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
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 （1
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）
