高通量透析对维持性血液透析患者皮肤瘙痒的疗效观察

Comparison between Effects of Highly Permeable Dialysis and Low Permeable Dialysis on Uremic Pruritus

目的:观察高通量透析与低通量透析在改善维持性血液透析患者皮肤瘙痒方面的临床疗效。方法:选择尿毒症皮肤瘙痒患者38例,随机分成观察组及对照组,分别行高通量透析与低通量透析治疗,每周3次,每次4h,共观察1年;检测透析前后患者血尿素氮(BUN)、肌酐(Cr)、血磷、β2-微球蛋白(β2-M)及甲状旁腺素(PTH)的变化,计算溶质清除率和尿素清除指数(Kt/V值)并用可视模拟评分法(VAS)评估瘙痒程度。结果:透析后2组BUN、Cr下降率比较差异无统计学意义(P>0.05),观察组血磷和β2-M下降率均高于对照组(P<0.05或P<0.01),治疗后观察组PTH下降明显,与对照组比较差异有统计学意义(P<0.05)。治疗后2组VAS评分均下降,观察组较对照组减轻更为明显(P<0.05)。透析后观察组Kt/V均值与对照组比较差异无统计学意义(P>0.05)。结论:高通量透析在保证对小分子毒素充分清除的基础上,增加了对于大、中分子毒素的清除,可以明显减轻维持性血液透析患者顽固性皮肤瘙痒症状。

Objective：To investigate the mechanism and the effect of highly permeable dialysis and low permeable dialysis on uremic pruritus. Methods：Thirty-eight patients with uremic pruritus were randomly divided into observed group and control group. All patients were received high permeable dialysis and low permeable dialysis three times/week and at 4 h/session. Patients were followed up for one year after treatment. The levels of blood urea nitrogen（BUN）, creatinine（Cr）, phosphate, β2-microglobulin and parathyroid hormone（PTH） were tested before and after dialysis, and the solute clearance and urea index （Kt/V value） were figured out. The degree of skin itch was evaluated by the visual analogue scales （VAS）. Results： There were no significant differences in the decreased levels of BUN and Cr between observed group and control group （P 0.05）. But the decreased levels of phosphate and β2-microglobulin were superior in observed group to those of control group. There was a significant decrease in the level of PTH after one year treatment in observed group than that of control group（P 0.05）. Compared to pretreatment, skin itch was relieved in both groups, but more significant in the observed group compared with that of control group（P 0.05）. There was no significant difference in Kt/V value between the two groups（P 0.05）. Conclusion： Compared to low permeable dialysis, highly permeable dialysis, which not only cleared the micromolecule toxins, but also increased the clearance of macro-middle molecule toxins, can significantly relieve uremic pruritus.