降浊止痒方治疗慢性肾脏病相关性皮肤瘙痒的临床观察

Clinical Observation of Turbidity Reduction and Itching Relieving Prescription in Treatment of Skin Pruritus Associated with Chronic Kidney Disease

目的观察降浊止痒方治疗慢性肾脏病相关性皮肤瘙痒的临床效果。方法收集2020年1月至2021年3月保定市第一中医院肾病风湿科门诊收治的80例慢性肾脏病相关性皮肤瘙痒患者的临床资料,按照治疗方法不同分为对照组和试验组,每组40例。两组均采用西医常规治疗,对照组在常规治疗基础上给予依巴斯汀片口服治疗,每次10 mg,每日2次;试验组在常规治疗基础上给予降浊止痒方中药颗粒剂口服治疗,每次1袋,用150 ml温水沏开调匀口服,每日2次。两组均治疗1个月。治疗后观察两组皮肤瘙痒情况和实验室相关指标(血肌酐、血尿素氮、血红蛋白、血磷、血钙、血镁、甲状旁腺激素)变化,临床疗效以及不良反应发生情况。结果瘙痒程度、瘙痒范围、瘙痒持续时间、对睡眠的影响评分的组间和时点间存在交互作用(P<0.05或P<0.01),治疗后,试验组瘙痒程度、瘙痒范围、瘙痒持续时间、对睡眠的影响评分低于对照组(P<0.05)。血肌酐、血尿素氮、血红蛋白组间和时点间存在交互作用(P<0.01),治疗后,试验组血肌酐、血尿素氮低于对照组(P<0.05),血红蛋白高于对照组(P<0.05)。血钙、血镁、血磷的组间和时点间存在交互作用(P<0.05或P<0.01),甲状旁腺激素的组间和时点间不存在交互作用(P>0.05),治疗后,试验组血钙水平高于对照组(P<0.05),血镁、血磷、甲状旁腺激素水平低于对照组(P<0.05)。治疗后,试验组总有效高于对照组[90.0%(36/40)比67.5%(27/40)],总不良反应发生率低于对照组[5.0%(2/40)比20.0%(8/40)](均P<0.05)。结论降浊止痒方口服治疗慢性肾脏病相关性皮肤瘙痒的临床疗效显著,不仅能改善患者皮肤瘙痒症状,纠正矿物质代谢紊乱,促进实验室指标好转,且不良反应发生率低。

Objective To observe the clinical effect of turbidity reduction and itching relieving prescription in the treatment of skin pruritus associated with chronic kidney disease.Methods The clinical data of 80 patients with chronic kidney disease-related skin pruritus admitted to the Department of Nephrology and Rheumatology of Baoding No.1 Hospital of Traditional Chinese Medicine(TCM)from Jan.2020 to Mar.2021 were included and divided into a control group and a test group according to different treatment methods,with 40 patients in each group.Both groups used conventional treatment in western medicine,and the control group was additionally given ebastine tablets orally,10 mg each time,twice a day,while the test group was given oral treatment of turbid reduction and itching relieving prescription of TCM granules on the basis of the conventional treatment,1 bag each time,dissolved in 150 ml warm water,twice a day.Both groups were treated for 1 month.After treatment,skin pruritus and changes of laboratory indicators(blood creatinine,blood urea nitrogen,hemoglobin,blood phosphorus,blood calcium,blood magnesium,parathyroid hormone),clinical efficacy and incidence of adverse reactions were observed in both groups.Results The itching degree,itching range,itching duration and the influence score on sleep had interactions between groups and time points(P<0.05 or P<0.01).After treatment,the itching degree,itching range,itching duration and the influence score on sleep in the test group were lower than those in the control group(P<0.05).The blood creatinine,blood urea nitrogen,hemoglobin had interactions between groups and time points(P<0.05),blood creatinine and blood urea nitrogen in the test group were lower than those in the control group(P<0.05),while hemoglobin was higher than that in the control group(P<0.05).The blood calcium,blood magnesium and blood phosphorus had interactions between groups and time points(P<0.05 or P<0.01),but there was no interaction between groups and time points of parathyroid hormone(P>0.05).After treatment,the level of blood calcium in the test group were higher than that in control group(P<0.05),while the levels of blood magnesium,blood phosphorus and blood parathyroid hormone were lower than those in the control group(P<0.05).After treatment,the total effective rate of the test group was higher than that of the control group[90.0%(36/40)vs 67.5%(27/40)],and the incidence of total adverse reactions was lower than that of the control group[5.0%(2/40)vs 20.0%(8/40)](both P<0.05).Conclusion Oral prescription for reducing turbidity and relieving itching has significant clinical effect on chronic kidney disease associated skin pruritus,which not only can improve pruritus symptoms,correct mineral metabolism disorders,promote the improvement of laboratory indicators,but also has low incidence of adverse reactions.