尿毒症患者皮肤屏障功能改变及含青刺果油保湿霜治疗尿毒症瘙痒疗效观察

Alteration of skin barrier function in uremia patients and therapeutic effect of emollient with prinsepia utilis royle oil on uremia pruritus: a clinical study

目的:探讨尿毒症瘙痒患者皮肤屏障功能改变及研究含青刺果油保湿霜对治疗尿毒症瘙痒的有效性及安全性。方法:分别测量60例尿毒症瘙痒患者(UP+组)、60例尿毒症无瘙痒的患者(UP-组)及30名健康人(HV组)胸前V形区、季肋区、前臂屈侧及小腿伸侧皮肤角质层含水量(SCH)、经皮失水率(TEWL)及酸碱度(p H)并分别进行问卷调查、干燥评分(XS)及尿毒症瘙痒评分(UIS)。随机将UP+组分为试验组及对照组,试验组予含青刺果油保湿霜治疗28d,对照组不给予干预。于D0、D28进行皮肤病生活质量评分(DLQI)。于D0、D7、D14及D28对受试者进行XS、UIS及SCH、TEWL及皮肤p H值测量。结果:UP+组及UP-组测SCH均显著低于健康人群(P<0.01)。UP+组胸前V形区、季肋区、小腿伸侧TEWL较健康人群显著升高(P<0.05)。UP+组胸前V形区及小腿伸侧皮肤p H值高于HV组(P<0.05)。尿毒症患者发生UP与TEWL呈正相关(P<0.001)。皮肤瘙痒程度与干燥程度呈正相关(P<0.001),糖尿病加重瘙痒程度(P=0.011)。试验组受试者经含青刺果油保湿霜治疗后,季肋区及小腿伸侧SCH较治疗前及对照组显著升高(P<0.05);各部位TEWL较治疗前及对照组显著降低(P<0.05);皮肤p H值较治疗前及对照组无明显变化。同时,治疗后XS、UIS及DLQI较治疗前及对照组均明显改善(P<0.001)。结论:尿毒症瘙痒患者表皮渗透屏障功能降低,可能是影响瘙痒发生的原因之一,且皮肤瘙痒程度与皮肤干燥程度平行,糖尿病也会加重UP患者瘙痒程度。应用含青刺果油保湿霜能帮助改善UP患者皮肤渗透屏障功能,减轻瘙痒及提高UP患者生活质量。

Objective: To reveal the relationship between alteration of skin barrier function and uremia pruritus(UP), and to evaluate the efficacy and safety of emollient with prinsepia utilis rogle oil in alleviating itch in UP patients. Methods: Sixty UP patients(UP+group), 60 non-pruritic uremia patients(UP-group) and 30 healthy volunteers(HV group) were enrolled in the study. The severity of xerosis(XS) and pruritus was assessed by dry skin clinical scoring systems and uremic itching scale, respectively. The conditions of all participants were investigated using questionnaire, XS and uremic pruritus score(UIS). The stratum corneum hydration(SCH), trans-epidermal water loss(TEWL) and skin p H were assessed in the V area of upper chest, hypochondriac region, flexor side of forearm and extensor side of lower leg. Sixty patients from UP+ group were randomly divided into a test group(treated with an emollient containing prinsepia utilis rogle oil for 28 days) and the control group(without any treatment). Skin conditions, XS, UIS and non-invasive skin measurements were performed at baseline, 7 days(D7), 14 days(D14) and 28 days(D28) after intervention. Life quality was assessed at baseline and D28 using dermatology life quality index(DLQI). Results: The SCH value of uremia patients was significantly lower than those in HV group(P<0.01). The TEWL values of V area of upper chest, hypochondriac region and extensor side of lower leg in UP+group were significantly higher than that of HV group(P<0.05). The skin p H values of V area of upper chest and extensor side of lower leg in UP+ group was higher than those in HV group(P<0.05). There existed significantly positive correlation between the presence of UP and TEWL on the measuring sites(P<0.001). Moreover, xerosis intensity(r=0.325, P=0.011) and diabetes(r=0.521, P<0.001) were shown to have significantly positive correlations with UP severity. After intervention, the SCH values presented an ascending tendency(P<0.05) in test group. The TEWL values showed a descending tendency(P<0.05), while the skin p H values showed no significantly difference compared with the values at baseline in test group. The XS and UIS were significantly reduced at D7, D14 and D28 compared with the baseline(P<0.001). The DLQI of the test group was significantly increased at D28 compared with the baseline and the control group(P<0.001). Conclusions: The impaired epidermal barrier function may cause and exacerbate UP. The severity of UP shows a significantly positive correlation with the intensity of xerosis. Diabetes can also aggravate UP. Regular use of emollients containing prinsepia utilis rogle oil can enhance skin barrier function, alleviate itch and improve life quality of UP patients.