瘙痒的发生机制-相关疾病和治疗(丁媛)

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媛 综述 普雄明 审校   瘙痒是一种引起搔抓欲望的不愉快的主观感觉,由于缺乏合适的动物模型及实验方法,人们至今还不能全面认识瘙痒,本文就近年来对瘙痒的发生机制、相关疾病和治疗的进展作一综述,为临床诊断及治疗提供参考。 瘙痒 发生机制 疾病 治疗  ,,,、。1 1.1 ,(),、、、、、、。,、、,,1。1.2 ,C,,(),,(0.5ms)、、C,。CC:,,830000,,。1.3  ,,,,A,,2。,,,C,,,3。2 2.1  ,,,,H1、H2、H3。,:、、、,492ChinaJLeprSkinDis.Jun2006,Vol.22,No.64。2.2  ,(M1-M5),:,,。M25,-C。2.3 5- 5-,,,。2.4  ,,。2.5 P (MC)P(SP),SP、、,SP,,SP,。SP,MCE2。2.6 (IL) IL-2;IL-4,6。2.7  、B-,(u、k、δ),,,,,u-,k-,SP,1。3 ,,,。3.1  ,:(、)、、(、)、、、、、、、、。:10%,6,,,,,,、、,。:80%,,,,。,,,。:Ozdemir717820,2,16,2,96%。,5。3.2  (),,、、,(60%~80%)8。,,,,(u-k-)。:,,9。:、、T、、、、,50%,30%。HIV:HIV,:、、、、、2。,,,,、10。:,、、、,、,,。:。,、、、,。:、。、、、493中国麻风皮肤病杂志 2006年6月第22卷第6期;、、、、。:,。4 4.1 4.1.1  UVB11,UVB()、、。4.1.2  Nilsson,27,,,,12。4.2 4.2.1 PH ,,PH,、、。4.2.2  、、,,。4.2.3  (EMLA),,。4.2.4  H1,,,。4.2.5  P、、、P,Lysy44(0.06%),30(65.2%)13。Stander33(0.025%~0.3%),3314。4.2.6  ,,,。4.2.7  15,,,、、、,、。4.3  ,,。4.3.1 ,Brune13350~150mg,(、、、)、、、,:86(65.4%),、、16。4.3.2  5-,Zylicz,,26,17,4,5,20mg,7,2,2417。4.3.3  Daly1118,、、、、,。4.3.4  5-,19。4.3.5 ,Davis、20,21。1StanderS,SteinhoffM,SchmelzM,etal.Neurophysiologyofpru-ritus:Cutaneouselicitationofitch.ArchDermatol2003;139:1463-1470.2YosipovitchG,GreavesMW,SchmelzM.Itch.Thelancet2003;361:690-695.3YosipovitchG,HundleyJ.Practicalguidelinesforreliefofitch.DermatologyNursing2004;16:325-328.4TwycrossR,GreavesMW,HandwerkerH,etal.Itch:scratchingmorethanthesurface.QJM2003;96:7-26.5WessJ,DuttaroyA,GomezaJ,eta1.Muscarinicreceptorsubtypesmediatingcentralandperipheralantinociceptionstudiedwithmusca-rinicreceptorknockoutmice:areview.LiteSci2003;72:2047-2054.6ChanLS,RobinsonN,XuL.Expressionofinterleukin-4intheepidermisoftransgenicmiceresultsinapruriticinflammatoryskindisease:anexperimentalanimalmodeltostudyatopicdermatitis.JInvestDermato12001;117:977-983.7OzdemirM,TuzunY.Herpeszosterandpruritus.InternationJour-nalofDermatology2004;43:779-780.494ChinaJLeprSkinDis.Jun2006,Vol.22,No.68LazrakS,SkaliH,BenchikhiH,eta1.Phototherapyandhemodi-alysispruritus.Nephrologie2004;25:293-295.9BergasaNV.Anapproachtothemanagementofthepruritusofchol-estasis.ClinLiverDis2004;8:55-66.10SinghF,RudikoffD.HIV-associatedpruritus:etiologyandman-agement.AmJClinDermato12003;4:177-188.11WallengrenJ,SundlerF.Phototherapyreducesthenumberofepi-dermalandCGRP-positivedermalnervefibres.ActaDermVene-reol2004;84:111-115.12NilssonHJ,PsouniE,CarstamR,etal.ProfoundinhibitionofchronicitchInducedbystimulationofthincutaneousnervefibres.JEurAcadDermato1Venereo12004;18:37-43.13JLysy,MSistiery-Ittah,YIsraelit,etal.Topicalcapsaicin-anovelandeffectivetreatmentforidiopathicintractablepruritusani:arandomised,placebocontrolled,crossoverstudy.Gut2003;52:1323-1326.14StanderS,LugerT,MetzeD.Treatmentofprurigonodulariswithtopicalcapsaicin.JAmAcadDermato12001;44:471-478.15StanderS,LugerTA.Antipruriticeffectsofpimecro1imusandtacro1imus.Hautarzt2003;54:413-417.16BruneA,MetzeD,LugerTA.AntipruritictherapywiththeoralopioidreceptorantagonistnaltrexoneOpen,non-placebocont-ro11edadministrationin133patients.Hautarzt2004;55:1130-1136.17ZyliczZ,KrajnikM,SorgeAA.Paroxetineinthetreatmentofse-verenon-dermatologicalpruritus:arandomized,controlledtrial.JPainSymptomManage2003;26:1105-1112.18DalyBM,ShusterS.Antipruriticactionofthalidomide.ActaDermVenereo12000;80:24-25.19SchumannR,HudcovaJ.Cholestasisofpregnancy,pruritusand5-hydroxytryptamine3receptorantagonists.ActaObstetGyneco1Scand2004;83:861-862.20DavisMP,FrandsenJL,WalshD,etal.Mirtazapineforpruritus.JPainSymptomManage2003;25:288-291

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