维持性血液透析患者炎症状态与瘙痒的关系

Relationship between inflammation status and uremic pruritus in maintenance hemodialysis patients

目的探讨维持性血液透析患者炎症状态与瘙痒的关系。方法 39例维持性血液透析患者及12例正常人入选本研究。按照直观类比标度(visual analog scale,VAS)评分系统对病例组瘙痒程度进行询问。病例组分别抽取问询期内同次透析前后血标本,对照组标本来自华中科技大学同济医学院附属同济医院健康体检人群。采用流式细胞仪的液相蛋白定量技术检测炎症因子:白介素(interleukin,IL)-2、IL-6、IL-10、肿瘤坏死因子(tumor necrosis factor,TNF)。结果 Spearman相关分析及线性回归显示透析前IL-2与VAS评分呈正相关(β=0.586,t=4.399,F=19.354P<0.01)。病例组按VAS得分分为3组,无瘙痒者(VAS=0)占38%,轻至中度瘙痒者(VAS=1～5)占41%,重度瘙痒者(VAS>5)占21%;重度瘙痒组透析前后IL-2显著高于无瘙痒组。结论维持性血液透析患者中瘙痒的发生率较高。炎症状态在瘙痒的发病机制中有重要作用。IL-2水平影响维持性血液透析患者的瘙痒状态。

Objective To investigate the correlation between inflammation status and uremic pruritus in maintenance hemodialysis (MHD) patients. Methods Thirty-nine MHD patients and twelve healthy controls were recruited to the study. We inquired of MHD patients about the severity of their pruritus by visual analog scale (VAS). Blood samples were taken before and after hemodialysis during the inquiry day. Inflammatory factors including interleukin (IL) -2, IL-6, IL-10, tumor necrosis factor (TNF) were measured by Cytometric Bead Array. Results Preand after-dialysis levels of IL-2, IL-6, IL-10 and TNF and pre-dialysis level of hsCRP were significantly higher in MHD patients than in healthy controls, and these levels had no significant correlation with age or sex. Spearman rank correlation analysis and linear regression analysis showed that pre-dialysis IL-2 level was positively correlated with VAS score (β=0.586, t=4.399, F=19.354, P< 0.01). Based on VAS score, MHD patients could be divided into 3 groups, no pruritus group (VAS=0.38%), mild to moderate pruritus group [VAS=1～5(41%)], and severe pruritus group [(VAS> 5(21%)]. Preand after-dialysis IL-2 levels were significantly higher in severe pruritus group than in no pruritus group. Conclusion A higher prevalence of uremic pruritus was found in MHD patients. Inflammation plays an important role in the pathogenesis of uremic pruritus. IL-2 closely relates to uremic pruritus in MHD patients.