S-腺苷蛋氨酸联合熊去氧胆酸治疗妊娠肝内胆汁淤积症疗效观察

Study of s-adenosyl methionine combined with ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy

目的评估两种药物联合应用治疗妊娠肝内胆汁淤积症的效果.方法临床诊断为妊娠肝内胆汁淤积症患者45例,随机分为联合用药组(n=24)和常规用药组(n=21).联合用药组给予熊去氧胆酸加S-腺苷蛋氨酸治疗,常规用药组给予能量合剂、维生素及地塞米松治疗.两组治疗均以10d为1疗程.用药10d后进行临床瘙痒症状、血中胆酸及转氨酶的评价.分娩后,观察两组的早产率、新生儿体质量和新生儿窒息率.结果联合治疗组治疗后皮肤瘙痒评分、血中胆酸、天冬氨酸转氨酶和丙氨酸转氨酶降低数值分别为3.01±0.29,(44±4)μmol/L,(3.13±0.28)μkat/L,(1.85±0.28)μkat/L;早产率、新生儿体质量和新生儿窒息率分别为16.7%,(3.4±0.2)kg,23.6%.常规用药组皮肤瘙痒评分、血中胆酸、转氨酶降低数值分别为1.57±0.23,(22±4)μmol/L,(0.93±0.20)μkat/L,(0.77±0.25)μkat/L;早产率、新生儿体质量和新生儿窒息率分别为33.3%,(3.2±0.1)kg,25.7%.与常规用药组相比,联合用药组皮肤瘙痒评分、血中胆酸、转氨酶的浓度明显下降(P<0.05);早产率下降(P<0.05),但新生儿体质量及新生窒息率差异无统计学意义(P>0.05).结论S-腺苷蛋氨酸联合熊去氧胆酸治疗妊娠胆汁淤积症效果确切,可部分改善围产儿的预后.

AIM： To evaluate the effect of s-adenosyl methionine combined with ursodeoxycholic acid in intrahepatic cholestasis of pregnancy. METHODS ： Forty-five cases of intrahepatic cholestasis of pregnancy had been chosen and randomly divided into 2 groups： the s-adenosyl methionine combined with ursodeoxycholic acid group （ n = 24 ） and the conventional group （Dexamethasone, intravenous administration of energy misture and vitamine supplement, n = 21 ）. After 10 d treatment, the liver function and itch score were observed. After parturition, the incidence of premature delivery, the weight of newborns and the incidence of neonatal asphyxia were studied. RESULTS： In the s-adenosyl methionine combined with ursodeoxycholic acid group, the decrease of itch score, TAB, AST and ALT were 3.01 ± 0.29, （44±4） μmol/L, （3. 13 ±0.28） and （1.85 ±0.28）μkat/L respectively. The incidence of premature delivery, the weight of newborns and the incidence of neonatal asphyxia were 16.7%, （3. 4 ±0. 2） kg and 23. 6%. In the conventional group, the decrease of itch score, TAB, AST and ALT were 1.57±0.23, （22±4） μmol/L, （0.93±0.20） and （0.77 ± 0.25） μkat/L. The incidence of premature delivery, the weight of newborns and the incidence of neonatal asphyxia were 33.3% , （3.2 ±0. 1 ） kg and 25.7%. Compared with the conventional group, the serum cholic acid, transaminase and score of itch were significantly decreased in the s-adenosyl methionine combined with ursodeoxycholic acid group （P 〈 0. 05 ）. The incidence of premature delivery was also lowered （P 〈 0. 05 ） but the difference in the weight of newborns and the incidence of neonatal asphyxia was not significant （ P 〉 0. 05）. CONCLUSION： S-adenosyl methionine combined with ursodeoxycholic acid exerts definite therapeutic effect on patients with intrahepatic cholestasis of pregnancy. The prognosis of their fetus can somewhat be improved by this treatment.