乌梅丸加减方外洗对维持性血液透析皮肤瘙痒症患者瘙痒程度及炎性指标的影响

Effects of External Washing of Modified Wumei Pills on Pruritus and Inflammatory Index in Patients with Pruritus of Maintenance Hemodialysis

目的观察乌梅丸加减方外洗联合常规疗法治疗维持性血液透析皮肤瘙痒症患者的临床疗效,及对瘙痒程度和炎性指标的影响。方法采用随机数字表法将70例患者分为治疗组和对照组各35例。2组均予常规疗法(血液透析+西医基础治疗)。对照组在常规疗法基础上予炉甘石洗剂,每日2~3次,摇匀后涂于患处。治疗组在常规疗法基础上予乌梅丸加减方煎剂泡洗双足,纱布湿敷身体瘙痒部位,每次30 min,每日1次。2组均连续治疗8周。观察2组临床疗效,比较2组治疗前后血钙、血磷、全段甲状旁腺激素(iPTH)、C反应蛋白(CRP)、β_(2)-微球蛋白(β_(2)-MG)、血清P物质水平及视觉模拟评分法(VAS)评分。结果治疗组剔除2例、脱落1例,对照组剔除1例。治疗组总有效率为93.75%(30/32),对照组为73.53%(25/34),2组比较差异有统计学意义(P=0.028)。与本组治疗前比较,2组治疗后血钙水平差异无统计学意义(P>0.05),2组治疗后血磷水平明显下降(P<0.01),治疗组治疗后血iPTH水平明显下降(P<0.01);2组治疗后血钙、血磷水平比较差异无统计学意义(P>0.05),治疗组血iPTH水平明显低于对照组(P<0.05)。与本组治疗前比较,2组治疗后血CRP水平明显降低(P<0.01),β_(2)-MG水平无明显变化(P>0.05);2组治疗后比较,治疗组血CRP水平低于对照组(P<0.05),2组血β_(2)-MG水平比较差异无统计学意义(P>0.05)。与本组治疗前比较,2组治疗后血清P物质水平明显降低(P<0.01);2组治疗后血清P物质水平比较差异无统计学意义(P>0.05)。与本组治疗前比较,2组治疗后VAS评分明显降低(P<0.01);2组治疗后比较,治疗组VAS评分明显低于对照组(P<0.01)。结论乌梅丸加减方外洗联合常规疗法治疗维持性血液透析皮肤瘙痒症患者临床疗效较好,可明显降低炎症因子水平,改善瘙痒临床症状。

Objective To observe the clinical efficacy of external washing of modified Wumei Pills combined with routine therapy for patients with pruritus of maintenance hemodialysis,and effects on pruritus and inflammatory index.Methods Totally 70 patients were divided into treatment group and control group according to random number table method,with 35 cases in each group.Both groups received routine therapy(hemodialysis+basic Western medicine treatment).On the basis of conventional treatment,patients in the control group were given calamine lotion for external application,twice or three times a day,while patients in the treatment group were given modified Wumei Pills of decoction for external washing,gauze compressing the rest of the itchy parts of the body,once a day,30 minutes each time.Both groups were treated for 8 weeks.Clinical efficacy for both groups was observed.Blood calcium,phosphorus,parathyroid hormone(iPTH),C-reactive protein(CRP),β_(2)-microglobulin(β_(2)-MG),serum substance P and visual analogue scale(VAS)score were compared before and after treatment.Results In the treatment group,2 cases were excluded and 1 case fell off,1 case in the control group were excluded.The total effective rate was 93.75%(30/32)in the treatment group and 73.53%(25/34)in the control group.The difference between the two groups was statistically significant(P=0.028).Compared with before treatment,there was no significant difference in blood calcium levels of the two groups after treatment(P>0.05),the blood phosphorus level was significantly reduced after treatment in the two groups(P<0.01),and blood iPTH levels significantly decreased in the treatment group(P<0.01);there was no significant difference in blood calcium and phosphorus levels between the two groups after treatment(P>0.05),and the blood iPTH level of the treatment group was significantly lower than that of the control group(P<0.05).Compared with before treatment,the blood CRP level was significantly reduced after treatment in the two groups(P<0.01),and the β_(2)-MG level did not change significantly(P>0.05);after treatment,the CRP level of the treatment group was lower than that of the control group(P<0.05),and there was no significant difference in the level of β_(2)-MG between the two groups(P>0.05).Compared with before treatment,the level of serum substance P in the two groups was significantly reduced after treatment(P<0.01);there was no significant difference in the level of substance P between the two groups after treatment(P>0.05).Compared with before treatment,the VAS score of the two groups was significantly reduced after treatment(P<0.01);after treatment,the VAS score of the treatment group was significantly lower than that of the control group(P<0.01).Conclusion External treatment of modified Wumei Pills combined with routine therapy can significantly reduce the levels of inflammatory factors and improve the clinical symptoms of pruritus in maintenance hemodialysis patients,with good clinical efficiency.