Dega H, Francès C, Dupin N, Lebre C, Simantov A, Callot C, Laporte J L, Blot C, Opolon P, Poynard T, Chosidow O
Service de Médecine Interne, Groupe hospitalier Pitié-Salpétrière, Paris.
Ann Dermatol Venereol. 1998 Jan;125(1):9-12.
Determine the characteristics of pruritus in a selected population of patients with positive hepatitis C virus serology.
In a retrospective study, we re-examined outpatient reports for patients who consulted for pruritus from January 1993 to April 1996 and were followed in a hepatology unit for hepatitis C infection. The following data were collected: age, sex, risk factors, HIV and HBV serologies, duration of pruritus and diagnosis, ALAT, gamma GT and total bilirubin, METAVIR score, HCV RNA PCR, search for cryoglobulins, antiviral and dermatology treatments. There were 1,060 patients followed in the hepatology unit during this period, including 327 with cirrhosis.
Twenty-seven patients were retained for study, 16 men and 11 women, mean age 53 years. None of the patients had HIV infection, 7 had a past history of hepatitis B infection (positive for anti-Hbc antibodies). Median duration of pruritus prior to consultation was 3 months (95 p. 100 CI: 3 months-2 years). Pruritus was associated with non-specific lesion in 19 cases (70 p. 100: 95 p. 100 CI: 51-85 p. 100). There were excoriated eczema-like lesions in 11 cases (41 p. 100: 95 p. 100 CI: 15-49 p. 100). Other causes were urticaria in 5 cases (18 p. 100: 95 p. 100 CI: 7-36 p. 100), including 1 case of urticarial vasculitis with cryoglobulinemia, 2 cases with atopic dermatitis, and 1 case of primary biliary cirrhosis. In four cases, lichen planus was associated. Skin biopsies were obtained in 10 patients and showed eczema-like alterations in 9 and urticarial vasculitis in 1. Mean ALAT and gamma GT levels were 2.6 N (95 p. 100 CI: 1.9 N-3.3 N) and 2.2 N (95 p. 100 CI: 1.4 N-3 N) respectively, including 11 cases without cholestasis (normal gamma Gt). PCR was positive in 13 cases out of 15. Cryoglobulinemia was found in 10 cases out of 24. At consultation, 3 patients were given ursolvan, 7 interferon, 1 ursolvan with ribavirin, and 3 an interferon-ribavirin combination. Dermatology treatment associated antihistamine agents, emollients, and corticosteroids. This population of hepatology patients referred for pruritus comprised 2.5 p. 100 of all patients (95 p. 100 CI: 1.7-3.6 p. 100). Among them, 1.8 p. 100 (95 p. 100 CI: 1.1-2.7 p. 100) had eczema-like lesions associated with cutaneous xerosis.
Pruritus in our patient population was generally associated with non-specific excoriations, prurigo or xerosis in 19 cases (70 p. 100). As only ambulatory patients were retained for analysis, this is not a comprehensive population and the percentage of non-specific pruritus, evaluated at 1.8 p. 100, is probably an underestimation. Cholestasis cannot explain alone these manifestations since 11 patients had normal gamma GT levels. Several etiologies could be involved: a direct effect of HCV, interferon. A prospective study should allow an estimation of frequency, risk factors and possible impact on quality of life.
确定丙型肝炎病毒血清学阳性特定患者群体中瘙痒的特征。
在一项回顾性研究中，我们重新检查了1993年1月至1996年4月因瘙痒前来咨询并在肝病科接受丙型肝炎感染随访的患者的门诊报告。收集了以下数据：年龄、性别、危险因素、HIV和HBV血清学、瘙痒持续时间和诊断结果、丙氨酸转氨酶（ALAT）、γ-谷氨酰转移酶（gamma GT）和总胆红素、METAVIR评分、HCV RNA聚合酶链反应（PCR）、冷球蛋白检测、抗病毒和皮肤科治疗情况。在此期间，肝病科共随访了1060例患者，其中327例患有肝硬化。
选取27例患者进行研究，16例男性，11例女性，平均年龄53岁。所有患者均无HIV感染，7例有乙型肝炎感染既往史（抗-Hbc抗体阳性）。就诊前瘙痒的中位持续时间为3个月（95%可信区间：3个月至2年）。19例（70%：95%可信区间：51%-85%）患者的瘙痒与非特异性皮损有关。11例（41%：95%可信区间：15%-49%）有抓痕性湿疹样皮损。其他病因包括5例（18%：95%可信区间：7%-36%）荨麻疹，其中1例为伴有冷球蛋白血症的荨麻疹性血管炎，2例为特应性皮炎，1例为原发性胆汁性肝硬化。4例患者伴有扁平苔藓。10例患者进行了皮肤活检，9例显示为湿疹样改变，1例显示为荨麻疹性血管炎。平均ALAT和gamma GT水平分别为2.6 N（95%可信区间：1.9 N-3.3 N）和2.2 N（95%可信区间：1.4 N-3 N），其中11例无胆汁淤积（gamma Gt正常）。15例中有13例PCR呈阳性。24例中有10例发现冷球蛋白血症。就诊时，3例患者给予熊去氧胆酸，7例给予干扰素，1例给予熊去氧胆酸联合利巴韦林，3例给予干扰素联合利巴韦林。皮肤科治疗包括抗组胺药、润肤剂和皮质类固醇。因瘙痒转诊至肝病科的这一患者群体占所有患者的2.5%（95%可信区间：1.7%-3.6%）。其中，1.8%（95%可信区间：1.1%-2.7%）有与皮肤干燥相关的湿疹样皮损。
我们患者群体中的瘙痒通常与19例（70%）患者的非特异性抓痕、痒疹或皮肤干燥有关。由于仅选取门诊患者进行分析，这并非一个全面的群体，非特异性瘙痒的比例估计为1.8%，可能被低估了。胆汁淤积不能单独解释这些表现，因为11例患者的gamma GT水平正常。可能涉及多种病因：HCV的直接作用、干扰素。一项前瞻性研究应能估计其发生率、危险因素以及对生活质量的可能影响。
