Robertson K E, Mueller B A
Ribordy Center for Community Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, USA.
Am J Health Syst Pharm. 1996 Sep 15;53(18):2159-70; quiz 2215-6. doi: 10.1093/ajhp/53.18.2159.
Uremic pruritus and its treatment are reviewed. Pruritus affects 50-90% of patients undergoing peritoneal dialysis or hemodialysis; symptoms usually begin about six months after the start of dialysis and range from localized and mild to generalized and severe. The mechanism underlying uremic pruritus is poorly understood; possibilities include secondary hyperparathyroidism and divalent-ion abnormalities; histamine, allergic sensitization, and proliferation of skin mast cells; hypervitaminosis A; iron-deficiency anemia; neuropathy and neurologic changes; or some combination of these. The cornerstone of therapy for uremic pruritus is regular, intensive, efficient dialysis. Other nonpharmacologic measures consist of the use of non-complement-activating dialysis membranes, compliance with dietary restrictions, electric-needle (acupuncture) therapy, and ultraviolet light therapy. Pharmacologic treatments that have been used include activated charcoal, antihistamines, capsaicin, cholestyramine, emollients and topical corticosteroids, epoetin, pizotyline, ketotifen, and nicergoline. Treatment results have been highly variable, and many of the clinical trials have been flawed. Phosphate-binding agents appear to be the most effective. Although enough is known to determine a reasonable set of steps in approaching a patient's uremic pruritus, more research is needed to understand the pathophysiology of this condition and to establish more reliable treatments. Pruritus is a common and sometimes severe complication of chronic renal failure. Efficient dialysis, dietary restrictions, phosphate-binding therapy, and phototherapy are the most effective treatments currently available.
本文综述了尿毒症瘙痒及其治疗方法。瘙痒影响50%-90%的腹膜透析或血液透析患者；症状通常在透析开始约六个月后出现，范围从局部轻度到全身重度。尿毒症瘙痒的潜在机制尚不清楚；可能的原因包括继发性甲状旁腺功能亢进和二价离子异常；组胺、过敏致敏和皮肤肥大细胞增殖；维生素A过多症；缺铁性贫血；神经病变和神经变化；或这些因素的某种组合。尿毒症瘙痒治疗的基石是规律、强化、有效的透析。其他非药物措施包括使用非补体激活透析膜、遵守饮食限制、电针（针灸）治疗和紫外线治疗。已使用的药物治疗包括活性炭、抗组胺药、辣椒素、考来烯胺、润肤剂和外用皮质类固醇、促红细胞生成素、苯噻啶、酮替芬和尼麦角林。治疗结果差异很大，许多临床试验存在缺陷。磷结合剂似乎是最有效的。虽然已经有足够的知识来确定治疗患者尿毒症瘙痒的合理步骤，但仍需要更多的研究来了解这种疾病的病理生理学并建立更可靠的治疗方法。瘙痒是慢性肾衰竭常见且有时严重的并发症。有效的透析、饮食限制、磷结合治疗和光疗是目前最有效的治疗方法。
