目的 观察和比较不同硫代硫酸钠剂量在维持性血液透析患者皮肤瘙痒治疗中的临床疗效和安全性。 方法 纳入2020年1月—2022年12月上海市13家综合性医院的维持性血液透析伴有皮肤瘙痒的患者，按随机数字表法分为3组：组1给予1.92 g的硫代硫酸钠，组2给予3.20 g的硫代硫酸钠，组3给予4.48 g的硫代硫酸钠治疗。3组治疗时间均为8周，观察和比较不同硫代硫酸钠剂量在维持性血液透析患者皮肤瘙痒治疗中的临床疗效和安全性，包括瘙痒评分、生化指标、治疗效果和不良反应等。 结果 共纳入226例患者。治疗8周后，组1(n=72)、2(n=79)、3(n=75)的患者5D瘙痒评分分别从(18.6±1.91)、(19.0±2.80)、(19.6±3.64)分降至(12.8±3.03)、(11.3±3.40)、(10.9±3.75)分。治疗8周后与治疗前5D瘙痒评分的差值，3组间差异有统计学意义(F=2.735，P=0.046)，两两比较显示组3的5D瘙痒评分下降幅度大于组1(差值为-1.352，95% CI:-2.645～-0.060，P=0.041)。观察期内，所有患者未出现过敏、皮疹及血压下降等不良反应。多因素分析结果显示：与组1相比，组3的5D瘙痒评分斜率β=     -1.650(95% CI：-3.046～-0.253，P=0.021)。 结论 硫代硫酸钠治疗可明显缓解血液透析患者皮肤瘙痒症状。随剂量增加，效果加强，无明显不良反应，安全有效。

Objective To observe and compare the efficacy and safety of different doses of sodium thiosulfate for the treatment of pruritus in maintenance hemodialysis (MHD) patients.  Methods  A total of 126 MHD patients with pruritus from 11 general hospitals in Shanghai during January 2020 to December 2022 were included in this study. They were randomly divided into three groups. The dose of sodium thiosulfate was 1.92g in group 1, 3.20g in group 2, and 4.48g in group 3. The treatment period lasted 8 weeks. Clinical effects and safety including pruritus score, biochemical indicators and adverse reactions were observed and compared between the groups.  Results Compared with the pruritus scores 5 days before the treatment and 8 weeks after the treatment, the decreases of pruritus score were 18.6±1.91 to 12.8±3.03, 19.0±2.80 to 11.3±3.40 and 19.6±3.64 to 10.9±3.75 in group 1 (n=72), 2 (n=79) and 3 (n=75) respectively; the extent of decrease were statistically significant among the 3 groups (F=2.735, P=0.046), and the extent of score decrease was greater in group 3 than in group 1 (score difference=-1.352, 95% CI: -2.645～-0.060, P=0.041). No adverse reactions such as allergic reactions, rash and hypotension were found during the observation period. Multivariate analysis showed that compared with group 1 the slope of pruritus score 5 days before the treatment and 8 weeks after the treatment in group 3 showed β= -1.650 (95% CI: -3.046～-0.253, P=0.021).  Conclusion  Sodium thiosulfate can effectively relieve the pruritus symptoms in MHD patients, and the effect is enhanced with increase of the dose. No obvious adverse reactions were found. This treatment is therefore safe and effective.