Düll Miriam M, Kremer Andreas E
Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, Erlangen 91054, Germany.
Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, Erlangen 91054, Germany.
Dermatol Clin. 2018 Jul;36(3):293-300. doi: 10.1016/j.det.2018.02.008. Epub 2018 May 1.
Hepatic itch remains among the most agonizing symptoms for affected patients and a major clinical challenge for physicians. Pruritus may occur in almost all liver diseases, particularly those with cholestatic features. Hepatic itch arises irrespective of the severity of the underlying liver disease or extent of cholestasis. Antihistamines are ineffective in hepatic itch. Therapeutic recommendations consist of a guideline-based stepwise approach, starting with the anion exchange resin cholestyramine, followed by rifampicin, naltrexone, and sertraline. Bezafibrate and ileal bile acid transporter inhibitors are promising future treatment options. Experimental and invasive procedures should be reserved for refractory pruritus.
肝性瘙痒仍然是困扰患者的最痛苦症状之一，也是医生面临的一项重大临床挑战。瘙痒几乎可能出现在所有肝脏疾病中，尤其是那些具有胆汁淤积特征的疾病。无论潜在肝脏疾病的严重程度或胆汁淤积的程度如何，都会出现肝性瘙痒。抗组胺药对肝性瘙痒无效。治疗建议包括基于指南的逐步方法，首先使用阴离子交换树脂考来烯胺，其次是利福平、纳曲酮和舍曲林。苯扎贝特和回肠胆汁酸转运抑制剂是未来有前景的治疗选择。实验性和侵入性程序应仅用于难治性瘙痒。
