Hiroshige K, Kabashima N, Takasugi M, Kuroiwa A
Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan.
Am J Kidney Dis. 1995 Mar;25(3):413-9. doi: 10.1016/0272-6386(95)90102-7.
The authors analyzed data on 59 hemodialyzed patients who did not have significant disorders of calcium and phosphate metabolism and found that more than 60% suffered from disabling pruritus possibly related to chronic uremia. Both biochemical correlates of the prevalence of pruritus and dialysis efficacy calculated by urea kinetics were investigated. Significantly higher values of blood urea nitrogen and plasma beta 2-microglobulin just before the dialysis session were observed in pruritic patients with lower dialysis efficacy estimated by Kt/V urea and normalized protein catabolic rate (nPCR). After 3 months without changing the dialysis prescriptions, 16 patients with a mean Kt/V urea and a normalized protein catabolic rate (nPCR) of 1.28 and 1.22 g/kg/d, respectively, experienced significant reductions in the degree of pruritus estimated by the pruritic score, from 12.6 +/- 5.1 to 6.3 +/- 3.2. Twenty-two patients with a mean Kt/V urea and an nPCR of 1.09 and 1.01, respectively, continued to have severe pruritus (score: 12.3 +/- 4.7 to 12.7 +/- 6.4). In 9 of 22 patients with prolonged severe pruritus, dialysis efficacy was heightened with an increase in dialyzer membrane area of more than 0.3 m2. Seven of nine patients with increased dialysis prescriptions had significant reductions of the mean pruritic score, from 12.6 +/- 4.8 to 6.3 +/- 2.4, which inversely related to the significant increase of Kt/V urea from 1.05 +/- 0.25 to 1.24 +/- 0.33; among patients whose dialysis prescriptions were not changed, only one had a significant reduction in score. The authors concluded that higher dialysis efficacy with good nutritional state reduces the prevalence and degree of pruritus in hemodialyzed patients.
作者分析了59例无明显钙磷代谢紊乱的血液透析患者的数据，发现超过60%的患者患有可能与慢性尿毒症相关的致残性瘙痒症。研究了瘙痒症患病率的生化相关因素以及通过尿素动力学计算的透析疗效。在透析疗程前，通过尿素Kt/V和标准化蛋白分解代谢率（nPCR）评估透析疗效较低的瘙痒患者中，观察到血尿素氮和血浆β2-微球蛋白的值显著更高。在不改变透析处方3个月后，16例平均尿素Kt/V和标准化蛋白分解代谢率（nPCR）分别为1.28和1.22 g/kg/d的患者，瘙痒评分估计的瘙痒程度显著降低，从12.6±5.1降至6.3±3.2。22例平均尿素Kt/V和nPCR分别为1.09和1.01的患者继续有严重瘙痒（评分：12.3±4.7至12.7±6.4）。在22例长期严重瘙痒患者中的9例中，通过增加超过0.3 m2的透析器膜面积提高了透析疗效。9例透析处方增加的患者中有7例平均瘙痒评分显著降低，从12.6±4.8降至6.3±2.4，这与尿素Kt/V从1.05±0.25显著增加到1.24±0.33呈负相关；在透析处方未改变的患者中，只有1例评分显著降低。作者得出结论，具有良好营养状态的更高透析疗效可降低血液透析患者瘙痒症的患病率和程度。
