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目的比较腹膜透析及不同血液透析方式对改善尿毒症皮肤瘙痒的疗效。方法将尿毒症皮肤瘙痒患者根据透析方法的不同分为3组,包括血液透析组(HD组)22例,血液透析滤过组(HDF组)18例及持续性非卧床腹膜透析(CAPD)组(PD组)16例。记录3组治疗前和治疗16周后皮肤瘙痒评分及血尿素氮(BUN)、肌酐(SCr)、β2微球蛋白(β2-MG)、钙(Ca)、磷(P)及全段甲状旁腺素(i PTH)水平。结果 PD组、HDF组总有效率明显高于HD组,差异均有统计学意义(P<0.05);PD组总有效率高于HDF组,但无显著差异(P>0.05)。治疗前3组BUN、SCr、Ca、P、β2-MG和i PTH均无显著差异(P>0.05)。16周后,HD组和HDF组BUN、SCr明显低于PD组(P<0.05);HDF组和PD组P显著低于HD组(P<0.05);HD组β2-MG明显高于治疗前,HDF组和PD组β2-MG、i PTH均明显低于同组治疗前,且均明显低于HD组(P<0.05);PD组β2-MG及i PTH比HDF组低,但无显著差异(P>0.05)。结论HDF与CAPD均能有效缓解尿毒症患者瘙痒症状,同时有效清除体内i PTH、β2-MG,提升患者生活质量,值得临床推广。至于CAPD是否比HDF更具有优势,尚有待更大样本量、更长随访时间的临床研究来明确。
Objective To compare the effects of peritoneal dialysis and different hemodialysis on the pruritus of uremic skin. Methods According to the method of dialysis, patients with uremic pruritus were divided into 3 groups: hemodialysis group (HD group), hemodialysis group (HDF group), 18 cases and continuous ambulatory peritoneal dialysis group (PD group) in 16 cases. The pruritus scores and the levels of blood urea nitrogen (BUN), creatinine (SCr), β2 microglobulin (β2-MG), calcium (Ca), phosphorus Adiponectin (i PTH) levels. Results The total effective rate of PD group and HDF group was significantly higher than that of HD group (P <0.05). The total effective rate of PD group was higher than that of HDF group, but no significant difference (P> 0.05). There were no significant differences in BUN, SCr, Ca, P, β2-MG and i PTH before treatment (P> 0.05). After 16 weeks, BUN and SCr in HD group and HDF group were significantly lower than those in PD group (P <0.05); P in HDF group and PD group was significantly lower than HD group (P <0.05); β2-MG in HD group was significantly higher than that in HD group , Β2-MG and i PTH in HDF group and PD group were significantly lower than those in HD group and HD group (P <0.05), while β2-MG and i PTH in PD group were lower than those in HDF group Difference (P> 0.05). Conclusions Both HDF and CAPD can effectively relieve pruritus symptoms in patients with uremia, and effectively remove i PTH and β2-MG in vivo to improve the quality of life of patients, which deserves clinical promotion. Whether CAPD is more advantageous than HDF remains to be seen in larger studies and clinical studies of longer follow-up periods.