Oeda Satoshi, Takahashi Hirokazu, Yoshida Hisako, Ogawa Yuji, Imajo Kento, Yoneda Masato, Koshiyama Yuichi, Ono Masafumi, Hyogo Hideyuki, Kawaguchi Takumi, Fujii Hideki, Nishino Ken, Sumida Yoshio, Tanaka Saiyu, Kawanaka Miwa, Torimura Takuji, Saibara Toshiji, Kawaguchi Atsushi, Nakajima Atsushi, Eguchi Yuichiro
Liver Center, Saga University Hospital, Saga, Japan.
Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
Hepatol Res. 2018 Feb;48(3):E252-E262. doi: 10.1111/hepr.12978. Epub 2017 Oct 10.
Pruritus is a common comorbidity in chronic liver disease. The aim of this study was to clarify the prevalence of pruritus and its characteristics in patients with chronic liver disease.
A total of 1631 patients with chronic liver disease who attended one of nine joint-research facilities from January to June 2016 were enrolled. We investigated the prevalence of pruritus, itch location, itch duration, daily itch fluctuation, seasonal itch exacerbation, treatment drugs, and therapeutic effects using a medical interview questionnaire.
The median age was 66 years and 890 (54.6%) patients were women. The prevalence of pruritus was 40.3% (658/1631), and it differed according to the underlying liver disease. The most frequent body location for pruritus was on the back (63.1%). Pruritus duration was more than 6 months in 252 (38.3%) patients. The severity of pruritus, assessed using a visual analog scale, was higher during the day than at night (median, 4 vs. 3, P < 0.001). Seasonal exacerbation was observed in 296 (45.0%) patients. Although 301 (45.7%) patients were treated with antipruritic agents, 57.8% (174/301) patients reported an insufficient effect. Active hepatitis B virus infection (odds ratio [OR], 2.51; P = 0.043), primary biliary cholangitis (OR, 3.69; P = 0.018), diabetes (OR, 1.57; P = 0.010), and aspartate aminotransferase ≥60 U/L (OR, 2.06; P = 0.011) were independent factors associated with pruritus.
The prevalence of pruritus varies according to the chronic liver disease etiology. Underlying liver disease, aspartate aminotransferase ≥60 U/L, and comorbid diabetes are factors associated with pruritus in patients with chronic liver disease.
瘙痒是慢性肝病中常见的合并症。本研究旨在明确慢性肝病患者中瘙痒的患病率及其特征。
纳入2016年1月至6月在9个联合研究机构之一就诊的1631例慢性肝病患者。我们通过医学访谈问卷调查了瘙痒的患病率、瘙痒部位、瘙痒持续时间、每日瘙痒波动情况、季节性瘙痒加重情况、治疗药物及治疗效果。
患者中位年龄为66岁,女性890例(54.6%)。瘙痒患病率为40.3%(658/1631),且因基础肝病不同而有所差异。瘙痒最常见的身体部位是背部(63.1%)。252例(38.3%)患者瘙痒持续时间超过6个月。采用视觉模拟量表评估,瘙痒严重程度白天高于夜间(中位数分别为4和3,P<0.001)。296例(45.0%)患者出现季节性加重。尽管301例(45.7%)患者接受了止痒药物治疗,但57.8%(174/301)的患者报告疗效不佳。乙型肝炎病毒感染活跃(比值比[OR],2.51;P=0.043)、原发性胆汁性胆管炎(OR,3.69;P=0.018)、糖尿病(OR,1.57;P=0.010)以及天冬氨酸转氨酶≥60 U/L(OR,2.06;P=0.011)是与瘙痒相关的独立因素。
瘙痒的患病率因慢性肝病病因不同而有所差异。基础肝病、天冬氨酸转氨酶≥60 U/L以及合并糖尿病是慢性肝病患者瘙痒的相关因素。