2022 Fiscal Year Final Research Report
Searching a novel pathogenetic mechanism of pruritus in hemodialysis patients for developing a new treatment -intracranial pressure and B-type natriuretic peptide in cerebrospinal fluid-
| Project/Area Number |
17K09039
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Research Field |
Pain science
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| Research Institution | Juntendo University |
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Principal Investigator |
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| Co-Investigator(Kenkyū-buntansha) |
遠藤 未来美 順天堂大学, 医学(系)研究科(研究院), 博士研究員 (70625855)
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| Project Period (FY) |
2017-04-01 – 2023-03-31
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| Keywords | 血液透析 / 痒み / 頭蓋内圧 / BNP |
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| Outline of Final Research Achievements |
We made a hypothesis that elevated concentration of B-type natriuretic peptide (BNP) in cerebrospinal fluid is a novel pruritic cause in hemodialysis patients. Since we could not ethically obtain cerebrospinal fluid, we measured intracranial pressure using an optical coherence tomography (OCT) as a surrogate marker of cerebrospinal BNP. The OCT clearly revealed the morphological changes around optic disc which is affected by intracranial pressure. We found that there are statistically significant correlation between pruritic VAS score and Rim area, and between dermatology life quality index (DLQI) and Rim area、Cup volume、average Cup/Disc (C/D) ratio and vertical C/D ratio. Each parameter derived OCT consistently moved in parallel with intracranial pressure. The correlation between VAS and intracranial pressure and between DLQI and intracranial pressure suited as our prediction. These findings suggest that elevated intracranial pressure worsen pruritus in hemodialysis patients.
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| Free Research Field |
腎臓内科学
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| Academic Significance and Societal Importance of the Research Achievements |
透析患者では透析方法の改良やステロイドや中枢性に作用する薬剤によっても痒みの改善がみられない患者が存在するため、未知の発痒機序の存在が示唆される。本研究は髄液中のBNPが上昇すると痒みが増悪するとの仮説にて開始した。倫理的な問題を解決するためサロゲートマーカーの頭蓋内圧と痒み・QOLスコアとの相関を検討したところ、頭蓋内圧亢進と痒み・QOLスコアには有意な相関が認められた。この知見は頭蓋内圧亢進が透析患者の痒みを誘発する新規の機序であることが示唆する。髄液中BNPを測定するというさらに進んだ研究の端緒となるとともに、一般的な頭蓋内圧亢進に対する治療が痒みに対する新規治療法であることを示唆する。
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