胆汁淤积性肝病并发皮肤瘙痒的发病机制及治疗进展

瘙痒是胆汁淤积性肝病如原发性胆汁性肝硬化、原发性硬化性胆管炎和妊娠期肝内胆汁淤积症的一个常见症状。既往研究的胆汁淤积性瘙痒的潜在致痒因子有胆盐、组胺、孕酮代谢产物、内源性阿片样物质和溶血性磷脂酸等。然而,胆汁淤积性瘙痒的确切发病机制尚不清楚,现有的止痒方法仅可使部分患者症状得到缓解,新的止痒方法已被提出和(或)正在研究中。在回顾近期关于胆汁淤积型肝病并发皮肤瘙痒的发病机制和治疗的实验和临床试验,以便提高对胆汁淤积性瘙痒的认识和治疗。

Recent advances in pathogenesis and management of pruritus in cholestatic liver disease

Pruritus is one of the common clinical manifestations of cholestatic liver diseases such as primary biliary cirrhosis,primary scle-rosing cholangitis,and intrahepatic cholestasis of pregnancy.Potential incentives of itching include bile salts,histamine,progesterone metabolites,endogenous opioid substances,and lysophosphatidic acid,according to previous studies.However,the exact pathogenesis of cholestatic pruritus remains unclear,and the current treatment can only alleviate the symptoms in some of the patients.Novel methods for treating pruritus have been proposed and/or are being studied.The recent experimental and clinical studies on the pathogenesis and treatment of pru-ritus in cholestatic hepatitis are reviewed,in order to improve the understanding and management of cholestatic pruritus.