摘要
目的:探讨维持性血液透析患者并发皮肤瘙痒的影响因素及其与血清炎性因子、β2-MG的相关性。方法:选择2019年1月至2023年12月来我院诊治的维持性血液透析患者100例,对比有瘙痒及无瘙痒患者的一般资料及实验室指标水平,有统计学意义的指标进行Logistic分析。根据5D-IS量表评估有瘙痒者的评分,根据评分将瘙痒者者分为轻度、中度及重度组,对比三组患者的血清炎性因子、β2-MG水平。给予皮肤瘙痒组患者普瑞巴林治疗,分析治疗效果,对比治疗前后有效组、无效组的血清β2-MG、CRP、TNF-α、IL-6水平。结果:皮肤瘙痒组年龄、透析前血肌酐水平、透析龄、钙磷乘积、血磷水平、甲状旁腺激素水平、皮肤干燥患病情况、血清β2-MG、CRP、TNF-α、IL-6水平明显较无瘙痒组的高,SF水平、Kt/V≥1.2占比明显比无瘙痒组低(P<0.05)。二分类Logistic回归分析发现,维持性血液透析并发皮肤瘙痒的危险因素为年龄≥60岁、透析龄≥1年、钙磷乘积≥65(mg^(2)/dl^(2))、Kt/V<1.2、甲状旁腺激素水平≥300 pg/mL、皮肤干燥患病、血清β2-MG≥4.06 mg/L、血清CRP≥10 mg/L、血清TNF-α≥1.54ng/mL、血清IL-6≥0.46 ng/L(P<0.05)。45例维持性血液透析并发皮肤瘙痒患者中,轻度者28例、中度者10例、重度者7例。重度组的血清β2-MG、CRP、TNF-α、IL-6水平明显较轻度、中度组高,中度组以上指标明显较轻度组高(P均<0.05)。45例维持性血液透析并发皮肤瘙痒患者中,完全缓解者15例,显效者10例,有效者10例,无效者10例。治疗后,有效组的血清β2-MG、CRP、TNF-α、IL-6水平明显较治疗前低(P<0.05);无效组以上指标治疗前后无统计学意义(P>0.05);治疗后有效组以上指标明显较无效组低(P<0.05)。结论:维持性血液透析患者并发皮肤瘙痒的危险因素包括年龄≥60岁、透析龄≥1年、钙磷乘积≥65(mg^(2)/dl^(2))、Kt/V<1.2、甲状旁腺激素水平≥300 pg/mL、皮肤干燥患病、血清β2-MG≥4.06 mg/L、血清CRP≥10 mg/L、血清TNF-α≥1.54ng/mL、血清IL-6≥0.46 ng/L,血清CRP、TNF-α、IL-6、β2-MG与维持性血液透析患者并发皮肤瘙痒严重程度及预后相关。
Objective:To explore the influencing factors of concurrent skin pruritus in maintenance hemodialysis patients and its correlation with serum inflammatory factors inβ2-MG.Methods:100 maintenance hemodialysis patients from our hospital from January2019 to December 2023,compared with general data and laboratory indicators of patients with and without pruritus,and statistically significant indicators for Logistic-analysis.The scores of pruritus patients were evaluated according to the 5D-IS scale,and the pruritus patients were divided into mild,moderate and severe groups according to the scores,and the serum inflammatory factors andβ2-MG levels of the three groups were compared.The therapeutic effect of pregabalin was analyzed,and the serum levels ofβ2-MG,CRP,TNF-αand IL-6 in the effective and ineffective groups were compared before and after treatment.Results:In the itching group,age,blood creatinine level,dialysis age,calcium and phosphorus product,blood phosphorus level,parathyroid hormone level,dry skin disease,serumβ2-MG,CRP,TNF-α,and IL-6 levels were significantly higher than in the no itching group,while SF level and Kt/V 1.2 proportion were significantly lower than in the no itching group(P<0.05).Binary Logistic regression analysis found that The risk factors of maintenance hemodialysis complicated with itching were age≥60 years,dialysis duration≥1 year,calcium-phosphorus product≥65(mg^(2)/dl^(2)),Kt/V<1.2,parathyroid hormone level≥300 pg/mL,dry skin disease,serumβ2-MG≥4.06 mg/L,serum CRP≥10 mg/L,and serum TNF-α≥1.54 ng/mL,serum IL-6≥0.46 ng/L(P<0.05).Among 45 patients with maintenance hemodialysis complicated with pruritus,28cases were mild,10 cases were moderate,and 7 cases were severe.Serum levels ofβ2-MG,CRP,TNF-αand IL-6 in severe group were higher than those in mild and moderate groups,and the above indexes in moderate group were higher than those in mild group(all P<0.05).Among 45 patients with pruritus caused by maintenance hemodialysis,15 cases had complete remission,10 cases had obvious effect,10cases were effective,and 10 cases were ineffective.After treatment,the levels of serumβ2-MG,CRP,TNF-αand IL-6 in the effective group were lower than those before treatment(P<0.05).There was no significance in the ineffective group before and after treatment(P>0.05).After treatment,the above indexes in effective group were lower than those in ineffective group(P<0.05).Conclusion:The risk factors for pruritosis in maintenance hemodialysis patients included age≥60 years,dialysis duration≥1 year,calcium-phosphorus product≥65(mg^(2)/dl^(2)),Kt/V<1.2,parathyroid hormone level≥300 pg/mL,dry skin disease,serumβ2-MG≥4.06 mg/L,serum CRP≥10mg/L Serum TNF-α≥1.54 ng/mL,serum IL-6≥0.46 ng/L,serum CRP,TNF-α,IL-6 andβ2-MG were correlated with the severity and prognosis of skin itching complicated by maintenance hemodialysis patients.
作者
赵景新
浮金晨
张东亮
王世长
赵海岳
ZHAO Jing-xin;FU Jin-chen;ZHANG Dong-liang;WANG Shi-chang;ZHAO Hai-yue(Department of Nephrology,Bejing Changping District Integrated Traditional Chinese and Western Medicine Hospital,Bejing,102208,China;Department ofNephrology,Beijing Jishuitan Hospital Affiliated to Capital Medical University,Beijing,100035,China)
出处
《现代生物医学进展》
CAS
2024年第13期2473-2477,2416,共6页
Progress in Modern Biomedicine
基金
国家重点研发计划项目(2020YFC2005403)。
