Freedman M R, Holzbach R T, Ferguson D R
Am J Med. 1981 May;70(5):1011-6. doi: 10.1016/0002-9343(81)90857-3.
Discrepancies have existed regarding the correlation between raised bile acid levels in cholestasis and the presence of pruritus. Nevertheless, the prevalent view is that bile acids have a direct etiologic role. To resolve the issue, we quantified separately all naturally-occurring bile acid species detectable in serum and skin, and on the skin surface of 13 patients with pruritus associated with cholestasis, 10 patients with cholestasis who did not have pruritus, three patients with uremia and generalized pruritus and in 10 controls. We were unable to find any correlations between the presence of pruritus and bile acid levels from the various sources. We did find great overlap in these same values with data from the group with cholestasis but without pruritus. As expected, the symptomatic (uremic) and asymptomatic control groups showed comparable levels. The results of the present study together with those of a similar recent study provide strong evidence against the hypothesis of a direct causative role for retained bile acids in pruritus associated with cholestasis.
胆汁淤积时胆汁酸水平升高与瘙痒症之间的相关性一直存在争议。然而，普遍的观点是胆汁酸具有直接的病因学作用。为了解决这个问题，我们分别对血清、皮肤以及13例胆汁淤积相关瘙痒症患者、10例无瘙痒症的胆汁淤积患者、3例尿毒症伴全身性瘙痒患者和10例对照者的皮肤表面中可检测到的所有天然存在的胆汁酸种类进行了定量分析。我们未能发现瘙痒症的存在与来自不同来源的胆汁酸水平之间存在任何相关性。我们确实发现这些相同的值与无瘙痒症的胆汁淤积组的数据有很大重叠。正如预期的那样，有症状的（尿毒症）对照组和无症状对照组显示出相当的水平。本研究结果与近期一项类似研究的结果共同提供了有力证据，反对胆汁酸潴留与胆汁淤积相关瘙痒症存在直接因果关系这一假说。
