Kremer A E, Oude Elferink R P J, Beuers U
Medizinische Klinik, Gastroenterologie, Hepatologie, Pneumologie und Endokrinologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland.
Hautarzt. 2012 Jul;63(7):532-8. doi: 10.1007/s00105-011-2321-8.
Pruritus is a common symptom of hepatobiliary disorders and may considerably diminish quality of life. Cholestatic pruritus exerts a circadian rhythm and is typically most severe in the evening hours and early at night. Itching is reported often to be most intense at the palms and the soles, but may also be generalized. The pathophysiological mechanisms of cholestatic pruritus have not been completely clarified. In the past, bile salts, histamine, progesterone metabolites and opioids have been discussed as potential causal substances; a correlation with itch intensity could never be proven. The enzyme autotaxin, which releases lysophosphatidic acid, has recently been identified as potential cholestatic pruritogen. Treatment aims to bind pruritogens in the gut lumen by resins such as cholestyramine, to modulate pruritogen metabolism by rifampicin and to influence central itch signaling by µ-opioid antagonists and selective serotonin re-uptake inhibitors. In cases of refractory pruritus experimental treatment options such as UV-therapy, extracorporeal albumin dialysis and nasobiliary drainage may be considered.
瘙痒是肝胆疾病的常见症状，可能会显著降低生活质量。胆汁淤积性瘙痒具有昼夜节律，通常在傍晚和深夜最为严重。据报道，瘙痒往往在手掌和脚底最为剧烈，但也可能是全身性的。胆汁淤积性瘙痒的病理生理机制尚未完全阐明。过去，胆汁盐、组胺、孕酮代谢物和阿片类物质曾被讨论为潜在的致病物质，但从未证实与瘙痒强度存在关联。最近，可释放溶血磷脂酸的自分泌运动因子酶已被确定为潜在的胆汁淤积性致痒原。治疗旨在通过消胆胺等树脂在肠腔内结合致痒原，通过利福平调节致痒原代谢，并通过μ-阿片拮抗剂和选择性5-羟色胺再摄取抑制剂影响中枢瘙痒信号。对于难治性瘙痒病例，可考虑紫外线治疗、体外白蛋白透析和鼻胆管引流等实验性治疗方案。
