Chia S C, Bergasa N V, Kleiner D E, Goodman Z, Hoofnagle J H, Di Bisceglie A M
Liver Diseases Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
Dig Dis Sci. 1998 Oct;43(10):2177-83. doi: 10.1023/a:1026646017851.
Pruritus is a common symptom in cholestatic liver disease but is rare in chronic hepatitis C. Eight patients with chronic hepatitis C and severe pruritus were compared with regard to biochemical, serological, and histological features to eight disease controls with primary biliary cirrhosis and seven with cirrhosis due to hepatitis C. Among those with severe pruritus associated with chronic hepatitis C, serum aminotransferases were raised in all, alkaline phosphatase in four, and gamma-glutamyl-transpeptidase levels in all except one. Serum cholylglycine levels were elevated in seven of eight patients. Liver biopsies showed moderate to severe fibrosis in all patients and cirrhosis in five. Compared to control subjects with cirrhosis due to hepatitis C but no pruritus, ductopenia, and cholestatic changes were prominent, although less so than in controls with primary biliary cirrhosis. Chronic hepatitis C with moderate to severe fibrosis may result in low-grade cholestasis with pruritus, possibly in association with bile duct disappearance.
瘙痒是胆汁淤积性肝病的常见症状，但在慢性丙型肝炎中罕见。将8例伴有严重瘙痒的慢性丙型肝炎患者与8例原发性胆汁性肝硬化疾病对照者及7例丙型肝炎肝硬化对照者在生化、血清学和组织学特征方面进行了比较。在伴有严重瘙痒的慢性丙型肝炎患者中，所有患者血清转氨酶均升高，4例碱性磷酸酶升高，除1例患者外所有患者γ-谷氨酰转肽酶水平均升高。8例患者中有7例血清胆酰甘氨酸水平升高。肝活检显示所有患者均有中度至重度纤维化，5例有肝硬化。与无瘙痒的丙型肝炎肝硬化对照受试者相比，胆管减少和胆汁淤积性改变较为突出，尽管程度不如原发性胆汁性肝硬化对照者。伴有中度至重度纤维化的慢性丙型肝炎可能导致伴有瘙痒的轻度胆汁淤积，可能与胆管消失有关。
