妊娠期肝内胆汁瘀积症的治疗与围产儿预后关系的探讨

Relationship between treatment of intrahepatic cholestasis during pregnancy and prognosis of prenatal infant

目的 :评估熊去氧胆酸 (UDCA)、地塞米松 (DX)治疗妊娠期肝内胆汁瘀积症 (ICP)的疗效及围产儿预后情况。方法 :12 6例患者随机分为UDCA组 (A组 )、DX组 (B组 )和对照组 (C组 ) ,各 4 2例 ,A、B、C 3组血清胆汁酸TBA(10～ 5 0μmol/L)分别为A1组 30例、B1组 2 7例、C1组 2 9例 ;TBA >5 0 μmol/L分别为A2 组 12例、B2 组 15例、C2 组 13例。A组给予UDCA 10 0mg ,3次 /d ,14d为 1个疗程 ;B组给予DX 3mg ,3次 /d ,10d后逐渐减量而停药 ;C组给予口服维生素C 0 .2 g ,连续服用 14d。结果 :A、B组患者治疗后皮肤瘙痒症状明显减轻 (P <0 .0 5 ) ,C组瘙痒症状无变化 ;A、B 2组治疗后血TBA明显下降 (P <0 .0 5 ) ;A2 组下降程度大于B2 组 (P <0 .0 5 ) ,C组稍上升 (P >0 .0 5 ) ;3组内早产、胎儿窘迫、新生儿窒息的发生率与TBA值呈正相关 ,A、B组的发生率明显低于C组 ,差异有显著性 (P <0 .0 5 ) ,A、B组内TBA值低的组 (A1、B1组 )早产、胎儿窘迫、新生儿窒息发生率差异无显著性 (P >0 .0 5 ) ,TAB值高的组 (A2 、B2 组 )早产、胎儿窘迫、新生儿窒息的发生率差异有显著性 (P <0 .0 5 )。结论 :UDCA、DX均能有效治疗ICP ,减少早产、胎儿窘迫、新生儿窒息的发生率 ,对于TBA值高的患者 ,UDCA疗效优于DX ,仅口服维生?

To evaluate the effect of ursodeoxycholic acid (UDCA) and dexamethasone (DX) on intrahepatic cholestasis during pregnancy and prognosis of the perinatal infant. Methods: 126 patients were randomly divided into the UDCA group (Group A), DX group (Group B) and the control group (Group C), with 42 patients in each group. And patients in the 3 groups were further divided into two sub-groups in accordance with the level of serum bile acid. There were 30 cases in A 1, 27 cases in B 1, and 29 cases in C 1, with 10 μmol/L<TBA≤50 μmol/L. And there were 12 cases in Group A 2, 15 cases in Group B 2, and 13 cases in Group C 2 respectively, with TBA>50 μmol/L. Patients in Group A were treated with UDCA, at a dose of 100 mg, 3 times a day for a succession of 14 days. Patients in Group B were treated with DX, at a dose of 3 mg, also 3 times a day for a succession of 10 days, after which medication was reduced and finally terminated. Patients in Group C were given vitamin C, 0.3 g, 3 times a day for a succession of 14 days. Results: For patients in Group A and Group B, the symptom of pruritus was released significantly after treatment (P< 0.05), while symptom remained unchanged for patients in Group C. The level of serum bile acid in Group A and B reduced significantly ( P<0.05), with the reduction in TBA being greater in A 2 than that in B 2 (P<0.05), while that of Group C rose slightly ( P<0.05). Incidence of premature birth, fetal distress and asphyxia of infant was positively correlated with the level of serum bile acid, with the incidence rate significantly lower in Group A and B than that in Group C (P<0.05). And there was no significant difference in the incidence of premature birth, fetal distress and asphyxia of infant in the lower TBA groups (Group A 1 and B 1). For the higher TBA groups (Group A 2 and B 2), there was significant difference in the incidence of premature birth, fetal distress and asphyxia of infant (P<0.05). Conclusion: UDCA and DX are all effective for the treatment of intrahepatic cholestasis during pregnancy. They can reduce incidence of premature birth, fetal distress and asphyxia of infant. For patients with higher TBA level, the effect of UDCA is better than DX, but vitamin C alone is of no effect for the treatment of intrahepatic cholestasis during pregnancy.