慢性肝病患者的瘙痒症与原发性胆汁性胆管炎患者的血清自分泌酶水平。
Pruritus in patients with chronic liver disease and serum autotaxin levels in patients with primary biliary cholangitis.
机构信息
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan.
出版信息
BMC Gastroenterol. 2019 Oct 24;19(1):169. doi: 10.1186/s12876-019-1092-z.
BACKGROUND
Pruritus is a common symptom seen in patients with chronic liver disease. However, frequency and severity of pruritus in patients with chronic liver disease is unclear. We investigated frequency, severity and predictive factors of pruritus in these patients from a large cohort.
METHODS
A total of 2477 patients with chronic liver disease without allergies or skin diseases were investigated for itch frequency and severity. Itch severity was self-assessed using pruritus scores using the numerical rating scale (NRS). Multivariate regression analysis was performed to identify factors associated with pruritus. Serum autotaxin levels were measured in patients with primary biliary cholangitis (PBC), and the relationship to liver fibrosis and pruritus was analyzed.
RESULTS
The frequency of pruritus in patients with chronic liver disease was significantly higher than in subjects without liver disease (29.8 and 16.2%, respectively, P < 0.001). NRS was high in patients with chronic liver disease, especially in those with PBC, as is generally expected. Multivariate analysis identified lower albumin, higher eosinophil count, and etiology of PBC as independent factors associated with severe pruritus (≥5 points of NRS). In patients with PBC, serum autotaxin levels were significantly correlated with liver fibrosis markers such as platelet count and liver stiffness, and hepatobiliary enzymes such as total bilirubin, aspartate aminotransferase and alkaline phosphatase. However, no significant correlations between serum autotaxin levels and frequency and severity of pruritus were observed in patients with PBC.
CONCLUSION
The frequency of pruritus was high in patients with chronic liver disease. Reduction of liver function is associated with severe pruritus based on the large number of patients with chronic liver disease. Serum autotaxin is useful for assessing liver fibrosis and severity of cholangitis; however, it is not a predictive marker for severe pruritus in patients with PBC.
背景
瘙痒是慢性肝病患者常见的症状。然而，慢性肝病患者瘙痒的频率和严重程度尚不清楚。我们从一个大样本中研究了这些患者瘙痒的频率、严重程度和预测因素。
方法
共调查了 2477 例无过敏或皮肤病的慢性肝病患者的瘙痒频率和严重程度。使用数字评分量表（NRS）对瘙痒严重程度进行自我评估。采用多元回归分析确定与瘙痒相关的因素。在原发性胆汁性胆管炎（PBC）患者中测量血清自分泌酶水平，并分析其与肝纤维化和瘙痒的关系。
结果
慢性肝病患者瘙痒的频率明显高于无肝病患者（分别为 29.8%和 16.2%，P<0.001）。慢性肝病患者的 NRS 较高，尤其是 PBC 患者，这是普遍预期的。多变量分析确定了较低的白蛋白、较高的嗜酸性粒细胞计数和 PBC 病因是与严重瘙痒（NRS≥5 分）相关的独立因素。在 PBC 患者中，血清自分泌酶水平与血小板计数和肝硬度等肝纤维化标志物以及总胆红素、天冬氨酸转氨酶和碱性磷酸酶等肝胆酶显著相关。然而，在 PBC 患者中，血清自分泌酶水平与瘙痒的频率和严重程度之间没有显著相关性。
结论
慢性肝病患者瘙痒的频率较高。基于大量慢性肝病患者的研究结果，肝功能下降与严重瘙痒相关。血清自分泌酶可用于评估肝纤维化和胆管炎的严重程度；然而，它不是 PBC 患者严重瘙痒的预测标志物。
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