Gittlen S D, Schulman E S, Maddrey W C
Department of Medicine, Jefferson Medical College, Philadelphia, PA.
Gut. 1990 Jan;31(1):96-9. doi: 10.1136/gut.31.1.96.
Pruritus is a frequent symptom in chronic cholestatic liver disease. To date, no single causative mechanism has been identified. We examined venous plasma concentrations of the known pruritogen, histamine, using a highly sensitive radioenzymatic assay in 42 patients with chronic cholestatic liver disease, and in normal controls. The mean plasma histamine level was significantly greater in chronic cholestatic liver disease patients (275 (117) pg/ml; X (SD) than in controls (140 (72) pg/ml, n = 20) (p less than 0.0001). No significant differences were found between histamine concentrations in the two chronic cholestatic liver disease subgroups: primary biliary cirrhosis and sclerosing cholangitis. Histamine concentrations were significantly greater (p less than 0.01) in the pruritic (319 (132) pg/ml) as compared with the non-pruritic (227 (75) pg/ml) chronic cholestatic liver disease patients. The histaminase activity was equivalent in patients and controls. The finding of raised histamine concentrations in chronic cholestatic liver disease suggests in vivo mast cell activation and a potential role for its mediators in the pruritus characteristic of these disorders.
瘙痒是慢性胆汁淤积性肝病的常见症状。迄今为止，尚未确定单一的致病机制。我们使用高灵敏度放射酶分析法检测了42例慢性胆汁淤积性肝病患者及正常对照者静脉血浆中已知的致痒原组胺的浓度。慢性胆汁淤积性肝病患者的血浆组胺平均水平（275（117）pg/ml；X（标准差））显著高于对照组（140（72）pg/ml，n = 20）（p < 0.0001）。在原发性胆汁性肝硬化和硬化性胆管炎这两个慢性胆汁淤积性肝病亚组中，组胺浓度未发现显著差异。与无瘙痒的慢性胆汁淤积性肝病患者（227（75）pg/ml）相比，有瘙痒的患者组胺浓度显著更高（p < 0.01）（319（132）pg/ml）。患者和对照者的组胺酶活性相当。慢性胆汁淤积性肝病中组胺浓度升高的发现提示体内肥大细胞活化，及其介质在这些疾病特征性瘙痒中可能发挥作用。
