乳果糖灌肠干预MHD的UP临床疗效及机制研究

Clinical Efficacy and Mechanism Study on Lactulose Enema Intervention to MHD with UP

目的:观察乳果糖灌肠疗法对持续性血透(MHD)的尿毒症性皮肤瘙痒(UP)患者的临床疗效,并从干预患者甲状旁腺激素(PTH)及微炎状态角度初步探讨其作用机制。方法:60例慢性肾脏病(CKD)5期,MHD的UP患者,按照不同干预方法随机分为3组:对照组、氯雷他定组及乳果糖组,对照组采用肾病一体化治疗,氯雷他定组在对照组基础上加氯雷他定口服,10 mg/次,1次/天,乳果糖组在对照组基础上加乳果糖灌肠,30 mg/次,2次/天,持续30天。治疗前后分别评价3组患者临床疗效,并观察其瘙痒可视模拟评分(VAS)及血清PTH、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平。结果:与治疗前比较,治疗后VAS、PTH及炎症指标(hs-CRP、TNF-α、IL-6)有显著改善(P<0.05或P<0.01);与对照组比较,治疗后氯雷他定组及乳果糖组临床总有效率明显升高(P<0.05),VAS、PTH及炎症指标(hs-CRP、TNF-α、IL-6)皆明显降低(P<0.05),而氯雷他定组及乳果糖组上述指标差异无统计学意义。结论:乳果糖灌肠疗法对MHD的UP患者PTH及微炎状态具有改善作用,此为其改善皮肤瘙痒的机制之一。

This article was aimed to discuss the mechanism of lactulose enema therapy to improve efficiency among maintenance hemodialysis （MHD） patients with uremic pruritus （UP） from the intervention of parathyroid hormone （PTH） and micro-inflammation state. A total of 60 cases of chronic kidney disease （CKD） stage 5, MHD patients with UP were randomly divided into 3 groups according to different intervention methods, which were the control group, loratadine and lactulose group. The integration of kidney disease treatment was adopted in the control group. In the loratadine group, on the basis of the control group medication, oral administration of loratadine, 10 mg/time, once a day, was combined. In the lactulose group, on the basis of the control group medication, lactulose enema, 30 mg/time, twice a day, was combined for 30 days. The pretreatment and posttreatment clinical curative effects were e-valuated among patients from 3 groups. Observation was also made on their itchy visual analogue scale （VAS） and serum PTH, high-sensitivity c-reactive protein （hs-CRP）, tumor necrosis factor-α （TNF-α）, interleukin 6 （IL-6） lev-el, respectively. The results showed that there were significant improvements on VAS, PTH and inflammation indexes （i.e., hs-CRP, TNF-α, IL-6） before and after treatment （P〈 0.05 or P〈 0.01）. Compared to the control group, the posttreatment clinical total curative effects were significantly increased in both the loratadine group and lactulose group （P〈 0.05）; VAS, PTH and inflammation indexes （i.e., hs-CRP, TNF-α, IL-6） were significantly decreased （P〈 0.05）. There was no statistical difference of indexes mentioned above in the loratadine group and lactulose group. It was concluded that lactulose enema therapy improve PTH and micro-inflammation state among MHD patients with UP. It is one of the mechanisms to relieve skin itching.