HD、HD+HDF及PD对老年尿毒症患者皮肤瘙痒症的疗效比较

Comparison of HD, HD+HDF and PD in Treating Pruritus Cutanea of Elderly Patients with Uremia

目的:对比分析血液透析(HD)、血液透析联合血液透析滤过(HD+HDF)、腹膜透析(PD)三种方式对老年尿毒症患者皮肤瘙痒症的疗效,为老年尿毒症患者皮肤瘙痒症的治疗提供参考。方法:选取2010年3月至2014年3月来我院就诊的老年尿毒症皮肤瘙痒症患者共100例作为研究对象,采用随机数表法随机分为HD组(33例)、联合组(33例)、PD组(34例),在初次透析前后、透析后1个月、透析后2个月记录患者皮肤瘙痒评分,并检测患者全段甲状旁腺激素(i PTH)、β2-微球蛋白(β2-MG)的水平。透析2个月后比较三组对皮肤瘙痒症的疗效。结果:联合组和PD组透析2月后β2-MG水平、i PTH水平、瘙痒症评分明显低于HD组,差异具有统计学意义(P<0.05)。PD组透析2月后β2-MG水平低于联合组,但差异不具有统计学意义(P>0.05)。PD组透析2月后i PTH水平明显低于联合组,差异具有统计学意义(P<0.05)。PD组透析2月后评分明显低于联合组,差异具有统计学意义(P<0.05)。PD组、联合组有效率明显高于HD组,差异具有统计学意义(P<0.05);PD组有效率高于联合组,但差异怒具有统计学意义(P>0.05)。结论 :血液透析联合血液透析滤过与腹膜透析均可以明显降低患者全段甲状旁腺激素、β2-微球蛋白的水平,缓解患者瘙痒症状,提升患者生活质量,值得临床推广。

Objective： To analyze and compare the effect of hemodialysis（HD）, hemadialysis plus hemodiafiltration（HD＋HDF）and peritoneal dialysis（PD） for pruritus cutanea for elderly patients with uremia, so as to provide references for the treatment. Methods：100 elderly patients with uremia and pruritus cutanea admitted in our hospital from March 2010 to March 2014 were enrolled and randomly divided into HD group（n=33）, HD＋HDF group（n=33） and PD group（n=34）. The pruritus cutanea scores were recorded, and the levels of intact parathyroid hormone（i PTH） and β2-microglobulin（β2-MG） were examined before and after the first dialysis, 1 month after the dialysis and 2 months after the dialysis. The clinical effect of the three groups were compared. Results： The β2-MG levels, i PTH levels and pruritus cutanea scores of HD＋HDF group and PD group were lower than those of HD groups two months after the dialysis（P0.05）. The β2-MG level of PD group was lower than that of HD＋HDF group with no statistical significance（P0.05）. The i PTH level of PD group was lower than that of HD＋HDF group（P0.05）. The scores of PD grousp was clearly lower than that of HD＋HDF group（P0.05）. The effective rates of PD group and HD＋HDF group were higher that of HD group（P0.05）. The effective rate of PD group was higher than that of HD＋HDF group with no statistical significance（P0.05）. Conclusion： Both HD combined with HDF and PD can obviously reduce β2-MG and i PTH levels of elderly patients with uremia and pruritus cutanea, as well as relieve the symptoms of pruritus cutanea and improve the life quality, which could be clinically popularized.