尿毒搔癢症治療之系統性回顧

Systemic Review of Medical Treatment of Uremic Pruritus

王裕方(Yu-Fang Wang) ； 廖建富(Jian-Fu Liao) ； 陳明新(Ming-Hsin Chen) ； 陳瑋毅(Wei-Yi Chen) ； 戴有志(Yu-Chih Tai) ； 呂秉勳(Ping-Hsun Lu)

《台灣醫學》 26卷3期 (2022/05) Pp. 271-286

https://doi.org/10.6320/FJM.202205_26(3).0002

摘要

尿毒症搔癢症（uremic pruritus, UP）好發於已接受透析之患者與終末期腎臟疾病患者。嚴重的搔癢會引起睡眠障礙，焦慮，沮喪並降低生活質量，甚至提高死亡率。目前推測其機轉，可能為免疫及鴉片類激素系統假說。由於發病機理未研究透徹，故目前尚無明確且滿意的治療方法。我們搜索電子數據庫PubMed、Medline、Cochrane Library、CINAHL和clinicaltrials.gov，收集有關西醫治療尿毒搔癢症的文章，並從實證研究分析，報導隨機對照試驗39篇與統合分析3篇文章結果，分類為口服／靜脈注射藥、外用藥膏與其他療法。隨機對照試驗文章以Jadad量表評量後平均分數為3.38分；系統性文獻回顧統合分析文章以GRADE評估，等級介於非常低至中度之間。最後，本文將所有文獻整理成治療成效表，期許對尿毒搔癢症的治療提供較高證據等級的選擇。然而，這些治療方法仍然需要大規模的臨床證據和進一步的機制探索。

關鍵字

尿毒搔癢症 ； 慢性腎臟病 ； 透析 ； 口服藥 ； 外用藥膏

並列摘要

Uremic pruritus (UP) often happens to patients who have undergone dialysis or with end-stage renal disease (ESRD). Refractory itching can cause sleep disorders, anxiety, depression, reduce the quality of life, and even increase mortality. The pathogenesis of UP is not fully understood, but systemic inflammation and opioid system imbalance are two major proposed hypotheses. Due to the lack of clear pathogenesis of UP, there is currently no satisfactory treatment for UP. We performed a literature search in the PubMed, Medline, Cochrane Library, CINAHL, and clinicaltrials.gov. The articles about Western medicine treatment for UP focused on a high level of evidence like randomized controlled trials (RCT) and meta-analysis. There were 39 RCTs and 3 meta-analyses were enrolled in our studies and were classified into three categories, which are systemic, topical, and other treatments for UP. The qualities of RCTs were evaluated by the modified Jadad scale and the average score was 3.38. GRADE was applied to access meta-analysis, the quality of evidences were ranged from very low to moderate. We summarized the treatment effects of Western medicine based on the high-level evidence, hoping to provide better suggestions for the treatment of UP. However, these treatment methods still required large-scale clinical evidence and further mechanism exploration.

並列關鍵字

uremic pruritus ； chronic kidney disease (CKD) ； dialysis ； systemic therapy ； topical therapy

參考文獻

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Kimmel M, Alscher DM, Dunst R, et al. The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients. Nephrol Dial Transplant 2006;21:749-55.

Wieczorek A, Krajewski P, Kozioł-Gałczyńska M, et al. Opioid receptors expression in the skin of haemodialysis patients suffering from uraemic pruritus. J Eur Acad Dermatol Venereol 2020;34:2368-72.