加巴喷丁治疗维持性血液透析患者皮肤瘙痒的临床研究

Clinical Study on Gabapentin in the Treatment of Skin Pruritus in Maintenance Hemodialysis Patients

目的:研究加巴喷丁(Gabapentin,GBP)治疗维持性血液透析(maintenance hemodialysis,MHD)患者皮肤瘙痒的临床效果。方法:采用随机数字表法将抚州市第一人民医院2022年7月—2023年9月收治的80例MHD合并皮肤瘙痒患者分为对照组40例、观察组40例。对照组接受尿素霜联合高通量血液透析(high-flux hemodialysis,HFHD)治疗,观察组在对照组基础上联合GBP治疗。比较两组临床疗效、肾功能指标、炎症因子指标、中大分子毒素清除效果、皮肤瘙痒程度及不良反应。结果:治疗后,观察组总有效率为95.00%,显著优于对照组的80.00%,差异有统计学意义(P<0.05)。治疗后,两组瘙痒评分均下降,且观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组甲状旁腺激素(parathyroid hormone,PTH)及血清β_(2)-微球蛋白(β_(2)-microglobulin,β_(2)-MG)水平均下降,差异均有统计学意义(P<0.05),但两组PTH、β_(2)-MG水平比较,差异均无统计学意义(P>0.05)。治疗后,两组白细胞介素-6(interleukin-6,IL-6)、白细胞介素-1β(interleukin-1β,IL-1β)、超敏C反应蛋白(hypersensitivity C reactive protein,hs-CRP)水平均较治疗前降低,差异均有统计学意义(P<0.05),但两组IL-6、IL-1β、hs-CRP水平比较,差异均无统计学意义(P>0.05);治疗后,两组血清肌酐(serum creatinine,Scr)、血尿素氮(blood urea nitrogen,BUN)、血磷(phosphorus,P)均较治疗前下降,血钙(calcium,Ca)均较治疗前上升,差异均有统计学意义(P<0.05),两组Scr、BUN、Ca、P比较,差异均无统计学意义(P>0.05)。治疗后两组均未见不良反应发生。结论:在HFHD、尿素霜基础上,联合GBP治疗MHD合并皮肤瘙痒患者可有效改善瘙痒程度,且GBP的应用对HFHD清除毒素、肾功能及炎症因子水平等指标无显著影响,安全性较好。

Objective:To study the clinical effect of Gabapentin(GBP)in the treatment of skin pruritus in maintenance hemodialysis(MHD)patients.Method:Using random number table method,80 MHD patients with skin pruritus who were admitted to the First People's Hospital of Fuzhou from July 2022 to September 2023 were divided into control group(40 cases)and observation group(40 cases).The control group was treated with Urea Cream combined with high-flux hemodialysis(HFHD).On this basis,the observation group was treated with GBP.Comparison between groups was made on clinical efficacy,renal function indicators,inflammatory factors,clearance of mediummolecular and macromolecular toxins,degree of skin pruritus and adverse reactions.Result:After treatment,the total effective rate of observation group(95.00%)was significantly higher than that of control group(80.00%),the difference was statistically significant(P<0.05).After treatment,pruritus scores of both groups decreased,and those of observation group were lower than those of control group,the differences were statistically significant(P<0.05).After treatment,the levels of parathyroid hormone(PTH),and serumβ_(2)-microglobulin(β_(2)-MG)in both groups decreased,the differences were statistically significant(P<0.05),however,there were no statistically significant differences in the levels of PTH andβ_(2)-MG between two groups(P>0.05).After treatment,the levels of interleukin-6(IL-6),interleukin-1β(IL-1β)and hypersensitivity C reactive protein(hs-CRP)in both groups decreased(P<0.05),the differences were statistically significant(P<0.05),however,there were no statistically significant differences in the levels of IL-6,IL-1βand hs-CRP between two groups(P>0.05).After treatment,the levels of serum creatinine(Scr),blood urea nitrogen(BUN)and phosphorus(P)in both groups decreased,while the levels of calcium(Ca)increased,the differences were statistically significant(P<0.05),however,there were no statistically significant differences in Scr,BUN,Ca and P between two groups(P>0.05).No adverse reaction was observed in either group.Conclusion:Additional use of GBP on the basis of HFHD and Urea Cream can effectively relieve skin pruritus in MHD patients with skin pruritus.Besides,the application of GBP has no significant influence on HFHD in terms of toxin clearance,renal function and inflammatory factors,indicating good safety.