臺灣博碩士論文加值系統

背景

尿毒症搔癢(uremic pruritus, UP)是血液透析(hemodialysis)患者常見和惱人的症狀。5-D搔癢量表(5-D itch scale)已被證明是具有可靠性的搔癢量表，但尚未運用於評估血液透析患者，對於5-D搔癢量表的搔癢程度分級目前並無分類。本研究的目的是利用5-D搔癢量表評估血液透析患者搔癢問題，並基於視覺評分量表(visual analogue scale, VAS)找出5-D搔癢量表得分的最佳的臨界值並予以搔癢程度分級。

方法

於2014年12月開始在中國醫藥大學附屬醫院收集409名血液透析患者，藉由VAS和5-D搔癢量表評估患者搔癢程度。利用線性迴歸分析VAS和5-D搔癢量表的相關性，並運用ROC曲線判別中度皮膚搔癢的切點，依據卡方檢定找出5-D搔癢量表得分的最佳的臨界值並予搔癢程度分級，再使用羅吉斯迴歸及線性迴歸探討與中度程度搔癢有關的相關因子。

結果

409名血液透析患者，平均年齡63±13歲，52.6％為男性，平均VAS得分為3.4±3.0，平均5-D搔癢得分為10.9±4.7。5-D搔癢量表與VAS有強烈相關：R = 0.825（P < 0.001）VAS score = - 1.67 + 0.51x（5-D搔癢量表得分）。對比5-D搔癢量表評估其得分，無搔癢組5-D平均值為6.44±1.61，輕度搔癢組5-D平均值為9.60±2.19，中度搔癢組5-D平均值為13.08±3.15，重度搔癢組5-D平均值為15.72±4.27，非常嚴重搔癢組5-D平均值為19.5±4.35，並提出5-D搔癢量表的分級，無搔癢(5-D: ≤ 8分)、輕度搔癢(5-D: 9-11分)、中度搔癢(5-D: 12-17分)、嚴重搔癢(5-D: 18-21分)、非常嚴重搔癢(5-D: ≥ 22分)，且定義中度程度的搔癢強度為有症狀搔癢(5-D: ≥ 12)，而與中度程度搔癢的相關的因子包括有：接受逶析時間較長、患有C型肝炎、Alk-P較高、Kt/V較低。

結論

利用5-D搔癢量表提出對血液透析患者測量搔癢的嚴重程度分級，此訊息提供5-D搔癢量表和VAS之間可輕鬆轉換，從建構良好的問卷評估，以利診斷尋找最好的治療方式，並提供臨床醫療人員方便評估搔癢程度。

Background

Uremic pruritus (UP) is a common and frustrating symptom in hemodialysis patients. 5-D itch scale was proposed as a reliable measurement of pruritus. However, it never used evaluation hemodialysis patients, information regarding 5-D itch scale categories was currently unavailable. The aim of the study was use 5-D itch scale to evaluation pruritus and to explore optimal cut-offs for categories of 5-D itch scale based on visual analogue scale (VAS) categories in chronic hemodialysis patients.

Methods

Four hundred and nine hemodialysis patients in China Medical University Hospital in Dec 2014 were included. Patients’ severity of pruritus was estimated using visual analogue scale (VAS) and 5-D itch scale. The association of VAS and 5-D itch scale was analyzed by linear regression. Using ROC curve to identify moderate pruritus cut-off point. Based on chi-square test the optimal cut-offs for 5-D itch scale according to VAS categories were generated, and moderate uremic pruritus related factors by using logistic regression and linear regression.

Results

The 5-D was administrated to 409 hemodialysis patients aged 63±13 years old and 52.6% of the patients were male. The average VAS was 3.4±3.0 and the average 5-D itch scale was 10.9±4.8. The 5-D score was strongly correlated with the VAS: R = 0.825（p < 0.001）.VAS score = - 1.67 + 0.51x (5-D itch score).The average of 5-D scales were 6.44±1.61, 9.60±2.19, 13.08±3.15, 15.72±4.27, 19.5±4.35 for no, mild, moderate, severe, and very severe pruritus based on categorized VAS. 5-D itch scale categories were proposed, ≤ 8 for no pruritus, 9-11 for mild pruritus, 12-17 for moderate pruritus, 18-21 for severe pruritus and ≥ 22 for very severe pruritus. A severity of pruritus more than moderate pruritus was considered as symptomatic pruritus (5-D: ≥ 12). And moderate uremic pruritus related factors may includ: long time hemodialysis, hepatitis C, high Alk-P, low Kt/V.

Conclusions

A 5-D itch scale categories were proposed based on the measurements of pruritus severity in hemodialysis patients. This information provides an easy transformation between 5-D itch scale and visual analogue scale. From the well constructed questionnaire to make a definite diagnosis of looking for the best treatment. And easily be used by clinical staff to assess the severity of pruritus.

摘要 i
Abstract iii
目次 v
表目次 vii
圖目次 viii
1.前言 1
2.文獻探討 2
2.1尿毒症搔癢 2
2.1.1定義 2
2.1.2現況 4
2.1.3致病機轉 7
2.1.4治療方法 11
2.2尿毒症搔癢臨床特徵 15
2.2.1搔癢特性 15
2.2.2皮膚變化 16
2.2.3心理影響 16
2.3搔癢量表在透析患者上的運用 17
2.2.1單層面評估 18
2.2.2多層面評估 19
2.3.3搔癢量表比較 21
3.研究方法 23
3.1研究設計 23
3.2研究對象 23
3.3評估方法 24
3.4統計分析 26
4.研究結果 27
4.1樣本分析 27
4.2 VAS與5-D搔癢量表相關性 30
4.3 VAS與5-D搔癢量表分級 37
4.4搔癢相關因子分析 39
5.討論 48
5.1基本資料與血液生化數值 48
5.2 VAS與5-D搔癢量表相關性 49
5.3 5-D搔癢程度分級 50
5.4與中度皮膚搔癢有關的相關因子 51
6.結論 54
7.參考文獻 56

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