血液透析患者尿毒症瘙痒患病率调查及其相关因素分析

Prevalence of uremic pruritus and related factors in patients undergoing hemodialysis

目的调查血液透析患者尿毒症瘙痒(UP)的患病率,分析其相关因素。方法选取因尿毒症于2021年3月在厦门大学附属第一医院行血液透析的患者212例进行横断面研究,收集患者性别、年龄及血生化指标等资料,应用五维瘙痒量表(5DIS)问卷对患者进行皮肤瘙痒评估,根据评估结果将患者分为瘙痒组和无瘙痒组,比较两组相关指标,并对瘙痒发生的危险因素进行二元logistic回归分析。结果根据5DIS评估结果,212例患者中无瘙痒者129例(60.85%,无瘙痒组),瘙痒者83例(39.15%,瘙痒组)。瘙痒组年龄、超敏C反应蛋白(hs-CRP)、碱性磷酸酶(ALP)、脑利钠肽(BNP)、铁蛋白(FER)分别为63.0(51.0,72.0)岁、1.66(0.30,7.85)mg/L、93.0(70.0,118.0)U/L、192.0(84.9,446.4)ng/L、421.0(291.6,577.6)μg/L,均高于无瘙痒组的53.0(42.0,63.0)岁、0.40(0.30,1.88)mg/L、79.0(62.0,99.0)U/L、143.3(65.8,256.5)ng/L、356.8(203.3,528.4)μg/L,差异均有统计学意义(Z=-3.14、-3.96、-3.05、-2.88、-2.11,均P<0.05)。hs-CRP、BNP、FER升高(Wald值=14.58、4.17、4.23,均P<0.05)是UP的独立危险因素。结论UP在血液透析患者中常见,hs-CRP、FER及BNP升高是UP的独立危险因素。在临床工作中应当着重加强对患者的早期识别,优化治疗措施,提高患者的生活质量。

Objective To investigate the prevalence of uremic pruritus and related factors in patients undergoing hemodialysis.Methods A total of 212 patients with uremia who undergo hemodialysis in the First Affiliated Hospital of Xiamen University in March 2021 were included in this cross-sectional study.Data including gender,age and blood biochemical indicators were collected.The 5D itch scale was used to evaluate skin itch in patients.The included patients were divided into pruritus and no pruritus groups according to evaluation results.Related indicators were compared between the two groups.Binary logistic regression analysis of skin itch related factors was performed.Results According to 5D itch scale evaluation results,129 patients(60.85%)of the 212 patients had no skin pruritus,and 83 patients(39.15%)had skin pruritus.In the pruritus group,age,hypersensitive C-reactive protein,alkaline phosphatase,brain natriuretic peptide,ferritin were 63.0(51.0,72.0)years,1.66(0.30,7.85)mg/L,93.0(70.0,118.0)U/L,192.0(84.9,446.4)ng/L and 421.0(291.6,577.6)μg/L,respectively,which were significantly higher than 53.0(42.0,63.0)years,0.40(0.30,1.88)mg/L,79.0(62.0,99.0)U/L,143.3(65.8,256.5)ng/L,356.8(203.3,528.4)μg/L in the pruritus group(Z=-3.14,-3.96,-3.05,-2.88,-2.11,all P<0.05).Increased hypersensitive C-reactive protein,brain natriuretic peptide,ferritin levels(Wald=14.58,4.17,4.23,all P<0.05)were independent risk factors for uremic pruritus.Conclusion Uremic pruritus remains a serious problem in patients undergoing hemodialysis.Increased hypersensitive C-reactive protein,ferritin,brain natriuretic peptide levels are independent risk factors for uremic pruritus.In clinical work,physicians should focus on strengthening the early identification of patients,optimizing treatment measures,and improving the quality of life of patients.