Tytgat Institute for liver and intestinal research, Department of gastroenterology and hepatology, Academic Medical Center, S1-164, University of Amsterdam, Meibergdreef 69-71, NL-1105 BK Amsterdam, The Netherlands.
Clin Res Hepatol Gastroenterol. 2011 Feb;35(2):89-97. doi: 10.1016/j.clinre.2010.10.007.
Pruritus is frequently reported by patients with cholestatic hepatobiliary diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, intrahepatic cholestasis of pregnancy and hereditary cholestatic syndromes, but may accompany almost any other liver disease. Increased concentrations of bile salts, histamine, progesterone metabolites or endogenous opioids have been controversially discussed as potential pruritogens in cholestasis in the past. Most recently, novel insights unravelled lysophosphatidic acid (LPA), a potent neuronal activator, as a potential pruritogen in pruritus of cholestasis. Nevertheless, the pathogenesis of pruritus in cholestasis is still not clearly defined and current antipruritic treatment strategies provide relief only in a part of the affected patients. Based on recent experimental and clinical findings, this review outlines the actual insight in pathogenesis of pruritus in cholestasis and summarizes evidence-based and experimental therapeutic interventions for cholestatic patients suffering from itch.
瘙痒症经常发生在原发性胆汁性肝硬化、原发性硬化性胆管炎、妊娠肝内胆汁淤积症和遗传性胆汁淤积综合征等胆汁淤积性肝胆疾病患者中，但也可能伴随几乎任何其他肝病。过去曾有争议地讨论过胆汁盐、组胺、孕酮代谢物或内源性阿片类物质浓度增加是否为胆汁淤积症中潜在的瘙痒原。最近，新的研究结果揭示了溶血磷脂酸（LPA），一种有效的神经元激活剂，作为胆汁淤积性瘙痒的潜在瘙痒原。然而，胆汁淤积性瘙痒症的发病机制仍不明确，目前的止痒治疗策略仅能为部分受影响的患者提供缓解。基于最近的实验和临床发现，本文综述了胆汁淤积性瘙痒症发病机制的最新认识，并总结了有循证医学证据和实验依据的针对瘙痒的胆汁淤积症患者的治疗干预措施。
