Ntshav Qab Zib Qib IL-31 nyob rau hauv Cov Neeg Mob Mob Raum Kab Mob Sib Kis-Associated Pruritus: Peb Yuav Ua Li Cas?

Abstract:Chronic-kidney-disease-associated pruritus(CKD-aP) yog ib qho ntawm cov tsos mob tshwm sim ntau tshaj plaws thiab hnyav rau cov neeg mob uas tau lim ntshav, thiab nws cov etiopathogenesis tseem tsis tau pom tag nrho. Txoj kev tshawb no tau tsim los tshawb xyuas qhov muaj peev xwm pab tau ntawm interleukin-31 (IL-31) rau cov kab mob khaus khaus hauv cov neeg mob uas tau kho hemodialysis (HD). Peb tau soj ntsuam cov qib ntshav ntawm IL-31 hauv HD cov neeg mob uas muaj pruritus, hauv HD cov neeg mob uas tsis muaj pruritus thiab tswj kev noj qab haus huv, nrog rau kev sib raug zoo rau qhov mob hnyav. Txoj kev tshawb no tau tso npe rau 175 tus neeg laus. Cov neeg koom tau muab faib ua peb pawg. Pawg A suav nrog 64 tus neeg mob ntawm kev saib xyuas HD nrogCKD-aP ib, Pawg B suav nrog 62 tus neeg mob ntawm kev saib xyuas HD tsis qhia CKDaP thiab Pab Pawg C suav nrog 49 kev tswj hwm kev noj qab haus huv. Pruritus qhov hnyav tau raug ntsuas los ntawm kev ntsuas tus lej ntsuas (NRS), thiab qib ntshav ntawm IL-31 raug ntsuas. Cov txiaj ntsig tau pom tias IL-31 qib ntshav qab zib tau nce siab dua hauv pawg khaus (p < 0.001) in comparison to the patients free from pruritus. Moreover, a marginal trend towards significance (r = 0.242, p = 0.058) tau pom nyob nruab nrab ntawm IL-31 qib ntshav qab zib thiab khaus khaus. Peb txoj kev tshawb fawb txhawb nqa kev tshawb pom yav dhau los ntawm lub luag haujlwm txuas ntxiv ntawm IL-31 hauv kev txhim kho CKD-aP.

Ntsiab lus:interleukin -31;chronic-kidney-disease-associated pruritus; cov neeg mob hemodialysis; raum tsis ua haujlwm

Kev Pabcuam Tseem Ceeb:Elevated serum interleukin-31 (IL-31) qib tau pom nyob rau hauv cov neeg mob uas muaj CKD-aP piv rau cov neeg mob uas tsis khaus hemodialysis thiab tswj kev noj qab haus huv. Yog li, txoj kev tshawb no taw qhia txog qhov ua tau ntawm IL-31 rau cov kab mob khaus khaus hauv cov neeg mob uas tau kho hemodialysis.

1. Taw qhia

Cov kab mob raum mob-koom nrog pruritus(CKD-aP) yog ib qho ntawm cov tsos mob tshwm sim ntau tshaj plaws thiab ua rau muaj kev cuam tshuam rau cov neeg mob uas tau lim ntshav. Qhov kev nthuav dav ntawm CKD-aP tau hloov pauv ntau xyoo dhau los, tsis tau raws li kev tshawb fawb pom zoo tshaj plaws ntawm hemodialysis (HD) uas suav nrog cov neeg mob los ntawm 12 lub teb chaws sib txawv, kwv yees li 40% ntawm cov neeg mob uas muaj kab mob hauv lub raum kawg (ESRD) qhia. nruab nrab-rau-hnyav pruritus [1]. Txog tam sim no, cov kev tshawb fawb tau ua pov thawj pom tseeb tias tus mob no tsis yog tsuas yog ua rau pw tsaug zog, mus ob peb vas, kev ua ub no thiab lub neej zoo (QoL), tab sis nws kuj ua rau muaj kev pheej hmoo tuag ntawm HD cov neeg mob [2,3]. Txawm hais tias muaj kev nthuav dav thoob ntiaj teb siab, qhov teeb meem no zoo li tsis tshua muaj txiaj ntsig hauvkev kho mob. Yog vim li cas rau qhov kev hloov no yuav yog qhov tsis muaj kev paub txog kev kho mob zoo rau CKD-aP [4]. Txawm hais tias muaj kev tshawb fawb ntev ntev thiab ntau qhov kev xav, lubcomplex etiopathogenesis ntawm CKD-aPtseem tsis tau pom tag nrho. Ntawm qhov tseem ceeb tshaj plaws uas ua rau muaj kev txhim kho ntawm CKD-aP, cov hauv qab no tuaj yeem hais tau: uremic toxins (UTs), kev tiv thaiv kab mob tsis zoo, hloov pauv opioid kis, tawv nqaij qhuav (xerosis), neuropathy, dialysis modality thiab nws cov tsis muaj [5] . Yog li ntawd, kev kho kub-txheej txheem hauv qhov xwm txheej no tseem tsis tau meej meej, thiab kev txiav txim siab txog kev kho mob zoo tseem yog ib qho nyuaj rau cov kws kho mob dermatologist thiab nephrologists. CKD-aP feem ntau rov tshwm sim thiab tsis teb rau cov kev kho mob uas muaj. Kev tshawb fawb ntxiv hauv thaj chaw ntawm pathophysiology ntawm CKD-aP tuaj yeem ua rau muaj kev hloov pauv hauv kev tswj hwm kev kho mob ntawm HD cov neeg mob uas muaj pruritus.

Txo lub raum ua haujlwm hauv cov neeg mob nrogmob raum mob (CKD)txwv tsis pub tshem tawm ntau yam metabolites, uas yog hu ua UTs. Tsis ntev los no, ntau thiab ntau cov kev tshawb fawb qhia txog lub luag haujlwm tseem ceeb ntawm UTs hauv kev nce qib ntawm CKD thiab nws cov teeb meem loj heev. Nyob rau hauv daim ntawv teev cov nruab nrab molecules cais raws li UTs, ob peb interleukins tuaj yeem pom, uas yog interleukin -10, -18, -1 thiab -6 [6]. Yog li, lub luag haujlwm ntawm lub cev tiv thaiv kab mob zoo li ua lub luag haujlwm tseem ceeb hauv CKD-aP. Qee cov kev tshawb fawb taw qhia txog qhov tsis txaus ntseeg ntawm T pab (TH) kev sib txawv ntawm tes ntawm Th1 qhov tseem ceeb hauv cov neeg mob nrog CKD-aP, uas tso cai rau ib tus xav txog qhov xwm txheej no raws li qhov tshwm sim ntawm qhov tshwm sim. Qhov kev xav no tau txais kev txhawb nqa los ntawm cov qib ntshav siab ntawm C-reactive protein (CRP) thiab inflammatory cytokines interleukin (IL)-2 thiab IL-6 hauv HD cov neeg mob uas muaj pruritus piv rau cov tsis muaj pruritus [7 ,8] ib.

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Interleukin-31 (IL-31) yog T-cell-derived cytokine uas koom nrog hauv cov tsos mob ntawm pruritus, thiab ob qho tib si IL-31 thiab nws cov receptor tau dhau los ua cov hom phiaj kho mob rau ntau yam. pruritic mob [9] Nws tau pom tias IL-31 taw qhia los ntawm heterodimeric receptor complex tsim los ntawm IL-31R subunit thiab oncostatin M receptor subunit (OSMR), qhia txog ntawm keratinocytes thiab cov hlwb epithelial, induces mob dermatitis thiab pruritus nyob rau hauv cov nas transgenic [10] Ntxiv mus, qib ntshav ntawm IL-31 tau nce siab hauv cov neeg mob atopic dermatitis. Cov kev tshawb fawb tau qhia txog kev sib raug zoo ntawm IL{10}} qib ntshav qab zib thiab Scoring Atopic Dermatitis Index (SCORAD) thiab tseem nyob nruab nrab ntawm IL-31 qib thiab qhov hnyav ntawm pruritus-[11–13]. Cov kev tshawb pom zoo sib xws tau tshaj tawm hauv kev tshawb fawb soj ntsuam txog lwm yam kab mob pruritic dermatological, xws li prurigo nodularis thiab psoriasis [14,15]. Txawm hais tias feem ntau ntawm cov kev tshawb fawb tshaj tawm txog tam sim no tau tshaj tawm txog qib IL{18}} nce qib hauv cov neeg mob uas muaj CKD-aP, kev sib raug zoo ntawm IL-31 thiab khaus khaus tseem tsis meej [16–19]. Yog li, txoj kev tshawb no tau tsim los tshawb xyuas qhov ua tau ntawm IL -31 rau cov kab mob khaus khaus hauv cov neeg mob uas kho HD. Peb tsom tsis tsuas yog txhawm rau ntsuas qib ntshav ntawm IL-31 hauv HD cov neeg mob uas muaj pruritus, hauv HD cov neeg mob uas tsis muaj pruritus thiab tswj kev noj qab haus huv, tab sis kuj txhawm rau txhawm rau txheeb xyuas qib ntshav ntawm IL-31 nrog khaus hnyav. Txhawm rau ntsuas tus yam ntxwv thiab qhov hnyav ntawm qhov khaus, Tus lej ntsuas ntsuas ntsuas (NRS) thiab cov cuab yeej tshiab-Uraemic Pruritus hauv Dialysis Patient (UP-Dial) cov lus nug-tau siv.

2. Cov txiaj ntsig

Hauv pab pawg ntawm HD cov neeg mob raug kev txom nyem los ntawmCKD-aP ib, 50% yog txiv neej, thiab qhov nruab nrab hnub nyoog yog 61.1 ± 15.9 xyoo. Qhov nruab nrab NRS qhab nia yog 4.9 ± 2.2 ntsiab lus. Raws li NRS kev txiav tawm, mob me me tau tshaj tawm hauv 14.5% ntawm cov neeg mob, nruab nrab hauv 59.7%, hnyav hauv 22.6% thiab hnyav heev hauv 3.2%. Qhov nruab nrab UP-Dial qhab nia yog 14.2 ± 9.8 ntsiab lus. Hauv 58% ntawm cov neeg mob CKD-aP, khaus cuam tshuam rau lawv txoj kev pw tsaug zog, thiab tsuas yog 29% tsis qhia txog qhov khaus khaus ntawm cov dej num hauv qab no: kev ua haujlwm lossis kev kawm, kev sib raug zoo, kev xav lossis kev sib deev. Qhov nruab nrab qib ntshav ntawm IL-31 yog 679.9 ± 1112.3 pg/mL hauv ib pawg ntawm HD cov neeg mob qhiaCKD-aP ib, 176.1 ± 290.7 pg/mL nyob rau hauv ib pab pawg neeg ntawm HD cov neeg mob uas tsis raug mob los ntawm CKD-aP thiab 57.3 ± 65.1 pg/mL nyob rau hauv ib pab pawg neeg ntawm kev noj qab nyob zoo tswj (Daim duab 1). IL{{10}} qib ntshav qab zib tau siab dua hauv pawg khaus khaus (p < 0.001) piv rau cov neeg mob uas tsis muaj pruritus. Ntxiv mus, muaj qhov sib txawv tseem ceeb (p < 0.001) hauv IL-31 qib ntshav qab zib ntawm HD cov neeg mob uas muaj thiab tsis muaj pruritus thiab kev noj qab haus huv tswj (p < 0.001 thiab p=0.019, ntsig txog).

Daim duab 1. Qib ntshav ntawm IL-31 hauv pawg kawm. IL-31-interleukin-31, Pawg A-cov neeg mob nrog ESRD ntawm kev saib xyuas HD qhia CKD-aP, Pab pawg B-cov neeg mob nrog ESRD ntawm kev saib xyuas HD tsis qhiaCKD-aP ib, Pawg C- noj qab nyob zoo contr

Txawm hais tias cov txiaj ntsig tau hais los saum toj no, qhov sib txawv ntawm qhov tseem ceeb (r=0.242, p=0.058) tau pom nyob nruab nrab ntawm IL-31 qib ntshav qab zib thiab qhov khaus khaus hnyav tshaj plaws thaum lub sijhawm 3 hnub dhau los raws li kev soj ntsuam los ntawm NRS (Daim duab 2). Daim ntawv nug UP-Dial tag nrho cov qhab nia sib raug zoo nrog NRS (r=0.399, p=0.001). Tsis tas li ntawd, txhua qhov chaw ntawm UP-Dial tau pom muaj kev sib raug zoo nrog NRS cov qhab nia (cov ntaub ntawv nthuav dav tsis qhia). Txawm li cas los xij, kev sib raug zoo ntawm qib ntshav ntawm IL-31 thiab UP-Dial tag nrho cov qhab nia tsis yog qhov tseem ceeb.

Daim duab 2. Kev vam meej ntawm IL-31 qib ntshav qab zib thiab NRS tus qhab nia (r=0.242, p=0.058). NRS-Numerical Rating Scale, IL-31-interleukin-31, voj voog-cov ntshav qab zib theem ntawm interleukin-31.