中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (11): 813-817,839.doi: 10.3969/j.issn.1671-4091.2022.11.006

• 临床研究 • 上一篇    下一篇

维持性血液透析患者皮肤瘙痒的发生情况及影响因素的多中心临床研究

鲍宏达  王筱霞   张黎明   王应灯   邹建洲   傅 鹏   马 骏   李江涛   王 锋   张 冉   汪年松   蒋更如   

  1. 201036 上海，1上海交通大学附属第六人民医院肾内科
    200025 上海，2上海交通大学医学院附属同仁医院肾内科
    200070 上海，3上海市静安区闸北中心医院肾内科
    200011 上海，4上海六通大学医学院附属第九人民医院肾内科
    200940 上海，5复旦大学附属中山医院吴淞医院肾内科
    200433 上海，6上海市东医院肾内科
    200040 上海，7上海市静安区中心医院肾内科
    200092 上海，8同济大学附属同济医院肾内科
    200235 上海，9上海市第八人民医院肾内科
    200331 上海，10上海天佑医院肾内科
    200092 上海，11上海交通大学附属新华医院肾内科

  • 收稿日期:2022-07-21 修回日期:2022-08-30 出版日期:2022-11-11 发布日期:2022-11-12
  • 通讯作者: 汪年松,蒋更如 E-mail:Email:wangniansong2012@163.com；jianggeng-ru@hotmail.com

A multi-center clinical research on the occurrence and influencing factors of pruritus in maintenance hemodialysis patients

BAO Hong-da, WANG Xiao-xia, ZHANG Li-ming, WANG Ying-deng, ZOU Jian-zhou, FU Peng, MA Jun, LI Jiang-tao, WANG Feng, ZHANG Ran, WANG Nian-song, JIANG Geng-ru   

  1. Department of Nephrology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 201306, China; 2Department of Nephrology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China; 3Department of Nephrology, Zhabei Central Hospital, Jing'an District, Shanghai 200070, China; 4Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China; 5Department of Nephrology, Wusong Hospital, Zhongshan Hospital, Fudan University, Shanghai 200940, China; 6Department of Nephrology, Shanghai East Hospital, Shanghai 200433, China; 7Department of Nephrology, Shanghai Jing'an District Central Hospital, Shanghai 200040, China; 8Department of Nephrology, Shanghai Tongji Hospital, Shanghai 200092, China; 9Department of Nephrology, Shanghai Eighth People's Hospital, Shanghai 200235, China; 10Department of Nephrology, Shanghai Tianyou Hospital, Shanghai 200331, China; 11Department of Nephrology, Xinhua Hospital，Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
  • Received:2022-07-21 Revised:2022-08-30 Online:2022-11-11 Published:2022-11-12
  • Contact: 年松 201306 上海，1上海交通大学附属第六人民医院肾内科； 蒋更如 200092 上海，11上海交通大学附属新华医院肾内科 E-mail:Email:wangniansong2012@163.com；jianggeng-ru@hotmail.com

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摘要： 目的 探讨维持性血液透析患者皮肤瘙痒的发生率和严重程度，并分析可能的影响因素。方法 研究对象为上海交通大学附属第六人民医院等11家医院的肾内科透析患者。通过患者自我报告的视觉模拟量表评估瘙痒的发生。观察指标包括透析方案、并发症、药物使用，以及钙磷代谢相关的实验室检查。结果 收集1540例血液透析患者，其中78.7%有瘙痒症状，中重度瘙痒34.2%，平均瘙痒VAS得分(2.85±2.52)分；Kt/V低(β=-0.562，95%CI：-0.916～-0.207,P=0.002)、使用拟钙剂(β=-1.094，95%CI：-1.462～-0.725,P＜0.001)、血液透析联用血液滤过方案(β=0.604，95%CI：0.119～1.089, P=0.015)、血液透析联用血液滤过及血液灌流透析方案(β=0.967，95% CI：0.453～1.481,P＜0.001)、联用腹膜透析(β=0.989，95% CI：0.078～1.900,P=0.033)、使用骨化三醇(β=0.564，95% CI：0.250～0.877,P＜0.001)、使用外用止痒药物(β=2.740,95% CI：2.052～3.428,P＜0.001)、合并贫血(β=0.575，95%CI：0.245～0.905,P＜0.001)、合并慢性肾病-矿物质和骨骼疾病(β=0.841，95%CI：0.527～1.155，P＜0.001)、高钙磷乘积(β=1.898,95% CI：0.645～3.152,P=0.003)者瘙痒发生风险高。 结论 维持性血液透析患者中皮肤瘙痒的发生比例高，主要与钙磷代谢的异常有关。

关键词: 血液透析, 瘙痒, 钙磷代谢

Abstract: Objective To investigate the incidence, severity and risk factors of pruritus in maintenance hemodialysis (MHD) patients.  Methods  The MHD patients in the nephrology departments of eleven hospitals were enrolled in this study. Patient self-reported pruritus was assessed by the Visual Analog Scale (VAS). The observed indicators included current dialysis scheme, dialysis age, complications, medications, and laboratory tests relating to calcium and phosphorus metabolism.  Results  A total of 1,540 patients were investigated, with 78.7% reporting pruritus, of which 34.2% had moderate to severe pruritus; the overall mean pruritus VAS score was 2.85±2.52. Lower Kt/V (β=-0.562, 95% CI:-0.916～-0.207, P=0.002), use of calcimimetics (β=-1.094, 95% CI: -1.462～-0.725, P＜0.001), HD+HDF protocol (β=0.604, 95% CI:0.119～1.089, P=0.015), HD+HDF+HP protocol (β=0.967, 95% CI:0.453～1.481, P＜0.001), hemodialysis combined with peritoneal dialysis (β=0.989, 95% CI:0.078～1.900, P=0.033), use of calcitriol (β=0.564, 95% CI:0.250～0.877, P＜0.001), use of topical antipruritics (β=2.740, 95% CI:2.052～3.428, P＜0.001), anemia (β=0.575, 95% CI:0.245～0.905, P＜0.001), chronic kidney disease-mineral and bone disease (β=0.841, 95% CI:0.527～1.155, P＜0.001), and higher calcium-phosphorus product (β=1.898, 95% CI:0.645～3.152, P=0.003) were associated with higher risk of pruritus.  Conclusion The higher prevalence of pruritus in MHD patients is mainly associated with the abnormalities of calcium and phosphorus metabolism.

Key words: Hemodialysis, Pruritus, Calcium and phosphorus metabolism

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