Recent advances in pathogenesis and management of pruritus in cholestatic liver disease
-
摘要: 瘙痒是胆汁淤积性肝病如原发性胆汁性肝硬化、原发性硬化性胆管炎和妊娠期肝内胆汁淤积症的一个常见症状。既往研究的胆汁淤积性瘙痒的潜在致痒因子有胆盐、组胺、孕酮代谢产物、内源性阿片样物质和溶血性磷脂酸等。然而,胆汁淤积性瘙痒的确切发病机制尚不清楚,现有的止痒方法仅可使部分患者症状得到缓解,新的止痒方法已被提出和(或)正在研究中。在回顾近期关于胆汁淤积型肝病并发皮肤瘙痒的发病机制和治疗的实验和临床试验,以便提高对胆汁淤积性瘙痒的认识和治疗。Abstract: Pruritus is one of the common clinical manifestations of cholestatic liver diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, and intrahepatic cholestasis of pregnancy. Potential incentives of itching include bile salts, histamine, progesterone metabolites, endogenous opioid substances, and lysophosphatidic acid, according to previous studies. However, the exact pathogenesis of cholestatic pruritus remains unclear, and the current treatment can only alleviate the symptoms in some of the patients. Novel methods for treating pruritus have been proposed and /or are being studied. The recent experimental and clinical studies on the pathogenesis and treatment of pruritus in cholestatic hepatitis are reviewed, in order to improve the understanding and management of cholestatic pruritus.
-
Key words:
- cholestasis /
- liver diseases /
- pruritus /
- review
-
[1]SCHAEFER B, SCHAEFER F, WITTMER D, et al.Molecular Adsorbents Recirculating System dialysisin children with cholestatic pruritus[J].Pediatr Nephrol, 2012, 27 (5) :829-834. [2]KREMER AE, BEUERS U, OUDE-ELFERINK RP, et al.Pathogenesis and treatment of pruritus in cholestasis[J].Drugs, 2008, 68 (15) :2163-2182. [3]ANONYMOUS.Relieve pruritus associated with cholestatic disease by treating the underlying cause and using antipuritic agents[J].Drugs Ther Perspectives, 2009, 25 (7) :20-23. [4]MELZACK R, WALL PD.Pain mechanism:a new theory[J].Scinece, 1965, 150 (3699) :971-979. [5]SHELLEY WB, ARTHUR RP.The neurohistology and neurophysiology of the itch sensation in man[J].AMA Arh Derm, 1957, 76 (3) :296-323. [6]McMAHON SB, KOLTZENBURG M.Itching for an explanation[J].Trends Neurosci, 1992, 15 (12) :497-501. [7]SCHMELZ M, SCHMIDT R, BICKEL A, et al.Specific C-receptors for itchin human skin[J].J Neurosci, 1997, 17 (20) :8003-8008. [8]SCHMELZ M, SCHMIDT R, WEIDNER C, et al.Chemical response patternof different classes of C-nociceptors to pruritogens and algogens[J].J Neurophysiol, 2003, 89 (5) :2441-2448. [9]STAPELBROEK JM, van ERPECUM KJ, KLOMP LW, et al.Nasobiliary drainage induces long-lasting remission in benign recurrent intrahepatic cholestasis[J].Hepatology, 2006, 43 (1) :51-53. [10]LEBOVICS E, SEIF F, KIM D, et al.Pruritus in chronic hepatitis C:association with high serum bile acids, advanced pathology, and bile duct abnormalities[J].Dig Dis Sci, 1997, 42 (5) :1094-1099. [11]PUSL T, BEUERS U.Extrahepatic manifestations of cholestatic liver diseases pathogenesis and therapy[J].Clin Rev Allergy Immunol, 2005, 28 (2) :147-157. [12]GAO YJ, WANG J, LIU XC.Update on pathogenesis and management of pruritus in cholestatic liver disease[J].Chin J Gastroenterol Hepatol, 2013, 22 (3) :286-290. (in Chinese) 高永健, 王静, 刘晓川.胆汁淤积性肝病相关皮肤瘙痒的机制和治疗进展[J].胃肠病学和肝病学杂志, 2013, 22 (3) :286-290. [13]GREEN AD, YOUNG KK, LEHTO SG, et al.Influnce of genotype, dose and sex on pruritogen-induced scratching behavior in the mouse[J].Pain, 2006, 124 (1-2) :50-58. [14]PUSL T, BEUERS U.Intrahepatic cholestasis of pregnancy[J].Orphanet J Rare Dis, 2007, 2:26. [15]DAVIS M.Cholestasis and endogenous opioids:liver disease and exogenous opioid pharmacokinetics[J].Clin Pharmacokinet, 2007, 46 (10) :825-850. [16]BERGASA NV, SABOL SL, YOUNG WS 3rd, et al.Cholestasis is associated with preproenkephalin mRNA expression in the adult rat[J].Am J Physiol, 1995, 268 (2Pt1) :g346-g354. [17]KREMER AE, MARTENS JJ, KULIK W, et al.Lysophosphatidic acid is a potential mediator of cholestatic pruritus[J].Gastroenterology, 2010, 139 (3) :1008-1018. [18]DATTA DV, SHERLOCK S.Cholestyramine for long term relief of the pruritus complicating intrahepatic cholestasis[J].Gastroenterology, 1966, 50 (3) :323-332. [19]BERG CL.Use of colesevelam hydrochloride (Welchol) as a novel therapeutic agent for the management of refractory pruritus in chronic liver disease[J].Hepatology, 2001, 34:541a. [20]TANDON P, ROWE BH, VANDERMEER B, et al.The efficacy and safety of bile Acid binding agents, opioid antagonists, or rifampin in the treatment of cholestasis-associated pruritus[J].Am J Gastroenterol, 2007, 102 (7) :1528-1536. [21]THOMTON JR, LOSOWSKY MS.Opioid peptides and primary biliary cirrhosis[J].BMJ, 1988, 297 (6662) :1501-1504. [22]WOLFHAGEN FH, STERNIERI E, HOP WC, et al.Oral naltrexone treatment for cholestatic pruritus:a double-blind, placebocontrolled study[J].Gastroenterology, 1997, 113 (4) :1264-1269. [23]WIKSTRM B, GELLERT R, LADEFOGED SD, et al.Kappaopioid system in uremic pruritus:multicenter, randomized, double-blind, placebo-controlled clinical studies[J].Am Soc Nephrol, 2005, 16 (12) :3742-3747. [24]BERGASA NV.Medical palliation of the jaundiced patient with pruritus[J].Gastroenterol Clin North Am, 2006, 35 (1) :113-123. [25]PRICE TJ, PATTERSON WK, OLVER IN.Rifampicin as treatment for pruritus in malignant cholestasis[J].Support Care Cancer, 1998, 6 (6) :533-535. [26]PRINCE MI, BURT AD, JONES DE.Hepatitis and liver dysfunction with rifampicin therapy for pruritus in primary biliary cirrhosis[J].Gut, 2002, 50 (3) :436-439. [27]SCHWRER H, RAMADORI G.Improvement of cholestatic pruritus by ondansetron[J].Lancet, 1993, 341 (8855) :1277. [28]SCHWRER H, HARTMANN H, RAMADORI G.Relief of cholestatic pruritus by a novel class of drugs:5-hydroxytryptamine type 3 (5-HT3) receptor antagonists:effectiveness of ondanstron[J].Pain, 1995, 61 (1) :33-37. [29]NEFF GW, O'BRIEN CB, REDDY KR, et al.Preliminary observation with dronabinol in patients with intractable pruritus secondary to cholestatic liver disease[J].Am J Gastroenterol, 2002, 97 (8) :2117-2119. [30]STNDER S, REINHARDT HW, LUGER TA.Topical cannabinoid agonists.An effective new possibility for treating chronic pruritus[J].Hautarzt, 2006, 57 (9) :801-807. [31]BORGEAT A, WILDER-SMITH OH, MENTHA G.Subhynotic doses of propofol relieve pruritus associated with liver disease[J].Gastroenterology, 1993, 104 (1) :244-247. [32]BALLANTYNE JC, LOACH AB, CARR DB.Itching after epidural and spinal opiates[J].Pain, 1988, 33 (2) :149-160. [33]PUSL T, DENK GU, PARTHOFER KG, et al.Plasma separation and anion adsorption transiently relieve intractable pruritus in primary biliary cirrhosis[J].J Hepatol, 2006, 45 (6) :887-891. [34]NG VL, RYCKMAN PC, PORTA G, et al.Long-term outcome after partial external biliary diversion for intractable pruritus with intrahepatic cholestasis[J].J Pediatr Gastroenterol Nutr, 2000, 30 (2) :152-156. [35]SONG XA, WEI ZM, SONG M, et al.Recent advances in traditional Chinese and western medicine diagnosis and treatment of itchy skin secondary to cholestatic liver disease[J].Infect Dis Info, 2012, 25 (6) :381-384. (in Chinese) 宋雪艾, 魏智民, 宋梅, 等.胆汁淤积性肝病继发皮肤瘙痒中西医诊疗研究进展[J].传染病信息, 2012, 25 (6) :381-384. [36]LI ZC.Efficacy of modified Dachaihu decoction combined with Xiaofeng powder plus naloxone in treatment of cholestatic pruritus:a report of 32cases[J].Clin J Anhui Tradit Chin Med, 2003, 15 (6) :489-490. (in Chinese) 李正才.大柴胡汤合消风散加减配合纳络酮治疗胆汁淤积性瘙痒症32例[J].安徽中医临床杂志, 2003, 15 (6) :489-490. [37]HUANG YK.Efficacy of integrated traditional Chinese and Western medicine therapy for pruritus in patients with jaundice[J].Mod J Integr Tradit Chin West Med, 2009, 18 (20) :2387-2388. (in Chinese) 黄永康.中西医结合治疗黄疸患者瘙痒症[J].现代中西医结合杂志, 2009, 18 (20) :2387-2388. [38]CHEN XH.Efficacy of herbal fumigation and washing recipe in treating pruritus among patients with cholestatic liver disease[J].Shanghai Nurs, 2011, 11 (2) :51-52. (in Chinese) 程雪花.中药熏洗治疗胆汁淤积性肝病患者皮肤瘙痒的疗效[J].上海护理, 2011, 11 (2) :51-52. [39]LIU XZ, JIN QX, YAO GF.Research advances in liver disease with pruritus[J].Chin J Integr Tradit West Med Liver Dis, 2009, 19 (5) :317-319. (in Chinese) 刘西忠, 金庆香, 姚桂芳.肝病并皮肤瘙痒的研究进展[J].中西医结合肝病杂志, 2009, 19 (5) :317-319.
本文二维码
计量
- 文章访问数: 3163
- HTML全文浏览量: 21
- PDF下载量: 814
- 被引次数: 0