Clinical Study On Improvement Of Skin Pruritus In Patients With Uremia By Hemoperfusion Combined With Hemodialysis

ObjectiveIn this study,the levels of serum interleukin-31(IL-31),neurotrophin-4(NT-4)and brain-derived neurotrophic factor(BDNF)in patients with maintenance hemodialysis(MHD)with different degrees of itching were detected to explore the role of IL-31,NT-4 and BDNF in the pathogenesis of uremia skin pruritus and its correlation with the severity of skin pruritus.On this basis,we explored the improvement of skin pruritus,the levels of the blood biochemical indicators,β2-microglobulin(β2-MG),high-sensitivity C-reactive(hs-CRP),parathyroid hormone(iPTH),IL-31,NT-4 and BDNF of MHD patients by hemoperfusion(HP)combined with hemodialysis(HD).Methods1.Sixty-four patients with pruritus who underwent maintenance hemodialysis in Qingdao Central Hospital from July 2019 to June 2020 were selected as the pruritus group,and the visual analog scale(VAS)was used to assess the pruritus of the patients,and the enzyme linked immunosorbent assay(ELISA)was used to determine the serum levels of IL-31,NT-4,and BDNF.Thirty-two patients who underwent maintenance hemodialysis in this hospital during the same period without skin pruritus were selected as the control group,and the serum levels of IL-31,NT-4,and BDNF were measured.2.64 patients undergoing maintenance hemodialysis and suffering from skin pruritus were randomly divided into HD group and HP+HD group.VAS was used to evaluate the pruritus of patients,and ELISA was used to measure the levels of serum IL-31,NT-4,and BDNF,and automatic biochemical analyzer was used to measure blood biochemical indicators.The degree of itching,the levels of the blood biochemical indicators(blood urea nitrogen,nitrogen,creatinine,uric acid,blood calcium,blood phosphorus),β2-MG,hs-CRP,iPTH,IL-31,NT-4 and BDNF before and after treatment were compared between the two groups.Results1.In the pruritus group,the serum IL-31 level was significantly higher than the control group(P<0.001);the serum NT-4 level was significantly higher than the control group(P<0.001);There was no significant difference in serum BDNF level(P>0.05).2.In the pruritus group,VAS score was positively correlated with serum IL-31 level(r=0.734,P<0.001)and serum NT-4 level was positively correlated with VAS score(r=0.791,P<0.001).Serum IL-31 level was positively correlated with serum NT-4 level(r=0.813,P<0.001).3.After treatment,the skin pruritus score of patients in HP+HD group and HD group was lower than before and the difference before and after treatment was statistically significant in HP+HD group(P<0.05);The skin pruritus score of HP+HD group(4.56± 1.41 points)was lower than that of HD group(7.16±1.02 points),and the difference was statistically significant(P<0.01).4.After treatment,the levels of blood urea nitrogen,creatinine,uric acid and blood phosphorus in HP+HD group and HD group were significantly lower than before treatment and the differences were statistically significant(P<0.01).5.After treatment,the levels of β2-MG,hs-CRP and iPTH in HP+HD group and HD group were all lower than before treatment,and the difference was statistically significant(P<0.05);The levels of β2-Mg,hs-CRP and iPTH in HP+HD group were all lower than those in HD group,and the difference was statistically significant(P<0.05).6.The levels of IL-31 and NT-4 in HD group showed no statistically significant difference after treatment compared with before treatment(P>0.05),and the levels of IL-31 and NT-4 in HP+HD group after treatment were significantly different from before treatment(P<0.01);The levels of IL-31 and NT-4 in HP+HD group were lower than those in HD group,and the difference was statistically significant(P<0.01).7.There was no significant difference in BDNF level between HP+HD group and HD group before and after treatment(P>0.05);The level of BDNF in HP+HD group was(48.55±2.95)pg/ml,which was higher than that in HD group(48.03±2.95)pg/ml,but the difference was not statistically significant(P>0.05).Conclusion1.The levels of NT-4 and IL-31 are significantly increased in patients with uremia pruritus and is positively correlated with the severity of the disease,which proves that IL-31 and NT-4 may be closely related to the occurrence of uremia pruritus and is an important indicator reflecting the severity of uremia pruritus.2.After treatment,the skin pruritus,the levels of β2-MG,hs-CRP,iPTH,IL-31,NT-4 in both groups were all decreased than before treatment,and the improvement of HP+HD group was better than that of HD group(P<0.05).These results indicated that HP+HD treatment could relieve the skin itching of patients by reducing some itching related factors,and the effect was significantly better than that of HD treatment alone.