生地黄四物汤加味对妊娠期肝内胆汁淤积症患者中医证候评分、肝功能指标及妊娠结局的影响

Influence of Modified Shengdi Siwu Decoction(生地黄四物汤)on TCM Syndrome Scores,Liver Function and Pregnancy Outcomes of Patients with Intrahepatic Cholestasis of Pregnancy

目的探讨生地黄四物汤加味对妊娠期肝内胆汁淤积症(ICP)患者中医证候评分、肝功能及妊娠结局的影响。方法选择2018年1月—2020年12月该院诊治的102例ICP产妇作为研究对象,采用随机数字表法分为观察组(50例)及对照组(52例),对照组进行常规西医治疗,观察组患者在常规西医治疗基础上应用生地黄四物汤加味治疗。于治疗前及治疗后进行中医证候积分,测定总胆汁酸(TBA)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)等肝功能指标及脐动脉收缩期/舒张期血流速度(S/D)、阻力指数(RI)等血流动力学指标,测定血清内皮素-1(ET-1)水平,收集妊娠结局情况,评估疗效及安全性。结果观察组及对照组总体有效率分别为96.00%(48/50)、82.69%(43/52)(P<0.05);治疗后两组患者中医证候积分、TBA、AST、ALT、TBIL、DBIL、S/D、RI等指标降低(P<0.05),观察组治疗后中医证候积分、TBA、AST、ALT、S/D、RI显著低于对照组(P<0.05);治疗后ET-1水平降低(P<0.05),观察组治疗后ET-1水平显著低于对照组(P<0.05);观察组早产、剖宫产率低于对照组(P<0.05);两组均未见明显不良反应发生。结论在常规西药基础上联合生地黄四物汤加味可改善ICP患者中医证候,改善肝功能及脐动脉血流动力学,降低不良妊娠结局的发生。

Objective To investigate the influence of Modified Shengdi Siwu Decoction(生地黄四物汤)on TCM syndrome scores,liver function and pregnancy outcomes of patients with intrahepatic cholestasis of pregnancy(ICP).Methods Totally 102 parturients with ICP admitted to the hospital from January 2018 to December 2020 were selected as study subjects.They were divided into observation group(50 cases)and control group(52 cases)by random number table method.The control group was treated with conventional western medicines,and on this basis,the observation group was treated with Modified Shengdi Siwu Decoction.TCM syndrome scores before and after treatment were recorded.Liver function indexes such as total bile acid(TBA),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)and direct bilirubin(DBIL),hemodynamic indicators such as umbilical artery systolic/diastolic blood flow velocity(S/D)and resistance index(RI),and serum endothelin-1(ET-1)were determined.Pregnancy outcomes were collected,and efficacy and safety were evaluated.Results The overall effective rates in the observation group and the control group were 96.00%(48/50)and 82.69%(43/52),respectively(P<0.05).After treatment,the TCM syndrome scores,levels of TBA,AST,ALT,TBIL,DBIL,S/D,RI and ET-1 were reduced in the two groups(P<0.05).The TCM syndrome scores,the levels of TBA,AST,ALT,S/D,RI and ET-1 of the observation group were significantly lower than those of the control group(P<0.05).The rates of premature delivery and cesarean section in the observation group were lower than those in the control group(P<0.05).No obvious adverse reactions were observed in the two groups.Conclusion On the basis of conventional western medicine,combined treatment with Modified Shengdi Siwu Decoction can improve TCM syndromes,liver function and umbilical artery hemodynamics,and reduce the occurrence of adverse pregnancy outcomes in patients with ICP.