Analysis Of Relationship Between Skin Pruritus In Maintenance Hemodialysis Patients And TCM Syndromes And Its Influencing Factors

ObjectiveTo explore the relationship between the degree of skin pruritus of uremic pruritus(UP)and TCM syndromes in maintenance hemodialysis patients,and to analyze relevant influencing factors to provide evidence for clinical relief of skin pruritus in patients with MHD.Method1.Convenient sampling methods are used to screen and select patients with UP diagnosis who have undergone maintenance hemodialysis treatment at the Hemodialysis Center of Wuhan First Hospital from October 2020 to December 2020 according to the inclusion and exclusion criteria,and collect the general conditions of the patients and related laboratories index.2.The UP patients who were screened into this study were scored for the degree of skin pruritus.The score was based on the Twelve-item Pruritus Sinicization Scale(12-PSS),and the patients were classified according to the interquartile range of the pruritus score(8,14,17)Four groups,namely,mild A group(3-8 points),moderate B group(9-14 points),severe C group(15-17 points),and extremely severe D group(18-22points);at the same time by professional TCM physicians of TCM perform TCM syndrome differentiation on maintenance hemodialysis patients,which are divided into blood deficiency and dryness syndrome,qi deficiency and body fluid deficiency,damp-heat syndrome,wind-cold syndrome,wind-heat syndrome,and fire-heat blood-heat syndrome;3.Observe the distribution characteristics of TCM syndrome types of UP patients,and compare the differences in skin pruritus scores of patients with different syndrome types;4.Compare the general conditions of patients with different skin pruritus,laboratory indicators and the differences between TCM syndrome types,and analyze the relevant influencing factors of the skin pruritus degree of UP patients.Result1.A total of 214 patients with UP were included and completed the study.Among them,116 were males and 98 were females.The ratio of male to female is about 1:1;the average age is 56.36±10.46 years;the average skin pruritus score is 11.42±5.56,which is more than half.(54.6%)patients are in a state of moderate to severe skin pruritus(pruritus score> 13 points);2.The distribution of TCM syndromes: patients with blood deficiency and dryness syndrome accounted for the largest proportion,accounting for 41.6%.Patients with fire-heat-blood-heat syndrome accounted for the least,accounting for 5.6%.The distribution frequency from high to low is as follows: blood deficiency and dryness syndrome> Qi deficiency and body fluid deficiency syndrome> damp-heat syndrome> wind-cold syndrome> wind-heat syndrome> fire,heat,blood and heat syndrome;3.Comparing the skin pruritus degree of different TCM syndromes,the skin pruritus score of damp-heat syndrome(13.89±5.96)is relatively high,which is higher than that of blood deficiency and dryness syndrome,qi deficiency and body fluid syndrome,wind-cold syndrome,fire-heat blood-heat syndrome(P<0.05).The skin pruritus score of wind-cold syndrome(9.36±5.32)is relatively low,which is lower than that of damp-heat syndrome,wind-heat syndrome,and fire-heat blood-heat syndrome;4.There was no significant difference in gender ratio,education level,frequency of dialysis,and BMI among UP patients with different skin pruritus degrees(P>0.05);the proportion of employees in the mild pruritus group was 30(69.7))The proportion of patients with low,college degree or above 12(27.9)is relatively high;the proportion of married patients in the moderate pruritus group is 54(84.4)is low;the proportion of patients with diabetic nephropathy in the severe pruritus group is relatively high in 19(40.4),The average age(59.68±9.68)is relatively high;5.UP patients with different skin pruritus systolic blood pressure(SBP),diastolic blood pressure(DBP),hemoglobin(HB),red blood cell volume(HCT),ferritin(SF),albumin(ALB),blood uric acid(UA),Serum calcium(Ca),blood sugar,total cholesterol(TC),and low-density lipoprotein(LDL)were not significantly different in different skin pruritus groups(P>0.05).Sp Kt/V and Scr were relatively higher in extremely severe pruritus in group D;P was relatively higher in severe pruritus in group C;BUN and PTH were relatively lower in moderate pruritus in group B;6.The multiple linear regression model showed that age,HB,ALB,Scr,PTH are related to the degree of skin pruritus in UP patients(P<0.05).Among them,age,Scr,PTH are positively correlated with the degree of skin pruritus,and HB,ALB and skin The degree of pruritus score is negatively correlated;single-factor Logistic regression model results show that age,primary disease is diabetic nephropathy,syndrome is damp-heat syndrome,Sp Kt/V,Scr,PTH are the influencing factors of high-level skin pruritus;multi-factor Logistic The regression model results show that PTH,Sp Kt/V,diabetic nephropathy,and damp-heat syndrome are independent risk factors for high-level skin pruritus;college degree or above is an independent protective factor for low-level pruritus;Conclusion(1)More than half(54.6%)of the patients are in a state of high-level skin pruritus(pruritic score> 13 points).There are many factors that affect the degree of skin pruritus in patients.The results of this study show age,PTH,Sp Kt/V,Primary diabetic nephropathy,and TCM syndrome of damp-heat syndrome have a significant impact on the fatigue score of patients,and they are all positively correlated with the course of pruritus score;college degree and above are independent protective factors for low-level pruritus.(2)The TCM syndromes of patients with UP are mainly deficiency syndromes,blood deficiency and dryness syndromes,and qi deficiency and body fluid deficiency syndromes;in terms of pruritus score,the score of damp-heat syndrome is higher and the degree of skin pruritus is higher.Clinically,more attention should be paid to patients with these syndromes.,To take appropriate integrated traditional Chinese and Western medicine to relieve the patient’s itching symptoms.