维持性血液透析患者尿毒症性瘙痒症的中西医结合治疗策略综述

A Review of Integrated Traditional Chinese and Western Medicine Treatment Strategies for Uremic Pruritus in Maintenance Hemodialysis Patients

摘要: 维持性血液透析患者并发的尿毒症性瘙痒症(现称慢性肾脏病相关性瘙痒症)是一种常见且严重影响生活质量的顽固性并发症。其发病机制复杂，涉及尿毒症毒素蓄积、免疫–炎症失衡、阿片受体系统功能紊乱及神经病变等多重因素。现代医学治疗策略包括基础皮肤护理、优化透析、光疗，以及以加巴喷丁/普瑞巴林为代表的神经调节剂和以κ-阿片受体激动剂(如纳呋拉啡、Difelikefalin)为代表的靶向药物，后者因其针对核心病理机制而成为近年来的重要突破。传统中医药则基于“辨证论治”原则，将本病分为血虚风燥、湿热蕴肤等证型，通过内服汤药(如当归饮子、消风散)、中成药(如尿毒清颗粒)及外治法等，进行整体调节。当前临床实践的趋势是采用中西医结合策略，融合西医靶向治疗的快速起效与中医整体调理的持续稳定优势，以实现增效减毒。然而，该领域仍面临缺乏权威诊疗指南、高质量中西医结合比较研究不足等挑战。未来需加强高质量临床研究，推动精准与个体化治疗，以期为患者提供更优的综合治疗方案。

Abstract: Uremic pruritus (now known as chronic kidney disease-related pruritus), which occurs concurrently with maintenance hemodialysis patients, is a common and stubborn complication that seriously affects the quality of life. Its pathogenesis is complex, involving multiple factors such as the accumulation of uremic toxins, immune-inflammatory imbalance, dysfunction of the opioid receptor system and neuropathy. Modern medical treatment strategies include basic skin care, optimized dialysis, phototherapy, as well as neuromodulators represented by gabapentin/pregabalin and targeted drugs represented by κ-opioid receptor agonists (such as nafurafine and Difelikefalin), the latter of which has become an important breakthrough in recent years due to its focus on core pathological mechanisms. Traditional Chinese medicine, based on the principle of “syndrome differentiation and treatment”, classifies this disease into syndrome types such as blood deficiency and wind-dryness, and damp-heat accumulation in the skin. It conducts overall regulation through internal administration of decoctions (such as Danggui Yinzi and Xiaofeng Powder), Chinese patent medicines (such as Niuduqing Granules), and external treatment methods. The current trend in clinical practice is to adopt a strategy of integrating traditional Chinese and Western medicine, combining the rapid onset of targeted therapy in Western medicine with the continuous and stable advantages of overall conditioning in traditional Chinese medicine, in order to achieve increased efficacy and reduced toxicity. However, this field still faces challenges such as the lack of authoritative diagnosis and treatment guidelines and insufficient high-quality comparative studies on the integration of traditional Chinese and Western medicine. In the future, it is necessary to enhance high-quality clinical research and promote precise and individualized treatment, with the aim of providing patients with better comprehensive treatment plans.