维持性腹膜透析患者皮肤瘙痒的发生情况和影响因素分析

何玉婷; 门春翠; 牛庆雨; 芦丽霞; 乔婕; 邵琳; 武向兰; 赵慧萍; 武蓓; 左力; 王梅

doi:10.3969/j.issn.1671-4091.2019.09.019

中国血液净化 >

2019 , Vol. 18 >Issue 09: 653 - 657

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.09.019

护理研究

维持性腹膜透析患者皮肤瘙痒的发生情况和影响因素分析

何玉婷 ,
门春翠 ,
牛庆雨 ,
芦丽霞 ,
乔婕 ,
邵琳 ,
武向兰 ,
赵慧萍 ,
武蓓 ,
左力 ,
王梅

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1. 北京大学人民医院肾内科
2. 北京清华长庚医院

收稿日期: 2019-01-02

修回日期: 2019-05-06

网络出版日期: 2019-09-02

基金资助

教育部留学回国启动基金(jwsl451)；人力资源和社会保障部留学人员科技活动项目择优资助基金(无编号)

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Study on the occurrence and influencing factors of pruritus in patients with maintenance peritoneal dialysis#br#

HE Yu-Ting ,
MEN Chun-Cui ,
NIU Qing-Yu ,
LU Li-Xia ,
QIAO Jie ,
SHAO Lin ,
WU Xiang-Lan ,
ZHAO Hui-Ping ,
WU Bei ,
ZUO Li ,
WANG Mei

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Received date: 2019-01-02

Revised date: 2019-05-06

Online published: 2019-09-02

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摘要

【摘要】目的探讨腹膜透析(peritoneal dialysis，PD)患者瘙痒的发生情况及影响因素。方法根据改良DUO 评分方法对北京大学人民医院肾内科规律随访的PD 患者进行瘙痒问卷调查及瘙痒评分。收集患者临床资料、钙磷代谢指标、血镁、透析充分性等。分别应用Logistic 回归、多元线性回归分析瘙痒及瘙痒严重程度的影响因素。结果①123 例PD 患者入选，其中男性53 例(43.1%),年龄(60.15±12.46)岁，透析龄(37.14±27.79)月，主要原发病为糖尿病肾病，占35.8%。②82 例PD 患者存在皮肤瘙痒，发生率66.7%。Logistic 回归分析显示，皮肤干燥(OR=4.956，95% CI;2.364～10.388,P＜0.001)、血清C 反应蛋白高(OR=1.251，95% CI;1.075～1.456,P=0.005)、血磷高(OR=5.029，95% CI;1.030～24.560,P=0.046)、血镁高(OR=3.533，95% CI;0.390~ 6.124, P=0.023)是PD 患者发生皮肤瘙痒的独立危险因素。③在82 名皮肤瘙痒患者中，轻度瘙痒40.2%、中度瘙痒46.3%,重度瘙痒13.4%。多元线性回归分析显示，皮肤干燥(β=0.674，P＜0.001)、血磷(β=0.631，P=0.004)、血iPTH 水平(β=0.001，P=0.04)是PD 患者皮肤瘙痒严重程度的独立危险因素。结论皮肤瘙痒在PD 患者中发生率较高。皮肤干燥、C反应蛋白高、血镁及血磷高的PD 患者更易发生皮肤瘙痒。皮肤干燥程度高、血磷高、iPTH 高的PD 患者瘙痒程度更严重。应针对这些患者加强皮肤瘙痒的预防及治疗。

关键词： 腹膜透析; 瘙痒; 高磷血症; 高镁血症; C 反应蛋白

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何玉婷 , 门春翠 , 牛庆雨 , 芦丽霞 , 乔婕 , 邵琳 , 武向兰 , 赵慧萍 , 武蓓 , 左力 , 王梅 . 维持性腹膜透析患者皮肤瘙痒的发生情况和影响因素分析[J]. 中国血液净化, 2019 , 18(09) : 653 -657 . DOI: 10.3969/j.issn.1671-4091.2019.09.019

Abstract

【Abstract】Objectives To investigate the incidence of pruritus and its influencing factors in patients with peritoneal dialysis (PD). Methods According to the improved DUO scoring method, the pruritus questionnaire survey was conducted among PD patients who were regularly followed up in the PD Center of Peking University People's Hospital. Clinical data and laboratory results were collected. Logistic regression was used to analyze the influencing factors for pruritus, and multivariate linear regression was used to analyze the influencing factors for the severity of pruritus. Results ①A total of 123 PD patients were enrolled in this study, including 53 males (43.1%) with an average age of 60.15±12.46 years and a dialysis duration of 37.14±27.79 months. The main primary disease was diabetic nephropathy (35.8%). ②Eight-two PD patients had skin pruritus,

with an incidence of 66.7% . Logistic regression analysis showed that dry skin (OR=4.956, 95% CI 2.364～10.388, P<0.001), high serum CRP (OR=1.251, 95% CI 1.075～1.456, P=0.005), high serum phosphorus (OR=5.029, 95% CI 1.030～24.560, P=0.046) and high serum magnesium (OR=3.533, 95% CI 0.390～6.124, P=0.023) were the independent risk factors for pruritus in PD patients. ③Of the 82 patients with pruritus, 40.2% had mild pruritus, 46.3% had moderate pruritus, and 13.4% had severe pruritus. Multivariate linear regression analysis showed that dry skin (β =0.674, P＜0.001), serum phosphorus (β =0.631, P=0.004) and serum iPTH level (β=0.001, P=0.040) were the independent risk factors for the severity of pruritus in PD patients. Conclusions The incidence of skin pruritus is higher in PD patients. PD patients with dry skin, higher serum levels of CRP, magnesium and phosphorus are more likely to suffer from pruritus. PD patients with dry skin, higher serum levels of phosphorus and iPTH had more severe pruritus.

Key words： Peritoneal dialysis; Pruritus; Hyperphosphatemia; Hypermagnesemia; C-reactive protein

参考文献

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