摘要
目的观察不同血液净化方法对老年尿毒症患者皮肤瘙痒的疗效。方法选择符合入选标准的老年维持性血透患者51例，随机分为血液透析串联血液灌流组（HD＋HP）、血液透析滤过组（HDF）及血液透析组（HD）3组。分别于首次透析前后及透析第4、8周后记录皮肤瘙痒临床症状评分，同时检测血B2微球蛋白（B2=MG）及全段甲状旁腺素（iPTH），8周后观察不同透析方法对患者皮肤瘙痒症疗效，对各组数据进行统计分析。结果（1）HD＋HP组首次透析前后B2-MG水平由（16．27±4．73）mg／L降为（13．48±3．05）mg／L（t=2．044，P=0．048），4周后降为（10．97±3．25）mg／L（t=3．808，P=0．002），8周后降为（6．47±2．35）mg／L（t=7．650，P=0．000）；透析4周后iPTH水平由（887．5±Z4Z．7）ng／L降为（688．3±Z23．4）ng／L（f-3．384，P=0．004），8周后降为（467．2±102．5）ng／L（t=6．578，P=0．000）；HDF组透析4周后B2-MG水平由（17．74±5．23）mg／L降为（14．08±3．32）mg／L（t=2．436，P=0．027），8周后降为（13．21±4．38）mg／L（t=2．738，P=0．015），透析4周后iPTH水平由（898．5±318．2）ng／L降为（701．8±197．3）ng／L（t=2．166，P=0．046），8周后降为（677．5±187．4）ng／L（t=2．468，P=0．025）；HD组首次透析后及透析4、8周后，82-MG、iPTH水平变化差异均无统计学意义（均为P〉0．05）。8周后，3组82-MG、iPTH水平比较，差异有统计学意义（均为P〈0．05）。（2）HD＋HP组透析4周后瘙痒评分由（21．17±5．01）分降至（13．37±2．85）分（f-5．580，P=0．000），8周后降为（8．52±4．38）分（t=7．838，P=0．000）；HDF组透析4周后瘙痒评分由（19．81±4．83）分降为（16．01±3．89）分（t=2．526，P=0．022），8周后降为（12．38±4．23）分（t=4．771，P=0．000）；HD组透析4、8周后，瘙痒评分无明显变化（均为P〉0．05）；8周后，3组瘙痒评分比较，差异有统计学意义（均为P〈0．05）。（3）治疗8周后瘙痒症治疗缓解率HD＋HP组为88．2％（15／17）、HDF组为58．8％（10／17）、HD组为23．5（4／17），HD＋HP组缓解率明显优于HD组（x2=14．44，P=0．000），HDF组优于HD组（x2=4．37，P=0．037）。结论HD＋HP能有效地清除老年尿毒症患者血清B2-MG、iPTH等中分子毒素，明显缓解皮肤瘙痒症状，其效果优于HDF，HDF治疗无效者改HD＋HP治疗可能有效，而HD清除中分子毒素及缓解皮肤瘙痒较差。
Objective To study the effect of different dialysis modalities on pruritus in elderly maintenance hemodialysis patients. Methods Totally 51 patients were randomly divided into hemoperfusion combined with hemodialysis group （HD＋ HP）, hemodiafiltration group （HDF） and hemodialysis group （HD）. Plasma β2-microglobulin（β2-MG） and intact parathyroid hormone （iPTH） were measured by means of radio immunoassay at pre and post dialysis, 4 weeks and 8 weeks after dialysis, cutaneous pruritus was scored. The remission rate of itching was calculated at 8 weeks after dialysis. The parameters were compared among different groups. Results The level of plasma β2- MG was lower in HD±HP group after dialysis than pre dialysis ^（13.48±3.05）mg/L vs. （16. 27± 4.73） mg/L, t=2. 044, P^0. 053, at 4 weeks and 8 weeks after dialysis, its levels were decreased to （10. 97 ± 3. 25 ） mg/L （ t = 3. 808 , P=0.002）and （6.47 ± 2.35）mg/L（t= 7. 650, P=0.000）, respectively. The levels of iPTH were also found decrease from（887.5 ± 242.7）ng/L to （688.3± 223.4）ng/L（t=3. 384, P=0. 004）at 4 weeks and （467.2±102.5） ng/L（t=6. 578,P=0. 000） at 8 weeks after dialysis in HD＋HP group （all P%0.01）. There were differences of the levels of plasma β2-MG and iPTH at 4 weeks and 8 weeks after dialysis in HDF group （all P% 0.05）, but no differences of the levels of plasma β2-MG and iPTH during every period were found in HD group（all P ~0.05）. The scores of cutaneous pruritus were decreased from （21. 17±5.01） scores to （13.37± 2.85） scores（t= 5. 580,P=0. 000）at 4 weeks and （8.52±.38） scores（t= 7. 838,P=0. 000）at 8 weeks after dialysis in HD＋ HP group, and also the scores at 4 and 8 weeks after dialysis in HDF group （all P%0.01）, but there were no significant differences of the scores during every period in HD group （all P〉0.05）. The remission rate of itching was better in HD＋HP group than in HDF group C88.24% （15/17 cases） vs. 58.82M （10/17 cases）, X2=14.44,P=0.0003, better in HDF group than in HD group 23.53% （4/17 cases） （;g2 =4.37,P=0. 037）. Conclusions HD＋HP is superior to HDF in efficiently clear β2-MG and iPTH, and relief cutaneous pruritus, but HD can poorly clear β2-MG and iPTH or relief itching.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2012年第12期1092-1096,共5页
Chinese Journal of Geriatrics
基金
苏州市科教兴卫青年科技项目（苏卫科20102318）
