血液灌流联合血液透析改善尿毒症患者皮肤瘙痒的临床机制研究
Study on the Clinical Mechanism of Hemoperfusion Combined with Hemodialysis to Improve Skin Itching in Patients with Uremia
DOI: 10.12677/ACM.2020.1012437, PDF,   
作者: 解秀荣*：青岛大学医学部，山东 青岛；季文萱, 安 茜, 单文红, 于芬芬, 黄俊彦#：青岛大学第二临床医学院肾内科，山东 青岛
关键词: 尿毒症；皮肤瘙痒；血液灌流；血液透析；IL-31；NT-4；BDNF；Uremia； Skin Itching； Hemoperfusion； Hemodialysis； IL-31； NT-4； BDNF
摘要: 目的：探讨血液灌流(hemoperfusion, HP)联合血液透析(hemodialysis, HD)对维持性血液透析(maintenance hemodialysis, MHD)患者皮肤瘙痒的改善情况及对患者血清白介素-31 (Interleukin-31, IL-31)、神经营养素-4 (neurotrophin-4, NT-4)及脑源性神经营养因子(brain derived neurotrophic factor, BDNF)水平的影响。方法：选取2019年7月~2020年6月于青岛市中心医院行维持性血液透析且患有皮肤瘙痒的患者64例，分为HD组和HP + HD组，对比两组患者治疗前后皮肤瘙痒情况、血生化指标、IL-31、NT-4、BDNF水平的变化情况。结果：两组患者治疗后皮肤瘙痒情况、β2-微球蛋白(β2-MG)、超敏-C反应蛋白(hs-CRP)、甲状旁腺激素(iPTH)及IL-31、NT-4水平均较治疗前减低，且HP + HD组患者改善情况优于HD组(P < 0.05)。两组治疗后BDNF水平均较治疗前增加，但差异无统计学意义(P > 0.05)。结论：HP + HD治疗可通过减少部分瘙痒相关因子，从而缓解患者的皮肤瘙痒情况，且效果明显优于单纯HD治疗。
Abstract: Objective: To explore the effect of hemoperfusion (HP) combined with hemodialysis (HD) on the improvement of skin itching and the levels of serum interleukin-31 (IL-31), neurotrophin-4 (NT-4) and brain-derived neurotrophic factor (BDNF) in maintenance hemodialysis (MHD) patients. Methods: 64 patients who underwent maintenance hemodialysis in Qingdao Central Hospital from July 2019 to June 2020 and suffered from skin pruritus were divided into HD group and HP + HD group. The changes of skin pruritus, blood biochemical indexes and the levels of IL-31, NT-4 and BDNF before and after treatment were compared between the two groups. Results: The skin pruritus, β2-microglobulin (β2-MG), hypersensitive C-reactive protein (hs-CRP) and parathyroid hormone (iPTH), IL-31, NT-4 in the two groups after treatment were lower than before treatment. The improvement of HP + HD group was better than that of HD group (P < 0.05). The levels of BDNF after treatment increased compared with before treatment in two groups, but the difference before and after was not statistically significant (P > 0.05). Conclusion: The treatment of HP + HD can relieve patients’ skin pruritus by reducing some itch-related factors, and the effect is significantly better than that of HD.
文章引用：解秀荣, 季文萱, 安茜, 单文红, 于芬芬, 黄俊彦. 血液灌流联合血液透析改善尿毒症患者皮肤瘙痒的临床机制研究[J]. 临床医学进展, 2020, 10(12): 2890-2897. https://doi.org/10.12677/ACM.2020.1012437

参考文献

[1] Satti, M.Z., Arshad, D., Javed, H., et al. (2019) Uremic Pruritus: Prevalence and Impact on Quality of Life and Depressive Symptoms in Hemodialysis Patients. Cureus, 11, e5178. [Google Scholar] [CrossRef] [PubMed]
[2] Rayner, H.C., Larkina, M., Wang, M., et al. (2017) International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis. Clinical Journal of the American Society of Nephrology, 12, 2000-2007. [Google Scholar] [CrossRef] 
[3] Ting, S.-W., Fan, P.-C., Lin, Y.-S., et al. (2020) Association between Uremic Pruritus and Long-Term Outcomes in Patients Undergoing Dialysis. Journal of the American Academy of Dermatology, 83, 924-925. [Google Scholar] [CrossRef] [PubMed]
[4] Suseł, J., Batycka-Baran, A., Reich, A. and Szepietowski, J.C. (2014) Uraemic Pruritus Markedly Affects the Quality of Life and Depressive Symptoms in Haemodialysis Patients with End-Stage Renal Disease. Acta Dermato-Venereologica, 94, 276-281. [Google Scholar] [CrossRef] [PubMed]
[5] Ibrahim, M.K., Elshahid, A.R., El Baz, T.Z., et al. (2016) Impact of Uraemic Pruritus on Quality of Life among End Stage Renal Disease Patients on Dialysis. Journal of Clinical and Diagnostic Research, 10, WC01-WC05. [Google Scholar] [CrossRef] 
[6] Ko, M.-J., Peng, Y.-S., Chen, H.-Y., et al. (2014) Interleukin-31 Is Associated with Uremic Pruritus in Patients Receiving Hemodialysis. Journal of the American Academy of Dermatology, 71, 1151-1159.E1. [Google Scholar] [CrossRef] [PubMed]
[7] Sorour, N.E., Elesawy, F.M., Tabl, H.A., Ibrahim, M.E. and Akl, E.M. (2019) Evaluation of Serum Levels of Neurotrophin 4 and Brain-Derived Nerve Growth Factor in Uremic Pruritus Patients. Clinical, Cosmetic and Investigational Dermatology, 12, 109-114. [Google Scholar] [CrossRef] 
[8] Cai, W., et al. (2015) Efficacy and Mechanism of Hemoperfusion plus Hemodialysis for Peripheral Neuropathy of Uremic Patients on Maintenance Hemodialysis. Zhonghua Yi Xue Za Zhi, 95, 1319-1322.
[9] Cupisti, A., Piccoli, G.B. and Gallieni, M. (2020) Charcoal for the Management of Pruritus and Uremic Toxins in Patients with Chronic Kidney Disease. Current Opinion in Nephrology and Hypertension, 29, 71-79. [Google Scholar] [CrossRef] 
[10] Furue, M., Ebata, T., Ikoma, A., et al. (2013) Verbalizing Extremes of the Visual Analogue Scale for Pruritus: A Consensus Statement. Acta Dermato-Venereologica, 93, 214-215. [Google Scholar] [CrossRef] [PubMed]
[11] Swarna, S.S., Aziz, K., Zubair, T., et al. (2019) Pruritus Associated With Chronic Kidney Disease: A Comprehensive Literature Review. Cureus, 11, e5256. [Google Scholar] [CrossRef] [PubMed]
[12] Wieczorek, A., Krajewski, P., Kozioł-Gałczyńska, M. and Szepietowski, J.C. (2020) Opioid Receptors Expression in the Skin of Haemodialysis Patients Suffering from Uraemic Pruritus. Journal of the European Academy of Dermatology and Venereology, 34, 2368-2372. [Google Scholar] [CrossRef] [PubMed]
[13] Verduzco, H.A. and Shirazian, S. (2020) CKD-Associated Pruritus: New Insights into Diagnosis, Pathogenesis, and Management. Kidney International Reports, 5, 1387-1402. [Google Scholar] [CrossRef] [PubMed]
[14] 陈敢, 王丽妍, 傅君舟, 刘文虎, 吴雯婷, 谢志强. 维持性血液透析患者中瘙痒症的现状调查研究[J]. 中国血液净化, 2019, 18(4): 242-245.
[15] Reszke, R. and Szepietowski, J.C. (2018) End-Stage Renal Disease Chronic Itch and Its Management. Dermatologic Clinics, 36, 277-292. [Google Scholar] [CrossRef] [PubMed]
[16] Attia, E.A. and Hassan, A.A. (2014) Uremic Pruritus Pathogenesis, Revisited. Arab Journal of Nephrology and Transplantation, 7, 91-96.
[17] 于婵媛, 杨立志, 窦海川, 张洋, 王月红. 不同外科术式治疗尿毒症继发性甲状旁腺功能亢进的效果分析[J]. 中国血液净化, 2017, 16(1): 44-47.
[18] Kremer, A.E. and Mettang, T. (2019) Pruritus in Systemic Diseases: Common and Rare Etiologies. Der Internist, 60, 814-820. [Google Scholar] [CrossRef] [PubMed]
[19] Britt Jr., R.D., Thompson, M.A., Wicher, S.A., et al. (2019) Smooth Muscle Brain-Derived Neurotrophic Factor Contributes to Airway Hyperreactivity in a Mouse Model of Allergic Asthma. FASEB Journal, 33, 3024-3034. [Google Scholar] [CrossRef] 
[20] Güvercin, B., et al. (2019) The Relationship between Dermatological Findings and Serum Interleukin 31 and Serum Uridine Diphosphate Glucose Ceramide Glucosyltransferase Levels among Patients with Chronic Kidney Disease. Hippokratia, 23, 75-80.
[21] Gibbs, B.F., Patsinakidis, N. and Raap, U. (2019) Role of the Pruritic Cytokine IL-31 in Autoimmune Skin Diseases. Frontiers in Immunology, 10, 1383. [Google Scholar] [CrossRef] [PubMed]

为你推荐