Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
The Solomon H Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Am Acad Dermatol. 2019 Dec;81(6):1371-1378. doi: 10.1016/j.jaad.2019.04.035. Epub 2019 Apr 19.
Patients suffering from cholestasis often report experiencing a debilitating, unrelenting itch. In contrast to conditions, such as urticaria, in which histamine primarily drives itch (pruritus), cholestatic pruritus is multifactorial and more difficult to treat. Existing therapies are not always effective and have undesirable adverse effect profiles. Here, we conducted a systematic literature review to evaluate conventional treatment strategy, current pathophysiologic understanding, and the role of new therapies in the context of cholestatic pruritus. We discuss novel findings implicating bile acids, lysophosphatidic acid, and bilirubin as potential important mediators of cholestatic itch. New therapies that aim to remove or modulate pruritogens have been supported in observational cohort studies and randomized controlled trials. Although these new therapies show promise, further research is needed to confirm the pathophysiology of cholestatic pruritus so that targeted therapy can be developed.
患有胆汁淤积症的患者常自述出现一种使人虚弱、持续不断的瘙痒。与荨麻疹等病症不同，后者的瘙痒主要由组织胺（瘙痒）引起，胆汁淤积性瘙痒是多因素的，且更难治疗。现有疗法并非总是有效，且具有不理想的不良反应谱。在这里，我们进行了系统的文献复习，以评估胆汁淤积性瘙痒的常规治疗策略、当前的病理生理理解以及新疗法的作用。我们讨论了新的发现，这些发现表明胆汁酸、溶血磷脂酸和胆红素可能是胆汁淤积性瘙痒的潜在重要介质。旨在去除或调节致痒原的新疗法已在观察性队列研究和随机对照试验中得到支持。尽管这些新疗法显示出希望，但仍需要进一步研究来确认胆汁淤积性瘙痒的病理生理学，以便开发靶向治疗。
