[血液透析患者瘙痒的临床特征]

Mesić Enisa, Tabaković Mithat, Habul Vildana, Atić Mirza, Lekić Slobodan, Resić Halima, Halilbasić Alma, Trnacević Senaid, Halilbasić Ahmet

Klinika za nefrologiju, urologiju, dijalizu i transplantaciju, Univerzitetski klinicki centar Tuzla, Tuzla, Bosna i Hercegovina.

Acta Med Croatica. 2004;58(5):377-80.

AIM

Aim of the research was to analyze clinical characteristics and most important risk factors of uremic pruritus.

PATIENTS AND METHODS

A total of 151 patients on chronic hemodialysis (CHD) during at least 12 months were analyzed. Thorough history was taken for pruritus, its presence and localization, sleep disorder and neuropathic symptoms. On physical examination, attention was focused on the skin. Laboratory tests includes blood cells count, serum urea, creatinine, electrolytes, aminotransferases, alkaline phosphatase and proteins. The dose of dialysis was followed by Kt/V. On statistical analysis, t-test and chi2 test were used.

RESULTS

Pruritus was present in 85 (56%) patients, 41 women and 44 men, mean age 53.56+/-13.36 (26-81) years, mean time on CHD 78.36+/-55.02 (12-268) months. There were 66 (44%) patients without pruritus, 32 women and 34 men, mean age 50.35+/-13.76 (22-73) years, on CHD for 58.64+/-50.40 (12-187) months. Although the patients with pruritus were somewhat older and longer on CHD, there was no significant difference either in sex structure or distribution according to primary renal disease. In the group with pruritus there were significantly more anuric patients (43 vs. 22) (p<0.01). The patients with pruritus had a higher rate of sleep disorder (NS), calcium deposits in soft tissues and blood vessels (NS) and clinical neuropathy (p<0.01). Skin changes were found in almost all patients with pruritus (93%), which differed significantly from the patients without pruritus (48%) (p<0.005). The mean value of Kt/V was 1.23+/-0.35 in patients with pruritus, and 1.34+/-0.41 in those without pruritus (NS). Kt/V higher than 1.4 was significantly less frequently recorded in patients with pruritus than in those without pruritus (55%) (p<0.005). The red cell and white cells count, serum hemoglobin, calcium, phosphorus and their products, aminotransferases, bilirubin, alkaline phosphatase and proteins were approximately the same in both groups of patients.

CONCLUSION

The loss of residual renal diuresis, Kt/V below 1.4, presence of calcium deposits and neuropathy were the most common risk factors for the extent of uremic pruritus in our CHD patients.

目的

本研究旨在分析尿毒症瘙痒的临床特征和最重要的危险因素。

患者与方法

对至少接受12个月慢性血液透析（CHD）的151例患者进行分析。详细询问瘙痒病史，包括瘙痒的存在情况、部位、睡眠障碍和神经病变症状。体格检查时，重点关注皮肤。实验室检查包括血细胞计数、血清尿素、肌酐、电解质、转氨酶、碱性磷酸酶和蛋白质。透析剂量采用Kt/V评估。统计分析采用t检验和卡方检验。

结果

85例（56%）患者出现瘙痒，其中女性41例，男性44例，平均年龄53.56±13.36（26 - 81）岁，平均CHD时间78.36±55.02（12 - 268）个月。66例（44%）患者无瘙痒，其中女性32例，男性34例，平均年龄50.35±13.76（22 - 73）岁，CHD时间58.64±50.40（12 - 187）个月。虽然有瘙痒的患者年龄稍大且CHD时间更长，但在性别结构或原发性肾脏疾病分布方面无显著差异。有瘙痒的患者中无尿患者明显更多（43例 vs. 22例）（p<0.01）。有瘙痒的患者睡眠障碍发生率更高（无统计学差异）、软组织和血管中有钙沉积（无统计学差异）以及临床神经病变发生率更高（p<0.01）。几乎所有有瘙痒的患者（93%）都有皮肤改变，这与无瘙痒的患者（48%）有显著差异（p<0.005）。有瘙痒的患者Kt/V平均值为1.23±0.35，无瘙痒的患者为1.34±0.41（无统计学差异）。Kt/V高于1.4的有瘙痒患者记录频率显著低于无瘙痒患者（55%）（p<0.005）。两组患者的红细胞和白细胞计数、血清血红蛋白、钙、磷及其乘积、转氨酶、胆红素、碱性磷酸酶和蛋白质大致相同。