Kanai H, Nagashima A, Hirakata E, Hirakata H, Okuda S, Fujimi S, Fujishima M
Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka City, Japan.
Life Sci. 1995;57(3):207-13. doi: 10.1016/0024-3205(95)00264-7.
Pruritus is a very common complication in chronic hemodialysis (HD) patients, however the exact mechanism for this affliction is still not known. Anti-histaminics usually failed to alleviate uremic pruritus. In others, an anti-allergic drug, which inhibits the release of chemical mediators, such as leukotrienes or histamine from mast cells, was reported to be effective. We evaluated the values of leukotriene B4 and interleukin 6 in HD patients with pruritus and the effect of an anti-allergic drug on these factors. Leukotriene B4, interleukin-6, C3a, C5a, the number of eosinophil and IgE at 0, 15 and 180 minutes after the start of regular HD in 11 HD patients suffering from pruritus and as well as in 11 HD patients without pruritus were examined. These HD patients in both groups showed significantly higher (p < 0.001) values of leukotriene B4 and C3a compared to healthy non-HD subjects. There was no difference in the leukotriene B4, interleukin-6, IgE, C3a and C5a levels between the patients with and without pruritus. Two mg/day of azelastin hydrochloride, an anti-allergic drug was orally given to the pruritus group for 3 weeks. In 5 of 11 patients, the pruritus symptoms disappeared, while in 4 of 11 they improved. Independent of the effect of the drug on pruritus, leukotriene B4 levels significantly decreased compared with those before the administration of this drug in the pruritus group (p < 0.01). Interleukin 6, C3a, C5a and the number of eosinophils demonstrated no significant change. In conclusion, although azelastin hydrochloride was effective in treating pruritus and also suppressed leukotriene B4 levels in hemodialysis patients, the high leukotriene B4 activity itself did not seem to be related to the development of pruritus in these patients.
瘙痒是慢性血液透析（HD）患者中非常常见的并发症，然而这种病症的确切机制仍不清楚。抗组胺药通常无法缓解尿毒症性瘙痒。在其他患者中，据报道一种抑制化学介质（如白三烯或组胺）从肥大细胞释放的抗过敏药物是有效的。我们评估了瘙痒性HD患者中白三烯B4和白细胞介素6的值以及一种抗过敏药物对这些因素的影响。检测了11例瘙痒性HD患者以及11例无瘙痒的HD患者在常规HD开始后0、15和180分钟时的白三烯B4、白细胞介素-6、C3a、C5a、嗜酸性粒细胞数量和IgE。与健康的非HD受试者相比，两组中的这些HD患者的白三烯B4和C3a值均显著更高（p < 0.001）。有瘙痒和无瘙痒患者之间的白三烯B4、白细胞介素-6、IgE、C3a和C5a水平没有差异。给瘙痒组口服2毫克/天的抗过敏药物盐酸氮卓斯汀，持续3周。11例患者中有5例瘙痒症状消失，11例中有4例症状改善。与药物对瘙痒的作用无关，瘙痒组中白三烯B4水平与给药前相比显著降低（p < 0.01）。白细胞介素6、C3a、C5a和嗜酸性粒细胞数量没有显著变化。总之，虽然盐酸氮卓斯汀在治疗瘙痒方面有效，并且还抑制了血液透析患者的白三烯B4水平，但高白三烯B4活性本身似乎与这些患者瘙痒的发生无关。
