目的 比较三醋酸纤维膜(cellulose triacetate,CTA)与聚砜膜(polysulfone,PS)透析器联合硫代硫酸钠(sodium thiosulfate,STS)对维持性血液透析(maintenance hemodialysis,MHD)患者皮肤瘙痒症状的治疗疗效。 方法 选取2022年6月—2023年6月在中国医科大学附属盛京医院第二血液净化中心接受血液净化治疗且瘙痒视觉模拟评分(visual analogue scale,VAS)≥7分的患者60例，依据随机数字法分为PS+STS组(n=30)、CTA+STS组(n=30)。干预6个月后，比较2组患者血清钙(Ca)、血磷(P)、全段甲状旁腺激素(iPTH)、补体C3、免疫球蛋白E(IgE)、β2微球蛋白(beta-2 microglobulin,β2-MG)、瘙痒程度、睡眠质量、微炎症指标[超敏C反应蛋白(hs-CRP)、白细胞介素-1β(interleukin-1beta,IL-1β)、肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α)]、氧化应激指标[过氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)、血清谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)]、总有效率和不良反应等。 结果 与PS+STS组相比，CTA+STS组患者血清P、C3、IgE，VAS评分和匹斯堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分，以及hs-CRP和IL-1β均下降(t值分别为3.045、2.746、3.327、2.088、2.154、2.772、2.546,P值分别为0.004、0.008、0.002、0.041、0.035、0.008、0.014)；SOD、MDA和GSH-Px均改善(t值分别为2.065、2.121、2.091,P值分别为0.043、0.038、0.041)，总有效率提高(Z =7.690,P =0.021)。 结论 与PS联合STS相比，CTA联合STS可以有效降低MHD伴瘙痒患者的血清P、C3及IgE，改善微炎症状态及氧化应激失衡，缓解皮肤瘙痒症状。
To compare the clinical therapeutic efficacy of cellulose triacetate (CTA) and polysulfone (PS) dialyzers in combination with sodium thiosulfate (STS) in alleviating skin pruritus symptoms among patients undergoing maintenance hemodialysis (MHD). Methods A total of 60 patients who received blood purification treatment and had a pruritus visual analogue scale (VAS) score ≥7 in the Second Blood Purification Center of Shengjing Hospital of China Medical University from June 2022 to June 2023 were enrolled. Based on random number allocation, patients were divided into the PS+STS group and the CTA+STS group, with 30 patients in each group. After 6 months of intervention, differences between the two groups were compared in terms of serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), complement C3, immunoglobulin E (IgE), beta-2 microglobulin (β2-MG), pruritus severity, sleep quality, micro-inflammatory markers (including high-sensitivity C-reactive protein (Hs-CRP), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α)), oxidative stress markers (including superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GSH-Px)), overall effective rate, and adverse reactions. Results Compared to the PS+STS group, patients in the CTA+STS group exhibited significant reduction in serum P, C3, IgE, VAS scores for pruritus, Pittsburgh Sleep Quality Index (PSQI) scores, and micro-inflammatory markers (Hs-CRP and IL-1β) (P: t=3.045, P=0.004; C3: t=2.746, P=0.008; IgE: t=3.327, P=0.002; VAS: t=2.088, P=0.041; PSQI: t=2.154, P=0.035; Hs-CRP: t=2.772, P=0.008; IL-1β: t=2.546, P=0.014). Additionally, oxidative stress markers (SOD, MDA and GSH-Px) improved significantly (SOD: t=2.065, P=0.043; MDA: t=2.121, P=0.038; GSH-Px: t=2.091, P=0.041), and the overall effective rate was significantly higher (Z=7.690, P=0.021). Conclusion Compared to PS combined with STS, CTA combined with STS can effectively reduce serum P, C3, and IgE levels in MHD patients with pruritus, improve micro-inflammatory status and oxidative stress imbalance, thereby significantly alleviating skin pruritus symptoms and ultimately enhancing patients' quality of life.
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