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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2026, Vol. 15 ›› Issue (04) : 213 -219. doi: 10.3877/cma.j.issn.2095-3216.2026.04.006

综述

慢性肾脏病相关瘙痒诊断与评估进展：从症状识别走向全程管理
李想1, 陈凤锟2, 李冀军1,†()   
  1. 1100048　北京，解放军总医院第四医学中心肾脏病科
    2100853　解放军总医院肾脏病医学部、肾脏疾病全国重点实验室、肾病与泌尿系统疾病国家临床医学研究中心、重症肾脏疾病器械与中西医药物研发北京市重点实验室、数智中医泛血管疾病防治北京市重点实验室、国家中医药管理局高水平中医药重点学科(zyyzdxk-2023310)、国家中医药管理局中医药创新团队及人才支持计划项目(ZYYCXTD-D-202402)
  • 收稿日期:2025-09-15 出版日期:2026-08-28
  • 通信作者: 李冀军

Advances in diagnosis and evaluation of chronic kidney disease-associated pruritus: from symptom recognition to full-course management

Xiang Li1, Fengkun Chen2, Jijun Li1,†()   

  1. 1Department of Nephrology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048
    2Senior Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney and Urological Diseases, Beijing Key Laboratory of Medical Devices and Integrated Traditional Chinese and Western Drug Development for Severe Kidney Diseases, Beijing Key Laboratory of Digital Intelligent TCM for Prevention and Treatment of Pan-vascular Diseases, Key Disciplines of National Administration of Traditional Chinese Medicine (zyyzdxk-2023310), Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine (ZYYCXTD-D-202402), Beijing 100853, China
  • Received:2025-09-15 Published:2026-08-28
  • Corresponding author: Jijun Li
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引用本文：

李想, 陈凤锟, 李冀军. 慢性肾脏病相关瘙痒诊断与评估进展：从症状识别走向全程管理[J/OL]. 中华肾病研究电子杂志, 2026, 15(04): 213-219.

Xiang Li, Fengkun Chen, Jijun Li. Advances in diagnosis and evaluation of chronic kidney disease-associated pruritus: from symptom recognition to full-course management[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2026, 15(04): 213-219.

慢性肾脏病相关瘙痒(chronic kidney disease-associated pruritus, CKD-aP)是终末期肾脏病患者常见但长期被忽视的并发症。CKD-aP可显著影响患者生活质量、睡眠及情绪，降低透析依从性，并与死亡风险升高密切相关。近年来，随着对其发病机制认识的加深与治疗药物研发进展，CKD-aP已从传统意义上的伴随"症状"被重新界定为需主动识别和系统干预的独立临床病症。本文从流行病学、发病机制、诊断流程、评估量表、分层管理策略及药物研究进展等方面，对CKD-aP进行系统综述，重点介绍各类瘙痒评估工具的特征、临床应用价值及其在κ阿片受体激动剂研发中的应用，并探讨基于瘙痒严重程度的分层管理方案，以期提升临床医师对CKD-aP的识别与规范化管理能力，改善患者预后。

关键词: 慢性肾脏病相关瘙痒, 诊断, 治疗, 评估, 生活质量, κ阿片受体激动剂

Chronic kidney disease-associated pruritus (CKD-aP) is a common yet long-overlooked complication among patients with end-stage renal disease. CKD-aP can significantly affect patients′ quality of life, sleep, and mood, reduce dialysis adherence, and is closely associated with an increased risk of mortality. In recent years, with deeper understanding of its pathogenesis and advances in the research and development of therapeutic drugs, CKD-aP has been redefined from a conventional accompanying "symptom" to an independent clinical disorder requiring active identification and systematic intervention. This article systematically reviewed CKD-aP from the perspectives of epidemiology, pathogenesis, diagnostic procedures, assessment scales, stratified management strategies, and advances in pharmaceutical research. It focuses on introducing the characteristics and clinical application value of various pruritus assessment tools as well as their applications in the research and development of κ-opioid receptor agonists, and discusses stratified management regimens based on pruritus severity. The aim is to improve clinicians′ ability to identify and standardly manage CKD-aP and improve patients′ prognosis.

Key words: Chronic kidney disease-associated pruritus, Diagnosis, Treatment, Assessment, Auality of life, κ opioid receptor agonist
表1 慢性肾脏病相关瘙痒患者常用单维及多维评估量表的优势和局限
量表 症状回忆 优势 局限性
单维      
数字评分量表 24 h内最严重瘙痒 简单快捷 高度主观
视觉模拟量表 24 h内最严重瘙痒 简单快捷 高度主观
语言评分量表 24 h内最严重瘙痒 简单快捷 高度主观
肾脏病生活质量简表 对过去4周的评估 便于大规模流行病学调查 用于衡量瘙痒严重程度的有效性尚未验证
多维      
5维瘙痒评分 过去14 d 验证评估瘙痒的病程(包括u患者) 耗时
皮肤生活质量指数量表 过去7 d 验证评估CKD-aP的强度 耗时
自我评估瘙痒严重程度量表 当下 快 较少用于研究
瘙痒相关睡眠量表 过去7 d 验证可评估CKD-aP患者的睡眠质量 专门评估睡眠障碍
表2 已上市具有慢性肾脏病相关瘙痒适应症的κ阿片受体激动剂注册研究评估指标
药物 适应症 已上市国家 使用方法 Ⅲ期评估指标
外周κ阿片受体激动剂        
安瑞克芬 治疗成人血透患者的中重度CKD-aP 中国 静脉注射 数字评分量表
5维瘙痒量表
皮肤生活质量指数量表
地非法林 治疗成人血透患者的中重度CKD-aP 美国、欧盟、日本 静脉注射 数字评分量表；
5维瘙痒量表
皮肤生活质量指数量表
中枢κ阿片受体激动剂        
纳呋拉啡 用于改善血透患者的瘙痒症状(仅限于现有治疗不理想的情况) 中国、日本 口服 视觉模拟量表
谢-川岛瘙痒量表
图1 血液透析患者慢性肾脏病相关瘙痒的诊断和治疗流程[5]注：KDQoL-36, Kidney Disease Quality of Life-36，肾脏病生活质量简表；CKD-aP, chronic kidney disease-associated pruritus，慢性肾脏病相关瘙痒；WI-NRS, Worst Itch Numeric Rating Scale，最严重瘙痒数字评分量表；SADS, Self-Assessed Disease Severity Scale，自我评估疾病严重程度量表；PTH, parathyroid hormone，甲状旁腺激素；UVB, ultraviolet B，中波紫外线
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