Treatment of Pruritus Secondary to Liver Disease.
Treatment of Pruritus Secondary to Liver Disease.
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DOI：
10.1007/s11894-019-0713-6
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发表时间：
2019-07-31
影响因子：
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通讯作者：
Kremer, Andreas E
中科院分区：
文献类型：
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作者：
Dull, Miriam M;Kremer, Andreas E
综述目的：瘙痒是各种肝病中常见的肝外症状，尤其是具有胆汁淤积特征的肝病。本文综述了流行病学、病理生理学、循证治疗建议和目前研究的肝胆疾病瘙痒症药物。最近的发现：最近的流行病学数据表明，瘙痒症是免疫介导的肝病的常见和相关症状，即，原发性胆汁性胆管炎（PBC），超过70%的患者受影响，高达56%的患者患有慢性瘙痒症。对肝瘙痒症的病理生理学更好的理解导致了新的治疗靶点的确定，在使用KOR激动剂、PPAR激动剂和回肠胆汁酸转运蛋白抑制剂的药物试验中得到了解决。肝痒仍然是受影响患者最痛苦的症状之一，也是医生的临床挑战。治疗建议包括以指南为基础的逐步方法，从考来烯胺开始，然后是利福平，纳曲酮和舍曲林。苯扎贝特和回肠胆汁酸转运蛋白抑制剂代表了未来有希望的抗胰腺炎治疗选择。
PURPOSE OF REVIEW: Pruritus is a common extrahepatic symptom in various liver disorders, in particularly those with cholestatic features. This review summarizes epidemiology, pathophysiology, evidence-based therapeutic recommendations and currently investigated drugs for pruritus in hepatobiliary disorders.RECENT FINDINGS: Recent epidemiological data suggest pruritus as a common and relevant symptom in immune-mediated liver diseases, i.e., primary biliary cholangitis (PBC) with over 70% affected patients, up to 56% suffering from chronic pruritus. The better pathophysiological understanding of hepatic pruritus has led to the identification of novel therapeutic targets, addressed in drug trials using KOR agonists, PPAR agonists, and ileal bile acid transporter inhibitors. Hepatic itch remains among the most agonizing symptoms for affected patients and a clinical challenge for physicians. Therapeutic recommendations include a guideline-based stepwise approach starting with cholestyramine, followed by rifampicin, naltrexone, and sertraline. Bezafibrate and ileal bile acid transporter inhibitors represent promising future anti-pruritic treatment options.