【摘要】目的观察硫代硫酸钠(sodium thiosulfate，STS)治疗尿毒症瘙痒的有效性及安全性。方法选取航天中心医院肾脏内科尿毒症瘙痒患者60 名，随机分为观察组和对照组，每组30 例。对照组予口服氯雷他定10mg/日；观察组在对照组基础上加硫代硫酸钠3.2g 透析后静脉推注，3 次/周，观察3 个月。比较2 组患者临床疗效和治疗前后炎症指标变化、改良Duo 氏瘙痒评分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index，PSQI)评分及不良反应发生率。结果观察组临床总有效率(96.70%)明显高于对照组(63.30%)，差异有统计学意义(χ2=10.892，P =0.001)；观察组在治疗前后C-反应蛋白、铁蛋白、白蛋白变化具有统计学意义(t 值分别为15.170，7.330，-9.030；P 值分别为＜0.001,＜0.001，＜0.001)；对照组治疗前后C-反应蛋白、铁蛋白变化无统计学意义(t 值分别为1.170，1.731；P 值分别为0.055，0.086)；观察组治疗后改良Duo 氏瘙痒评分( 组内t=14.480，P＜0.001；组间t= -11.220，P＜0.001)和PSQI 评分(组内t=33.240，P＜0.001；组间t=-14.480，P ＜0.001)明显低于治疗前及对照组，差异有统计学意义；2 组不良反应发生率比较无统计学意义(χ2=0.218，P=0.640)。结论硫代硫酸钠治疗尿毒症瘙痒效果显著，无严重不良反应。
【Abstract】Objective To observe the efficacy and safety of sodium thiosulfate (STS) in the treatment of uremic pruritus. Methods Sixty patients with uremic pruritus were randomly divided into observation group (n=30) and control group (n=30). The control group was given loratadine 10mg orally once daily, and the observation group was given STS 3.2g intravenously three times a week after dialysis in addition to the loratadine treatment in control group. They were observed for 3 months. The changes of inflammatory index, modified Duo's pruritus score, Pittsburgh sleep quality index (PSQI) score and the incidence of adverse reactions were compared before and after the treatment. Results The total clinical effective rate was 96.70% in the observation group, significantly higher than that (63.30%) in the control group (χ2=10.892, P=0.001). The changes of C- reactive protein (t=15.170, P<0.010), ferritin (t=7.330, P<0.010) and albumin (t=- 9.030, P<0.010) before and after treatment were statistically significant in the observation group; however, the changes of C-reactive protein (t=1.170, P=0.055) and ferritin (t=1.731, P=0.086) before and after treatment did not have statistical significances in the control group. Modified Duo score (intra-group: t=14.480, P<0.001; intergroup: t=- 11.220, P<0.001) and PSQI score (intra- group: t=33.240, P< 0.001; inter- group: t=- 14.480, P<0.001) after the treatment were significantly lower than those before the treatment in the observation group and were also lower than those before treatment in the control group. There was no significant difference in
the incidence of adverse reactions between the two groups (χ22=0.218, P=0.640). Conclusions STS combined with anti-allergic therapy is more effective in the treatment of uremic pruritus without serious adverse reactions.
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