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題 名 | 膽汁鬱積性搔癢之可能機轉及藥物治療之新方向=Cholestatic Pruritus: Current Concepts in Pathogenesis and Therapeutic Directions |
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作 者 | 黃惠君; 洪弘昌; 李重賓; 趙毅; 黃以信; 劉春櫻; 張扶陽; | 書刊名 | 內科學誌 |
卷 期 | 9:1 1998.03[民87.03] |
頁 次 | 頁7-11 |
分類號 | 415.538 |
關鍵詞 | 膽汁鬱積性搔癢; 5-HT[feb0]接受器拮抗劑; Cholestatic pruritus; 5-Hydroxytryptamine receptor antagonist; |
語 文 | 中文(Chinese) |
中文摘要 | 全身性搔癢是一種常見於膽汁鬱積性肝病患者之不舒服的肝外表徵。內科治療 包括抗組織胺(antihistamine)及膽鹽結合劑(如cholestyramine)是較常使用的藥物,但 臨床經驗報告其治療效果常不盡理想。近年來發現,以選擇具特異性的阻斷藥物,包括 Opioid接受器拮抗劑(如naloxone)及5-hydroxytryptamine第三型接受器拮抗劑,(如 ondansetron)這兩類藥物,可用來舒解對傳統止痰療法反應不佳的膽汁鬱積性搔癢。 Opioid接受器拮抗劑會造成嗎啡類藥物的退癒現象,影響其臨床之使用性。ondmsetron類 之藥物則無此副作用,其作用機轉被認為可能與降低膽汁鬱積性患者對搔癢的感受度有關 。因此,5-hydroxytryptamine第三型接受器拮抗劑可能是未來治療膽汁鬱積性搔癢具有 潛能的藥物之一。然而,受限於價格及靜脈注射之不方便性,目前此類藥物宜用於接受傳 統止癢治療失敗之持續搔癢病例。 病例。 |
英文摘要 | Generalized pruritus as an extrahepatic manifestation of cholestatic liver disease is a well-known, uncomfortable symptom. Cholestatic pruritus may not only interfere with normal activity but may lead to sleep deprivation and suicidal attempt. The pathogenesis of cholestatic pruritus has not been well understood and several hypothesis have been proposed. Previous treatments of cholestatic pruritus including bile acids chelating agents, antihistamine, hepatic enzyme inducers ( phenobarbitone, rifampin), propofol, anabolic steroids, and heroic measures ( e.g., charcoal hemoperfusion, partial external diversion of bile) have been proven not consistently efficacious. Treatment of patients with cholestatic pruhtus with opiate receptor antagonist (e.g., naloxone, nalmefene) leads to a relief of pruritus but can induce an opioid withdrawa syndrome, suggesting the participation of endogenous opioids in the generation and/ or sensation of pruritus. But no signs of withdrawal syndrome or known side effects could be observed under treatment with ondansetron a specific sero. tonin type 3 receptor antagonist (5-HT3). In conclusion ondansetron administration is associated with amelioration of the perception of pruritus in cholestatic patients. It is suggested that serotonin, acting via the 5-HT3 receptor antagonist is involved in the generation or sensation of pruritus. Furthermore, the 5-HT3 receptor antagonist may be a novel therapeutic principle for the treatment of cholestatic pruritus. (J Intern Med Taiwan 1998 ; 9: 7-1 1) |
本系統中英文摘要資訊取自各篇刊載內容。