Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain.
J Hepatol. 2010 Aug;53(2):307-12. doi: 10.1016/j.jhep.2010.02.031. Epub 2010 May 7.
BACKGROUND & AIMS: Albumin dialysis using molecular adsorbent recirculating system (MARS) is a new procedure for treating resistant pruritus from cholestasis, but it is usually published as a case report or a short series. Therefore, we analyzed patients with resistant pruritus treated with MARS from three centers, to assess the changes on pruritus and the indices of cholestasis.
Twenty patients (12 female, mean age: 51+/-3.4 years) with chronic cholestatic liver disease or chronic liver-graft rejection were evaluated. The severity of pruritus was assessed using a visual analogue scale (VAS) before and after treatment, and 30 days thereafter. Liver tests, including total bilirubin, alkaline phosphatase, gamma-glutamyl-transferase, cholesterol, triglycerides, and total bile acid were also determined, as well as the number of sessions and the coupled procedure (dialysis or perfusion).
Albumin dialysis resulted in a decrease of pruritus (VAS: from 70.2+/-4.8 to 20.1+/-4.2, p<0.001), which partially resumed after 30 days (38.7+/-6.6). VAS decreased by 72% immediately after treatment and by 51% after 1 month. Pruritus decreased in all but one patient. MARS resulted in a significant bile acid decrease of 41% after treatment and by 37% after 1 month. The effect of MARS on pruritus and markers of cholestasis was similar in patients with different diseases and was independent of the coupled procedure. The improvement of pruritus in individuals was positive in 75% of patients. No major adverse effects were observed.
Albumin dialysis using MARS is an effective procedure for managing resistant pruritus in most patients with chronic cholestasis and graft rejection.
使用分子吸附再循环系统（MARS）进行白蛋白透析是治疗胆汁淤积性难治性瘙痒的一种新方法，但通常以病例报告或短篇系列形式发表。因此，我们分析了来自三个中心的接受 MARS 治疗的难治性瘙痒患者，以评估瘙痒和胆汁淤积相关指标的变化。
评估了 20 例（12 例女性，平均年龄：51+/-3.4 岁）患有慢性胆汁淤积性肝病或慢性肝移植排斥反应的患者。治疗前后及治疗后 30 天，使用视觉模拟量表（VAS）评估瘙痒严重程度。还测定了肝试验，包括总胆红素、碱性磷酸酶、γ-谷氨酰转移酶、胆固醇、甘油三酯和总胆汁酸，以及治疗次数和耦合程序（透析或灌注）。
白蛋白透析导致瘙痒（VAS：从 70.2+/-4.8 降至 20.1+/-4.2，p<0.001）降低，30 天后部分恢复（38.7+/-6.6）。VAS 在治疗后立即降低 72%，1 个月后降低 51%。除 1 例患者外，所有患者瘙痒均减轻。MARS 治疗后胆汁酸降低 41%，1 个月后降低 37%。MARS 对瘙痒和胆汁淤积标志物的作用在不同疾病的患者中相似，且与耦合程序无关。75%的患者瘙痒改善呈阳性。未观察到主要不良事件。
MARS 白蛋白透析是治疗大多数慢性胆汁淤积和移植排斥反应患者难治性瘙痒的有效方法。
