analysis. The relationship between UP and patient prognosis was also tested by Kaplan-meier analysis. RESULTS：One hundred and thirty-two patients were found having UP with a frequency of 55.5%. Of them,53 cases（40.2%） had mild UP with a VAS score 1-3,59 cases（44.7%） had moderate UP with a VAS score 4-6 and 20 cases（15.1%）had severe UP with a VAS score 7-10. There were 31 patients （23.5%）with local UP and 101 patients （76.5%） with generalized UP. The analysis of multiple linear regression indicated that VAS score of UP was associated with the levels of serum iPTH,Ca×P product and hematocrit,but not with age,sex,duration of hemodialysis,blood pressure,serum urea nitrogen,creatinine,uric acid,calcium,phosphate,albumin,transferrin,Kt/V and C reactive protein （CRP）. Kaplan-meier analysis also indicated that UP was not associated with the prognosis of patients. CONCLUSION：The intensity of UP in patients maintaining hemodialysis is associated with the levels of serum iPTH,Ca×P product and hematocrit,but not with age,sex,duration of hemodialysis,blood pressure,serum urea nitrogen,creatinine,uric acid,calcium,phosphate,albumin,transferrin,Kt/V and CRP. UP is not a marker for poor prognosis.