维持性血液透析患者皮肤弹性纤维/胶原纤维变化与瘙痒症关系的研究

Relationship between the skin elastin-to-collagen ratio and pruritus in maintenance hemodialysis patients

目的:首次使用双光子显微镜检测维持性血液透析(MHD)患者皮肤纤维组织变化,探讨皮肤瘙痒症与皮肤纤维组织变化的相关性。方法:纳入MHD患者147例,健康对照组43例。应用双光子显微镜检测受试者皮肤纤维组织成分及形态结构变化,计算皮肤弹性纤维与胶原纤维相对量比值(ELCOR)。同时对皮肤瘙痒情况进行量表分析评估。结果:MHD患者皮肤出现弹性纤维退化,胶原纤维断裂,ELCOR值显著升高,且随透析时间增加而上升(P<0.01)。合并有皮肤瘙痒症的患者皮肤ELCOR显著升高(P<0.01),且患者皮肤瘙痒程度与ELCOR正相关(r=0.397)。血液透析+血液滤过+血液灌流治疗的患者皮肤ELCOR[1.119(1.079,1.181)]较血液透析、血液透析+血液滤过治疗、血液透析+血液灌流治疗的患者[1.573(1.339,2.059)、1.442(1.346,1.558)、1.419(1.326,1.487)]低,差异具有统计学意义(P<0.05)。结论:MHD患者皮肤弹性纤维/胶原纤维(ELCOR)升高与皮肤瘙痒症密切相关。血液透析、血液灌流和血液滤过三者联合治疗能显著降低ELCOR,改善皮肤瘙痒。

Objective:To detect the changes of skin fiber tissue in maintenance hemodialysis(MHD)patients by two-photon microscopy for the first time,and to explore the correlation between skin pruritus and skin fi-ber tissue changes.Methods:A total of 147 MHD patients and 43 healthy controls were enrolled in this study.Two-photon microscopy was used to detect the composition and morphological structure of skin fibers,and the elastin to collagen ratio(ELCOR)was calculated.At the same time,the skin pruritus was evaluated by scale analysis.Results:Under two-photon microscopy,elastic fiber degradation and collagen fiber rupture were observed in the skin of MHD patients,and the calculated ELCOR was significantly increased and the value kept increasing with dialysis time extension(P<0.01).ELCOR was significantly increased in patients with pruri-tus(P<0.01),and the degree of skin pruritus was positively correlated with ELCOR(r=0.397).The ELCOR of patients treated with hemodialysis+hemofiltration+hemoperfusion[1.119(1.079,1.181)]was lower than that of pa-tients treated with hemodialysis,hemodialysis+hemofiltration,and hemodialysis+hemoperfusion[1.573(1.339,2.059),1.442(1.346,1.558),1.419(1.326,1.487)]and the differences were statistically significant(P<0.05).Conclusion:The increase of skin elastic/collagen fibers(ELCOR)is closely related to skin pruritus in MHD patients.The combination of hemodialysis,hemoperfusion and hemofiltration can significantly reduce ELCOR and improve pruritus.