维持性腹膜透析患者皮肤瘙痒的发生情况和影响因素分析

Study on the occurrence and influencing factors of pruritus in patients with maintenance peritoneal dialysis

目的探讨腹膜透析(peritoneal dialysis,PD)患者瘙痒的发生情况及影响因素。方法根据改良DUO评分方法对北京大学人民医院肾内科规律随访的PD患者进行瘙痒问卷调查及瘙痒评分。收集患者临床资料、钙磷代谢指标、血镁、透析充分性等。分别应用Logistic回归、多元线性回归分析瘙痒及瘙痒严重程度的影响因素。结果①123例PD患者入选,其中男性53例(43.1%),年龄(60.15±12.46)岁,透析龄(37.14±27.79)月,主要原发病为糖尿病肾病,占35.8%。②82例PD患者存在皮肤瘙痒,发生率66.7%。Logistic回归分析显示,皮肤干燥(OR=4.956,95%CI;2.364~10.388,P<0.001)、血清C反应蛋白高(OR=1.251,95%CI;1.075~1.456,P=0.005)、血磷高(OR=5.029,95%CI;1.030~24.560,P=0.046)、血镁高(OR=3.533,95%CI;0.390~6.124,P=0.023)是PD患者发生皮肤瘙痒的独立危险因素。③在82名皮肤瘙痒患者中,轻度瘙痒40.2%、中度瘙痒46.3%,重度瘙痒13.4%。多元线性回归分析显示,皮肤干燥(β=0.674,P<0.001)、血磷(β=0.631,P=0.004)、血iPTH水平(β=0.001,P=0.04)是PD患者皮肤瘙痒严重程度的独立危险因素。结论皮肤瘙痒在PD患者中发生率较高。皮肤干燥、C反应蛋白高、血镁及血磷高的PD患者更易发生皮肤瘙痒。皮肤干燥程度高、血磷高、iPTH高的PD患者瘙痒程度更严重。应针对这些患者加强皮肤瘙痒的预防及治疗。

Objectives To investigate the incidence of pruritus and its influencing factors in patients with peritoneal dialysis (PD). Methods According to the improved DUO scoring method, the pruritus questionnaire survey was conducted among PD patients who were regularly followed up in the PD Center of Peking University People's Hospital. Clinical data and laboratory results were collected. Logistic regression was used to analyze the influencing factors for pruritus, and multivariate linear regression was used to analyze the influencing factors for the severity of pruritus. Results ①A total of 123 PD patients were enrolled in this study, including 53 males (43.1%) with an average age of 60.15±12.46 years and a dialysis duration of 37.14±27.79 months. The main primary disease was diabetic nephropathy (35.8%).②Eight-two PD patients had skin pruritus, with an incidence of 66.7%. Logistic regression analysis showed that dry skin (OR=4.956, 95% CI 2.364~10.388, P<0.001), high serum CRP (OR=1.251, 95% CI 1.075~1.456, P=0.005), high serum phosphorus (OR=5.029, 95% CI 1.030~24.560, P=0.046) and high serum magnesium (OR=3.533, 95% CI 0.390~6.124, P=0.023) were the independent risk factors for pruritus in PD patients.③Of the 82 patients with pruritus, 40.2% had mild pruritus, 46.3% had moderate pruritus, and 13.4% had severe pruritus. Multivariate linear regression analysis showed that dry skin (β=0.674, P<0.001), serum phosphorus (β=0.631, P=0.004) and serum iPTH level (β=0.001, P=0.040) were the independent risk factors for the severity of pruritus in PD patients. Conclusions The incidence of skin pruritus is higher in PD patients. PD patients with dry skin, higher serum levels of CRP, magnesium and phosphorus are more likely to suffer from pruritus. PD patients with dry skin, higher serum levels of phosphorus and iPTH had more severe pruritus.