Düll Miriam M, Kremer Andreas E
Department of Medicine 1, Gastroenterology, Hepatology, Pneumology and Endocrinology, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, D-91054, Erlangen, Germany.
Curr Gastroenterol Rep. 2019 Jul 31;21(9):48. doi: 10.1007/s11894-019-0713-6.
Pruritus is a common extrahepatic symptom in various liver disorders, in particularly those with cholestatic features. This review summarizes epidemiology, pathophysiology, evidence-based therapeutic recommendations and currently investigated drugs for pruritus in hepatobiliary disorders.
Recent epidemiological data suggest pruritus as a common and relevant symptom in immune-mediated liver diseases, i.e., primary biliary cholangitis (PBC) with over 70% affected patients, up to 56% suffering from chronic pruritus. The better pathophysiological understanding of hepatic pruritus has led to the identification of novel therapeutic targets, addressed in drug trials using KOR agonists, PPAR agonists, and ileal bile acid transporter inhibitors. Hepatic itch remains among the most agonizing symptoms for affected patients and a clinical challenge for physicians. Therapeutic recommendations include a guideline-based stepwise approach starting with cholestyramine, followed by rifampicin, naltrexone, and sertraline. Bezafibrate and ileal bile acid transporter inhibitors represent promising future anti-pruritic treatment options.
瘙痒是各种肝脏疾病常见的肝外症状，尤其是那些具有胆汁淤积特征的疾病。本综述总结了肝胆疾病中瘙痒的流行病学、病理生理学、循证治疗建议以及目前正在研究的治疗药物。
最近的流行病学数据表明，瘙痒是免疫介导性肝病的常见且相关症状，即原发性胆汁性胆管炎（PBC），超过70%的患者受影响，高达56%的患者患有慢性瘙痒。对肝性瘙痒病理生理学的更好理解已促成了新治疗靶点的确定，在使用κ阿片受体激动剂、过氧化物酶体增殖物激活受体激动剂和回肠胆汁酸转运体抑制剂的药物试验中得到了探讨。肝性瘙痒仍然是受影响患者最痛苦的症状之一，也是医生面临的临床挑战。治疗建议包括基于指南的逐步方法，从考来烯胺开始，接着是利福平、纳曲酮和舍曲林。苯扎贝特和回肠胆汁酸转运体抑制剂是未来有前景的止痒治疗选择。
