Predictors of pruritus in patients with chronic liver disease and usefulness of nalfurafine hydrochloride
Predictors of pruritus in patients with chronic liver disease and usefulness of nalfurafine hydrochloride
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DOI：
10.1111/hepr.12894
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发表时间：
2018-01-01
影响因子：
4.2
通讯作者：
Ikeda, Kenji
中科院分区：
文献类型：
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作者：
Akuta, Norio;Kumada, Hiromitsu;Ikeda, Kenji
目的瘙痒是慢性肝病的并发症之一，研究瘙痒的预测因素具有重要意义。此外，在所有673名患者中，有138名患者被介绍使用盐酸呋喃呋喃，并对瘙痒严重程度的改善进行了评估。结果673例患者中229例(34.0%)瘙痒程度达到或超过川岛标准的1分，46例(6.8%)达到或超过3分。多因素分析显示，乙肝表面抗原阴性和肝细胞癌是瘙痒的显著影响因素(川岛标准的1分)，而乙肝表面抗原阴性和血小板计数降低是严重瘙痒的显著决定因素(3分)。138例患者中有93例(67.4%)瘙痒有改善，即VAS减少50 mm或以上。无论瘙痒的三个预测因素(乙肝表面抗原、肝细胞癌和血小板计数)如何，盐酸那呋芬的治疗效果均无显著差异。结论本研究基于大量慢性肝病患者，提出了瘙痒的预测因素。此外，这项研究表明，无论预测因素如何，盐酸纳呋芬对瘙痒都可能有效。
AimPruritus is one of the complications of chronic liver disease, and it is important to investigate the predictors.MethodsSix hundred and seventy-three consecutive Japanese patients with chronic liver disease were retrospectively investigated for itch severity. Furthermore, 138 of all 673 patients were introduced to nalfurafine hydrochloride, and the improvement of itch severity was evaluated. The itch severity was self-assessed using the pruritus scores by Kawashima's criteria and visual analog scale.ResultsTwo hundred and twenty-nine of the 673 patients (34.0%) were evaluated as 1point or more of pruritus severity of Kawashima's criteria, and 46 patients (6.8%) as 3points or more. Multivariate analysis established that being negative for hepatitis B surface antigen (HBsAg) and presence of hepatocellular carcinoma (HCC) were significant determinants of pruritus (1point of Kawashima's criteria), and being negative for HBsAg and having lower levels of platelet count were significant determinants of severe pruritus (3points). Ninety-three of the 138 patients (67.4%) with nalfurafine hydrochloride indicated improvement of itch, defined as a decrease in VAS of 50mm or more. There were no significant differences in treatment efficacy of nalfurafine hydrochloride, regardless of the three predictors of pruritus (HBsAg, HCC and platelet count).ConclusionThe present retrospective study indicated the predictors for pruritus, based on the large number of patients with chronic liver disease. Furthermore, this study demonstrated that nalfurafine hydrochloride may be useful for pruritus, regardless of the predictors.