Bergasa Nora V
Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, 630 West 168th Street, P&S 10- 508, New York, NY 10032, USA.
Curr Gastroenterol Rep. 2004 Feb;6(1):10-6. doi: 10.1007/s11894-004-0020-7.
Pruritus is a complication of liver disease. It can have a marked negative impact on quality of life; when intractable, it is an indication for liver transplantation. The cause of this type of pruritus is unknown. There is, however, evidence to suggest that the pruritus associated with liver disease is mediated, at least in part, by endogenous opioids. A central mechanism has been proposed. Therapeutic interventions have concentrated on the removal of presumed and unknown pruritogens from the circulation, hepatic enzyme induction, and, over the past decade, opiate antagonists, the first specific treatment for the pruritus of cholestasis. Other pharmacologic interventions that change neurotransmission have recently been reported to decrease the pruritus in patients with liver disease, as has a newly developed system that applies albumin-based dialysis. These interventions are promising, but they must be tested in properly controlled behavioral trials.
瘙痒是肝病的一种并发症。它会对生活质量产生显著的负面影响；当瘙痒难以控制时，是肝移植的指征。这类瘙痒的病因尚不清楚。然而，有证据表明，与肝病相关的瘙痒至少部分是由内源性阿片类物质介导的。一种中枢机制已被提出。治疗干预措施集中在从循环中清除假定的和未知的致痒原、诱导肝酶，以及在过去十年中使用阿片拮抗剂，这是胆汁淤积性瘙痒的首个特异性治疗方法。最近有报道称，其他改变神经传递的药物干预措施可减轻肝病患者的瘙痒，一种新开发的基于白蛋白透析的系统也有此效果。这些干预措施很有前景，但必须在适当控制的行为试验中进行测试。
