标题：祛风固肾汤对血液透析皮肤瘙痒患者钙磷代谢、血清 IL-31、CRP水平的影响

      作者：李文丽 1，杨雪梅 1，闫建锋 2    1.安康市中医医院高新分院肾病—血液净化中心，陕西 安康 725000；2.安康市中医医院肾病—血液净化中心，陕西 安康 725000

      卷次： 2023年34卷12期

      【摘要】 目的 探讨祛风固肾汤对血液透析皮肤瘙痒患者钙磷代谢、血清白细胞介素-31 (IL-31)、C反应蛋白(CRP)水平的影响。方法 选择 2019年 4月至 2022年4月安康市中医医院高新分院肾病—血液净化中心收治的100例血液透析皮肤瘙痒患者纳入研究，采用随机数表法将患者分为观察组和对照组各50例。对照组患者给予常规药物治疗，观察组患者在此基础上联合祛风固肾汤治疗，均治疗28 d。比较两组患者治疗前后的皮肤瘙痒情况、钙磷代谢[血钙(Ca)、血磷(P)、甲状旁腺素(iPTH)]和炎症因子[IL-31、CRP、肿瘤坏死因子-α (TNF-α)]水平，并统计其不良反应发生情况。结果 治疗后，两组患者的瘙痒程度、瘙痒频率、瘙痒部位评分均降低，且观察组分别为(1.21±0.18)分、(0.89±0.11)分、(1.03±0.17)分，明显低于对照组的(1.98±0.21)分、(1.41±0.18)分、(1.73±0.19)分，差异均有统计学意义(P<0.05)；治疗后，两组患者的Ca水平均升高，且观察组为(3.24±0.37) mmol/L，明显高于对照组的(2.61±0.32) mmol/L，而P和 iPTH水平明显降低，且观察组分别为(1.02±0.12) mmol/L、(181.14±17.45) ng/L，明显低于对照组的(1.42±0.11) mmol/L、(194.31±17.89) ng/L，差异均有统计学意义(P<0.05)；治疗后，两组患者的 IL-31、CRP、TNF-α均降低，且观察组分别为(81.34±7.21) pg/L、(3.10±0.32) mg/L、(78.31±9.21) pg/L，明显低于对照组的(97.31±7.24) pg/L、(4.21±0.30) mg/L、(97.82±9.42) pg/L，差异均有统计学意义(P<0.05)；治疗期间，观察组患者的不良反应总发生率为4.00%，略低于对照组8.00%，但差异无统计学意义(P>0.05)。结论 祛风固肾汤可有效缓解血液透析患者皮肤瘙痒症状，调节钙磷代谢水平，抑制机体炎症反应，安全性高，具有临床应用价值。
      【关键词】 血液透析；皮肤瘙痒；祛风固肾汤；钙磷代谢；炎症因子；不良反应
      【中图分类号】 R459.5 【文献标识码】 A 【文章编号】 1003—6350（2023）12—1705—05

Effect of Qufeng Gushen Decoction on calcium and phosphorus metabolism, serum IL-31, CRP levels in patientswith skin pruritus undergoing hemodialysis.
LI Wen-li 1, YANG Xue-mei 1, YAN Jian-feng 2. 1. Nephropathy—BloodPurification Center, High-tech Branch of Ankang Traditional Chinese Medicine Hospital, Ankang 725000, Shaanxi, CHINA;2. Nephropathy—Blood Purification Center, Ankang Traditional Chinese Medicine Hospital, Ankang 725000, Shaanxi,CHINA
【Abstract】 Objective To investigate the effects of Qufeng Gushen Decoction on calcium and phosphorus me-tabolism, serum interleukin-31 (IL-31), C-reactive protein (CRP) levels in patients with skin pruritus undergoing hemo-dialysis. Methods One hundred patients with skin pruritus on hemodialysis admitted to Nephropathy—Blood Purifica-tion Center, High-tech Branch of Ankang City Hospital of Traditional Chinese Medicine from April 2019 to April 2022were selected for the study. The patients were divided into observation group and control group (each with 50 patients)using a random number table method. Patients in the control group were treated with conventional drugs, while pa-tients in the observation group were treated with Qufeng Gushen Decoction on this basis for 28 days. The skin itching,calcium and phosphorus metabolism [blood calcium (Ca), blood phosphorus (P), parathyroid hormone (iPTH)], and in-flammatory factors [IL-31, CRP, tumor necrosis factor-α (TNF-α)] levels of the two groups of patients before and af-ter treatment were compared, and the occurrence of adverse reactions was statistically analyzed. Results After treat-ment, the itching degree, itching frequency, and itching site scores of the two groups of patients decreased, and thescores of the observation group were (1.21±0.18) points, (0.89±0.11) points, and (1.03±0.17) points, which were signifi-cantly lower than (1.98±0.21) points, (1.41±0.18) points, and (1.73±0.19) points of the control group (P<0.05). Aftertreatment, the level of Ca in both groups increased, and the level of Ca in the observation group was (3.24±0.37) mmol/L,which was significantly higher than (2.61±0.32) mmol/L in the control group; the levels of P and iPTH were signifi-cantly lower, and the levels in the observation group were (1.02±0.12) mmol/L and (181.14±17.45) ng/L, which weresignificantly lower than (1.42±0.11) mmol/L and (194.31±17.89) ng/L in the control group, with statistically significantdifferences (P<0.05). After treatment, the levels of IL-31, CRP, and TNF-α in both groups decreased, and the levelswere (81.34±7.21) pg/L, (3.10±0.32) mg/L, and (78.31±9.21) pg/L in the observation group, significantly lower than(97.31±7.24) pg/L, (4.21±0.30) mg/L, and (97.82±9.42) pg/L in the control group, with statistically significant differ-ences (P<0.05). During the treatment period, the total incidence of adverse reactions in the observation group wasslightly lower than that in the control group (4.00% vs 8.00%), but the difference was not statistically significant (P>0.05). Conclusion Qufeng Gushen Decoction can effectively alleviate skin itching symptoms in patients undergoing he-modialysis, regulate calcium and phosphorus metabolism levels, inhibit inflammatory reactions in the body, with highsafety, which has clinical application value.
      【Key words】 Hemodialysis; Skin pruritus; Qufeng Gushen Decoction; Calcium and phosphorus metabolism; In-flammatory factors; Adverse reactions