摘要
目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者皮肤瘙痒的影响因素及中医证候分型情况。方法选取2024年7月至9月在嘉兴市中医医院行规律MHD的174例患者作为研究对象,根据有无尿毒症性皮肤瘙痒症(uremic pruritus,UP),分为瘙痒组(n=66)和无瘙痒组(n=108)。对两组患者进行中医证候分型,采用Logistic回归分析MHD患者皮肤瘙痒的影响因素并建立评估模型。采用受试者操作特征曲线评价该模型评估效能。分析中医证候分型与瘙痒程度的关系。结果两组患者均以脾肾气虚为主要证型,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,β2微球蛋白(β2 microglobulin,β2-MG)、血磷、超敏C反应蛋白、甲状旁腺激素(parathyroid hormone,PTH)均为MHD患者皮肤瘙痒的危险因素。MHD患者皮肤瘙痒的曲线下面积为0.962(95%CI:0.930~0.995)。UP患者本虚证以脾肾气虚为主,标实证以血虚风燥为主。结论β2-MG、血磷、超敏C反应蛋白、PTH与MHD患者皮肤瘙痒发生均密切相关,UP患者的中医本证以脾肾气虚为主,标证以血虚风燥为主,且中医证候分型与皮肤瘙痒程度存在一定的相关性。
Objective To investigate the influencing factors and Traditional Chinese Medical(TCM)syndrome classification of skin pruritus in patients with maintenance hemodialysis(MHD).Methods A total of 174 hemodialysis patients who underwent regular dialysis in Zhejiang Chinese Medical University Affiliated Jiaxing TCM Hospital from July to September 2024 were selected as study subjects.According to the presence or absence of uremic pruritus(UP),they were divided into pruritus group(n=66)and non-pruritus group(n=108).Both groups of patients were classified into TCM syndromes,and the factors affecting skin pruritus in MHD patients were analyzed by Logistic regression analysis and an evaluation model was established.The evaluation efficiency of the model was evaluated by receiver operating characteristic curve.The relationship between TCM syndromes and pruritus degree was analyzed.Results Both groups of patients were mainly characterized by spleen and kidney Qi deficiency,and the difference was statistically significant(P<0.05).Logistic regression analysis showed thatβ2 microglobulin(β2-MG),blood phosphorus,hyper-sensitive C-reactive protein and parathyroid hormone(PTH)were all risk factors for skin pruritus in MHD patients.The area under the curve of skin pruritus in MHD patients was 0.962(95%CI:0.930-0.995).The underlying syndrome of UP patients was mainly spleen and kidney Qi deficiency,and marked syndrome was mainly blood deficiency and wind-dryness.Conclusionβ2-MG,blood phosphorus,hyper-sensitive C-reactive protein and PTH are closely related to the occurrence of skin pruritus in MHD patients.The TCM syndrome of UP patients is mainly characterized by spleen and kidney Qi deficiency,and syndrome of blood deficiency and wind-dryness is mainly characterized by UP patients,and there is a certain correlation between TCM syndrome classification and the degree of skin pruritus.
作者
夏苑莺
范小平
方晓娟
张丽艳
张一
XIA Yuanying;FAN Xiaoping;FANG Xiaojuan;ZHANG Liyan;ZHANG Yi(Department of Blood Purification Center,Zhejiang Chinese Medical University Affiliated Jiaxing TCM Hospital,Jiaxing 314001,Zhejiang,China)
出处
《中国现代医生》
2025年第17期20-24,共5页
China Modern Doctor
基金
浙江省中医药科技计划项目(2023ZL174)。
关键词
维持性血液透析
皮肤瘙痒
影响因素
中医证候分型
Maintenance hemodialysis
Skin pruritus
Influencing factors
Traditional Chinese medicine syndrome classification
