针药并用治疗维持性血液透析患者皮肤瘙痒症的临床研究

Clinical study of acupuncture combined with medication in the treatment of skin pruritus in maintenance hemodialysis patients

目的:观察针刺结合西药治疗维持性血液透析患者皮肤瘙痒症的临床疗效.方法:将80例患者随机分为对照组和观察组,每组40例.对照组予氯雷他定口服,观察组在此基础上加针刺治疗.比较四项目瘙痒量表(FIIQ)评分、皮肤屏障功能指标、血清白介素(IL)-2和IL-31水平.治疗结束后判定疗效.结果:观察组总有效率高于对照组(P<0.05).治疗后,两组瘙痒的部位、频率、严重程度、对睡眠影响评分及FIIQ总分均较治疗前降低(P<0.05),观察组各项评分均低于对照组(P<0.05).对照组胸前V形区、前臂屈侧、小腿伸侧的角质层含水量(SCH)、经皮水分丢失(TEWL)无明显变化(P>0.05);观察组胸前V形区、前臂屈侧、小腿伸侧的SCH、TEWL均改善(P<0.05),且均优于对照组(P<0.05).对照组血清IL-2和IL-31水平无明显变化(P>0.05);观察组血清IL-2和IL-31水平均明显降低(P<0.05),且低于对照组(P<0.05).结论:针刺结合氯雷他定治疗维持性血液透析患者皮肤瘙痒症疗效显著,可缓解瘙痒症状,改善皮肤屏障功能,降低血清IL-2及IL-31水平.

Objective:To observe the clinical effect of acupuncture combined with Western medicine in the treatment of skin pruritus in maintenance hemodialysis patients.Methods:Eighty patients were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was given loratadine orally,and the observation group was given acupuncture treatment in addition to the treatment used in the control group.The four-item itch questionnaire(FIIQ)score,indicators for skin barrier function,and serum interleukin(IL)-2 and IL-31 levels were compared.The efficacy was judged after the treatment ended.Results:The total effective rate was higher in the observation group than in the control group(P<0.05).After treatment,the site,frequency,severity of pruritus,sleep impact sub-scores,and FIIQ total score in both groups were reduced compared with those before treatment(P<0.05),and all scores in the observation group were lower than those in the control group(P<0.05).The stratum corneum hydration(SCH)and transepidermal water loss(TEWL)in the V-shaped area of the chest,the flexor side of the forearm,and the extensor side of the lower leg were not significantly changed in the control group(P>0.05);the SCH and TEWL in the V-shaped area of the chest,the flexor side of the forearm,and the extensor side of the lower leg in the observation group were improved(P<0.05),and all were better than those in the control group(P<0.05).The serum IL-2 and IL-31 levels in the control group did not change significantly(P>0.05);the serum IL-2 and IL-31 levels in the observation group were both significantly decreased(P<0.05)and were lower than those in the control group(P<0.05).Conclusion:Acupuncture combined with loratadine is highly effective in the treatment of pruritus in maintenance hemodialysis patients,and it can relieve pruritus,improve skin barrier function,and reduce serum IL-2 and IL-31 levels.