中华皮肤科杂志 ›› 2008, Vol. 41 ›› Issue (1): 32-35.

• 论著 • 上一篇    下一篇

维持性血液透析终末期肾病患者皮肤病变调查分析

王世相1,李寒1,何焱玲2,等3   

  1. 1. 北京 首都医科大学北京朝阳医院血液净化中心
    2. 北京市朝阳区首都医科大学北京朝阳医院皮肤科
    3. 湖北省中山医院整形美容外科
  • 收稿日期:2007-07-17 修回日期:2007-09-04 发布日期:2008-01-31
  • 通讯作者: 王世相 E-mail:wxy1988@263.net

  • Received:2007-07-17 Revised:2007-09-04 Published:2008-01-31

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摘要： 目的　调查进行维持性血液透析（maintenance hemodialysis, MHD）的终末期肾脏病患者皮肤病变的发病情况和病变特点，探讨其危险因素。方法　对181例MHD的终末期肾病患者进行皮肤体检；收集其临床和生化资料，分析皮肤病变的患病率，病变类型及其危险因素。结果　 ①181例患者中161例（88.95％）存在不同种类的皮肤病变，其中38例（23.60％）存在1种皮肤病变，52例（32.30％）有2种，40例（24.84％）有3种、26例（16.15％）有4种、5例（3.11％）有5种。②最常见是皮肤干燥（128/181， 77.72％），其次是瘙痒（101/181，55.80％）、脱屑（73/181，40.33％）和色素沉着（70/181，38.67％）。其他有皮肤苍白（6/181，3.31％）、瘀斑（4/181，2.21％）、指（趾）干性坏疽（3/181，1.66％）、足部溃疡（2/181，1.10％）、甲纵裂（1/181，0.55％）。③皮肤病变组患者的透析龄、超滤量、血磷、钙磷乘积、甲状旁腺激素、超敏C-反应蛋白（Hs-CRP）水平，乙肝、丙肝病毒标志物阳性率明显高于无皮肤病变组；而血红蛋白、血清尿素清除指数（Kt/V）明显低于无皮肤病变组。④Logistic回归分析结果显示，透析龄、KT/V、血钙磷乘积、血甲状旁腺激素、高敏C反应蛋白（Hs-CRP）和丙肝病毒标志物阳性是MHD患者发生皮肤病变的独立危险因素。结论MHD的终末期肾病患者皮肤病变的患病率高，以皮肤干燥症和皮肤瘙痒最常见。透析龄、KT/V、血钙磷乘积、血甲状旁腺激素、Hs-CRP和丙肝病毒标志物阳性是MHD终末期肾病患者发生皮肤病变的独立危险因素。

关键词: 肾功能衰竭，慢性, 皮肤表现, 肾透析

Abstract: Objective To investigate the prevalence and risk factors of skin abnormality in patients with chronic renal failure （CRF） on maintenance hemodialysis. Methods One hundred and eighty-one patients with CRF on maintenance hemodialysis were examined for skin abnormality. The following data were collected from patients: age, gender, ultrafiltration volume, urea clearing index （Kt/V）, blood pressure, levels of hemoglobin, serum albumin, lipid, calcium phosphorus product and parathyroid hormone, etc. Results Skin abnormalities were observed in 88.95% of these patients. Among them, 23.60% had one kind of abnormality, 32.30% had two, 24.84% had three, 16.15% had four, and 3.11% had five. The most common manifestation was xerosis （77.72％, 128/181）, followed by pruritus （55.80％, 101/181）, epidermal desquamation （40.33％, 73/181） and cutaneous pigmentation （38.67％, 70/181）. Other cutaneous disorders included skin pallor （3.31％, 6/181）, ecchymosis （2.21％, 4/181）, mummification necrosis of digits（1.10%, 2/181）, foot ulcer （1.66％, 3/181）, onychorrhexis （0.55％, 1/181,）. The levels of dialysis duration, ultrafiltration volume, serum phosphonium, calcium phosphonium product, serum parathyroid hormone, high sensitivity C-reactive protein, positivity rate of hepatitis B virus and hepatitis C virus markers were significantly higher in the hemodialysis patients with skin abnormalities than in those without, while the levels of hemoglobin and Kt/V were significantly lower in the hemodialysis patients with skin abnormalities than in those without. As shown by logistic regressive analysis, the levels of dialysis duration, Kt/V, serum calcium phorsphorum product, serum parathyroid hormone, high sensitivity C-reactive protein, and the presence of hepatitis C virus were the independent risk factors for the occurrence of skin abnormalities in hemodialysis patients. Conclusions There is a high prevalence of skin abnormality in patients with CRF on maintenance hemodialysis, and, xerosis and pruritus are the most common skin abnormalities.