血液透析患者瘙痒症的发病机制及药物治疗进展

Advances in pathogenesis and drug therapy in hemodialysis patients with pruritus

慢性肾脏病相关性瘙痒症(chronic kidney disease-associated pruritus,CKD-aP)是血液透析患者常见且难以忍受的并发症,不仅严重影响其生活质量和身心健康,而且增加其远期死亡风险。CKD-aP的发病机制仍不明确,免疫炎症失调、内源性阿片类系统失衡、代谢产物异常蓄积、皮肤干燥症、组胺水平异常、甲状旁腺功能亢进等因素都被证实与其相关。CKD-aP目前缺乏满意、特效的治疗策略,主要包括药物治疗、非药物治疗和透析方式调整。该文主要就CKD-aP的发病机制及药物治疗进展作一综述。

Chronic kidney disease-associated pruritus(CKD-aP),one of the most common and intolerable complications in hemodialysis patients,not only seriously affects patients'quality of life and physical and mental health,but also increases the risk of long-term mortality.The pathogenesis of CKD-aP remains unclear,and immune-inflammatory dysregulation,imbalance of endogenous opioid system,abnormal accumulation of metabolites,xerosis,abnormal histamine level as well as hyperparathyroidism,have all been shown to be associated with pruritus.There is a lack of satisfactory and effective treatment strategies for CKD-aP,which mainly include pharmacological treatment,non-pharmacological treatment and dialysis modality modification.This article mainly reviews recent advances in the pathogenesis and pharmacological treatment of pruritus among hemodialysis patients.