Súhrn

Cieľ štúdie: Zistiť incidenciu pruritu a efektivitu liečby cholestyramínom u pacientov s primárnou biliárnou cirhózou.

Súbor pacientov a metodika: Sedemnásť pacientov (16 žien, 1 muž; priemerný vek 56,7 ± 11,5 rokov) s primárnou biliárnou cirhózou sme vyšetrili v hepatologickej ambulancii FN Louisa Pasteura Košice. Pacienti mali diagnostikovanú primárnu biliárnu cirhózu 4,8 ± 5,4 roka pred zaradením do nášho pozorovania. V štádiu Child-Pugh A bolo14 pacientov, 2 v štádiu Child-Pugh B a 1 v štádiu Child-Pugh C, priemerné Childovho-Pughovej skóre bolo 6,1 ± 1,4 bodu. Dvaja pacienti mali komplikácie v dôsledku portálnej hypertenzie. Všetci pacienti boli liečení ursodeoxycholovou kyselinou (dávka 14 – 19 mg/kg telesnej hmotnosti denne). Žiadny pacient nemal ochorenie kože pred manifestáciou primárnej biliárnej cirhózy.

Výsledky: Deväť pacientov (52,9 %) malo pruritus pred diagnostikovaním primárnej biliárnej cirhózy pečene. Pri zaradení do nášho pozorovania bol pruritus prítomný u 11 pacientov (64,7 %). Permanentný pruritus bol u 3 pacientov (17,6 %), intermitentný u ôsmich (47,1 %). Generalizovaný pruritus mali 3 pacienti (17,6 %), lokalizovaný ôsmi (47,1 %). Najväčšia intenzita pruritu bola u všetkých pacientov v noci (11 pacientov, 64,7 %). Osem pacientov malo pruritus minimálnej intenzity (47,1 %), 2 pacienti strednej intenzity (11,8 %) a 1 pacient ťažkej intenzity (5,9 %). Pacienti so strednou a ťažkou intenzitou pruritu boli liečení cholestyramínom (iniciálna dávka 8 g denne, u pacienta s ťažkou intenzitou pruritu bola dávka postupne zvýšená na 16 g denne). U všetkých liečených pacientov došlo po 3-mesačnej liečbe k zníženiu intenzity pruritu.

Závery: Pruritus je často sa vyskytujúci symptóm u pacientov s primárnou biliárnou cirhózou. Liečba cholestyramínom, ktorý je liekom voľby, môže znížiť intenzitu pruritu.

Kľúčové slová: Primárna biliárna cirhóza – pruritus – incidencia – liečba – cholestyramín.

Pruritus in primary biliary cirrhosis

Summary

Aim of the study. To determine the pruritus incidence and cholestyramine effectivity in patients with primary biliary cirrhosis.

Patients and methods. 17 patients (16 female, 1 male; median age 56.7±11.5 years) with primary biliary cirrhosis were examined at the Hepatology Out-Patient Department of the University Hospital Košice. The diagnosis of primary biliary cirrhosis was determined 4.8±5.4 years before patients were enrolled in our observation. Fourteen patients were in Child-Pugh A stage, 2 subjects in Child-Pugh B stage and 1 patient in Child-Pugh C, stage; the median Child-Pugh score was 6.1±1.4 points. Two patients had complications associated with portal hypertension. All patients were treated by ursodeoxycholic acid (dose 14-19 mg/kg of body weight daily). No patient had skin disease before the onset of primary biliary cirrhosis.

Results. Pruritus was observed in 9 patients (52.9%) before diagnosis was determined. By enrollement in our study  the pruritus was found in 11 patients (64.7%).  The pruritus was permanent in 3 patients (17.6%) and intermittent in 8 patients (47.1%). Generalized pruritus was found in 3 patients (17.6%), localized pruritus in 8 patients (47.1%). Maximum itching was experienced in all patients during night hours (11 patients, 64.7%). Eight patients had pruritus of minimal intensity (47.1%), 2 patients had mild pruritus  (11.8%), and 1 patient  suffered from severe pruritus (59%). Patients with mild and severe pruritus were treated by cholestyramine (intitial dose 8 g daily, in patient with severe intensity the dose was increased to 16 g daily). In all treated patients the pruritus intensity decreased after 3 months of therapy.

Conclusions. Pruritus is a common symptom in patients with primary biliary cirrhosis. Administration of cholestyramine, which is drug of choice, could decrease severity of the pruritus.

Key words: Primary biliary cirrhosis – pruritus – incidence – therapy – cholestyramine.

Peter  JARČUŠKA, Martin JANIČKO, Miriam JARČUŠKOVÁ, Eduard VESELINY, Jagienka JAUTOVÁ