加巴喷丁治疗维持性血液透析患者皮肤瘙痒的疗效和安全性

Efficacy and safety of gabapentin in treatment of uremic pruritus in maintenance hemodialysis patients

目的观察加巴喷丁治疗维持性血液透析患者皮肤瘙痒的疗效及不良反应。方法维持性血液透析经常规治疗无效的皮肤瘙痒患者47例，随机分为试验组24例和对照组23例。在充分透析、血液灌流的基础上，对照组维持原外用药及氯雷他定10mg，po，qd；试验组加巴喷丁100-300mg．每次透析当日晚间服用，疗程4周。检测治疗前后患者血钙、磷、甲状旁腺素水平，评估皮肤瘙痒的视觉模拟量表（VAS）评分、Shiratori评分，并记录不良反应发生情况。结果试验组完成22例，对照组完成23例。治疗后，对照组患者皮肤瘙痒症状无明显改善，VAS评分和Shiratori评分与治疗前比较无显著差异（P〉0．05）；试验组患者皮肤瘙痒症状明显改善，VAS评分和Shiratori评分均低于治疗前（P〈0．05）。且低于对照组（P〈0．05）。治疗前后两组患者血钙、磷、甲状旁腺素水平均无显著变化（P〉0．05）。试验组中有1例因眩晕、头痛、感觉异常症状停药，6例出现嗜睡、头晕不适等症状，均l周内缓解。结论加巴喷丁治疗经常规治疗无效的维持性血液透析患者的皮肤瘙痒有效且安全。长期疗效及安全性尚待进一步观察。

AIM To observe the efficacy and safety of gabapentin in treatment of uremic pruritus in maintenance hemodialysis patients. METHODS Forty- seven maintenance hemodialysis patients with severe pruritus resistant to conventional treatment were randomly divided into control group （n = 23） and trial group （n = 24）. Based on sufficient hemodialysis hemoperfusion, the original drug loratadine （10 mg, po, qd） was maintained in the control group; gabapentin （100 - 300 mg） was administrated before sleep at dialysis day in the trial group for 4 weeks. The levels of blood calcium, serum phosphorus and parathyroid hormone were examined before and after the treatment. The efficacy was assessed by visual analogue score （VAS） and Shiratori score, and the adverse reactions were also observed to assess the safety. RESULTS There were 22patients completed the trail in the trial group and 23 patients in the control group. After the treatment, pruritus symptoms were no significantly alleviated in the control group, VAS and Shiratori score had no significant difference compared with those before the treatment （P 〉 0.05）. The frequency, degree and area of pruritus alleviated in the trial group, VAS and Shiratori score decreased significantly compared with those before the treatment in the control group （P 〈 0.05）. There were no significant change of blood calcium, serum phosphorus and parathyroid hormone before and after the treatment in two groups （P 〉 0.05） . One patient interrupted therapy because of vertigo, headache and paresthesia in the trial group. And drowsiness and dizziness occurred in 6 patients which relieved within 1 week in the trial group. CONCLUSION Gabapentiu is safe and effective for refractory uremic pruritus in maintenance haemodialysis patients, and its long- term efficacy and safety requires further observation.