碳酸镧联合血液净化治疗尿毒症患者皮肤瘙痒的疗效分析

Effectiveness of combined treatment of lanthanum carbonate and hemodialysis for uremic pruritus of skin

目的：探讨血液透析联合血液灌流、口服药物碳酸镧治疗方案对尿毒症患者皮肤瘙痒的疗效。方法选择2012年10月至2014年4月武汉市三医院血液净化室尿毒症皮肤瘙痒的患者21例,按照随机数字表法分为血液透析（hemodialysis,HD）联合血液灌流（hemoperfusion,HP）组（A组）11例、血液透析联合血液灌流＋口服碳酸镧组（B组）10例。观察并比较2组患者治疗前及治疗后第8周的血肌酐（SCr）、尿素氨（BUN）、血磷水平、甲状旁腺素（PTH）水平及皮肤瘙痒程度。结果2组治疗后,血磷均有下降,差异有统计学意义（P〈0.01）；B组较 A组血磷水平显著下降,差异有统计学意义（P〈0.01）；2组治疗后,B 组较 A 组的 PTH 水平显著下降,差异有统计学意义（P〈0.01）。2组治疗后,原有皮肤瘙痒程度均有改善；其中,A组的治疗有效率（部分缓解3例,完全缓解7例）为63.6%,B组治疗有效率（部分缓解4例,完全缓解5例）为90.0%；B组的治疗有效率较 A 组高,2组比较差异有统计学意义（P〈0.01）。结论将新型磷结合剂碳酸镧及 HD联合 HP 应用方法可以更有效的降低尿毒症患者血磷水平、清除引起患者皮肤瘙痒的各种中小分子物质,从而达到缓解尿毒症患者皮肤瘙痒的治疗目的。

Objective To observe the treatment efficiency of hemodialysis combined with he-moperfusion and oral lanthanum carbonate for uremic pruritus.Methods Twenty-one patients with uremic pruritus attending blood purification room in Wuhan Third Hospital from October 2012 to A-pril 2014 were selected and divided into two groups：A,hemodialysis and hemoperfusion treated group （n=11）,and B,hemodialysis,hemoperfusion and oral lanthanum carbonate treated group （n=10）. The renal function,blood phosphorus,parathyroid pixel and the extent of skin itch were observed and compared before and 8 weeks after treatment.Statistical tests were used to reveal the differences.Re-sults The blood phosphorus levels in both groups were declined significantly after treatment （P〈0.01）,more significantly in group B than in group A （P〈0.01）.After treatment,PTH level in group B was significantly lower than in group A （P〈0.01）.The symptom of skin itch was signifi-cantly alleviated in both groups after treatment.The remission rate of treatment in group B was 90%, which was significantly higher than 63.6% in group A （P〈0.01）.Conclusions The combination of new phosphate binder lanthanum carbonate,hemodialysis and hemoperfusion can more effectively re-duce the levels of blood phosphorus and small molecular that can cause skin pruritus,therefore relieve uremic pruritus for therapeutic purposes.