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中性大孔树脂血液灌流治疗血液透析患者顽固性尿毒症瘙痒的疗效

Curative effect of neutral macroporous resin hemoperfusion on treating hemodialysis patients with refractory uremic pruritus.

作者信息

Li Wen-Hong, Yin Yu-Min, Chen Hao, Wang Xiao-Dan, Yun He, Li Hui, Luo Jie, Wang Jin-Wen

机构信息

Department of Kidney Disease, Yan'an Hospital Affiliated to Kunming Medical University, Nephrology, Kunming, China.

出版信息

Medicine (Baltimore). 2017 Mar;96(12):e6160. doi: 10.1097/MD.0000000000006160.

Abstract

This study aims to investigate the efficacy and safety of neutral macroporous resin hemoperfusion in treating maintenance hemodialysis (MHD) patients with refractory uremic pruritus (RUP).Ninety patients were enrolled and were randomly divided into 3 groups: control group, experiment 1 group, and experiment 2 group. Clinical symptom scores of skin itching were recorded before and at 4 and 8 weeks after the treatment. In addition, serum parathyroid hormone (PTH), calcium (Ca), phosphorus (P), and C-reactive protein (CRP) were detected; and the calcium-phosphorus product ([Ca] × [P]) was calculated to compare the curative effect.VSA score, modified Duo pruritus score, and CRP: these indices decreased to some extent at 4 and 8 weeks after treatment in the 2 experiment groups, compared with pretreatment (P < 0.05); and differences among these 3 groups were statistically significant (P < 0.05). PTH, P, and [Ca] × [P]: these indices decreased to some extent at 4 and 8 weeks after treatment in the 2 experiment groups, compared with pretreatment (P < 0.05); and differences between the control and experiment 1 groups, as well as between the control and experiment 2 groups, were statistically significant (P < 0.05). However, the difference between the experiment 1 and experiment 2 groups were not statistically significant (P < 0.05).The effects of HA330 and HA130 resin hemoperfusion apparatus on secondary hyperparathyroidism and the disorder of calcium and phosphorus metabolism are similar. The mechanism may be related to its strong adsorption effect, and its capacity to widely remove inflammatory mediators, immune mediators, and endotoxins.

摘要

本研究旨在探讨中性大孔树脂血液灌流治疗维持性血液透析(MHD)患者顽固性尿毒症瘙痒(RUP)的疗效及安全性。纳入90例患者并随机分为3组:对照组、实验1组和实验2组。记录治疗前及治疗后4周和8周时皮肤瘙痒的临床症状评分。此外,检测血清甲状旁腺激素(PTH)、钙(Ca)、磷(P)和C反应蛋白(CRP);计算钙磷乘积([Ca]×[P])以比较疗效。视觉模拟评分(VSA)、改良杜氏瘙痒评分和CRP:与治疗前相比,2个实验组在治疗后4周和8周时这些指标均有一定程度下降(P<0.05);3组间差异有统计学意义(P<0.05)。PTH、P和[Ca]×[P]:与治疗前相比,2个实验组在治疗后4周和8周时这些指标均有一定程度下降(P<0.05);对照组与实验1组之间以及对照组与实验2组之间的差异有统计学意义(P<0.05)。然而,实验1组与实验2组之间的差异无统计学意义(P>0.05)。HA330和HA130树脂血液灌流装置对继发性甲状旁腺功能亢进及钙磷代谢紊乱的作用相似。其机制可能与其强大的吸附作用以及广泛清除炎症介质、免疫介质和内毒素的能力有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5ded/5371439/8350831b575d/medi-96-e6160-g001.jpg

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