维持性血液透析患者皮肤瘙痒的发生情况及影响因素的多中心临床研究

A multi-center clinical research on the occurrence and influencing factors of pruritus in maintenance hemodialysis patients

目的探讨维持性血液透析患者皮肤瘙痒的发生率和严重程度,并分析可能的影响因素。方法研究对象为上海交通大学附属第六人民医院等11家医院的肾内科透析患者。通过患者自我报告的视觉模拟量表评估瘙痒的发生。观察指标包括透析方案、并发症、药物使用,以及钙磷代谢相关的实验室检查。结果收集1540例血液透析患者,其中78.7%有瘙痒症状,中重度瘙痒34.2%,平均瘙痒VAS得分(2.85±2.52)分;Kt/V低(β=-0.562,95%CI:-0.916~-0.207,P=0.002)、使用拟钙剂(β=-1.094,95%CI:-1.462~-0.725,P<0.001)、血液透析联用血液滤过方案(β=0.604,95%CI:0.119~1.089,P=0.015)、血液透析联用血液滤过及血液灌流透析方案(β=0.967,95%CI:0.453~1.481,P<0.001)、联用腹膜透析(β=0.989,95%CI:0.078~1.900,P=0.033)、使用骨化三醇(β=0.564,95%CI:0.250~0.877,P<0.001)、使用外用止痒药物(β=2.740,95%CI:2.052~3.428,P<0.001)、合并贫血(β=0.575,95%CI:0.245~0.905,P<0.001)、合并慢性肾病-矿物质和骨骼疾病(β=0.841,95%CI:0.527~1.155,P<0.001)、高钙磷乘积(β=1.898,95%CI:0.645~3.152,P=0.003)者瘙痒发生风险高。结论维持性血液透析患者中皮肤瘙痒的发生比例高,主要与钙磷代谢的异常有关。

Objective To investigate the incidence,severity and risk factors of pruritus in maintenance hemodialysis(MHD)patients.Methods The MHD patients in the nephrology departments of eleven hospitals were enrolled in this study.Patient self-reported pruritus was assessed by the Visual Analog Scale(VAS).The observed indicators included current dialysis scheme,dialysis age,complications,medications,and laboratory tests relating to calcium and phosphorus metabolism.Results A total of 1,540 patients were investigated,with 78.7%reporting pruritus,of which 34.2%had moderate to severe pruritus;the overall mean pruritus VAS score was 2.85±2.52.Lower Kt/V(β=-0.562,95%CI:-0.916~-0.207,P=0.002),use of calcimimetics(β=-1.094,95%CI:-1.462~-0.725,P<0.001),HD+HDF protocol(β=0.604,95%CI:0.119~1.089,P=0.015),HD+HDF+HP protocol(β=0.967,95%CI:0.453~1.481,P<0.001),hemodialysis combined with peritoneal dialysis(β=0.989,95%CI:0.078~1.900,P=0.033),use of calcitriol(β=0.564,95%CI:0.250~0.877,P<0.001),use of topical antipruritics(β=2.740,95%CI:2.052~3.428,P<0.001),anemia(β=0.575,95%CI:0.245~0.905,P<0.001),chronic kidney disease-mineral and bone disease(β=0.841,95%CI:0.527~1.155,P<0.001),and higher calcium-phosphorus product(β=1.898,95%CI:0.645~3.152,P=0.003)were associated with higher risk of pruritus.Conclusion The higher prevalence of pruritus in MHD patients is mainly associated with the abnormalities of calcium and phosphorus metabolism.