中西医结合治疗轻、重度妊娠肝内胆汁淤积症临床分析

Analysis on the efficacy of the combination of TCM and Western Medicine in treating intrahepatic cholestasis of pregnancy with different degree

目的:评估中西医结合分度治疗妊娠肝内胆汁淤积症(ICP)的疗效。方法:240例ICP患者按我院自拟的分度诊断标准诊断为轻度ICP(170例)和重度ICP(70例),并随机分成两组。A组(120例)中轻度ICP(85例)给予茵陈汤加西药治疗(思泰美、地塞米松、能量合剂),重度ICP(35例)给予郁胆汤加西药治疗(同前),B组(120例)中轻度ICP(85例)和重度ICP(35例)均给予西药治疗(同前)。同时将60例因入院3天内即分娩而未给予治疗的ICP孕妇作为C组。观察三组患者治疗前后瘙痒评分、肝胆系B超声像图特征、血清生化指标和围生儿预后情况。结果:A组轻度和重度ICP患者治疗一个疗程后瘙痒评分和血清生化指标明显下降,肝胆系B超声像图特征明显改善,与B组相比有统计学差异。与B、C组相比,A组围生儿预后明显改善。结论:针对不同程度的ICP患者给予相应的中西医结合治疗是合理、有效的方法。

Objective： To study the efficacy of the combination of TCM and Western Medicine in treating intrahepatic cholestasis of pregnancy with different degree. Methods： 240 patients were randomly divided into two groups： A group （n = 120） and B group （n = 120）. In A group, TCM YCT and western medicine （Transmetic, Dexamethasone, and Energy Mixture） were together used for the mild ICP, while TCM YDT and Western Medicine were together used for the severe ICP. In B group only Western Medicine was used for whichever mild ICP or severe ICP. 60 patients of non - treatment were C group because of delivering within 3 days after hospitalization. The itch score, type - B ultrasonic efficacy, serum biochemical indexes, including TBA, ALT, and TBIL were observed before the treatment and after 2 weeks treatment, and the prognosis of perinatal newborn babies between the three groups was compared after delivery. Results： （ 1 ） The itch score, serum biochemical indexes of group A decreased significantly lower than those of group B （P 〈0.05 or P 〈0.01 ） . （2） According to the type - B ultrasonic sonogram, the total effective power of group A was 95. 83% , which was significantly higher than that of group B （85.00%） （P 〈0.01 ） . （3） The premature delivery rate, fetal distress rate and amniotic fluid pollution rate of mild ICP in group A were 16. 5% , 12.9% , and 12. 9% , which were significantly lower than those of group B （23.5%, 32. 9%, 17.6% ） and group C （45.7% , 50%0,43.5% ） （P 〈0.01）, but the perinatal babies mortality was no -significant among three groups. The premature delivery rate, fetal distress rate amniotic fluid pollution rate and perinatal babies mortality of severe ICP in group A were 20% , 28.6% , 25.7% and 2. 9% , which were significantly lower than those of group B （31.4%, 45.7%, 42.9% , 5.7%） and group C （64.3%, 42.9%, 71.4%, 28. 6% ） （P 〈0. 05） . Conclusion ： The combination of TCM and Western Medicine for the different degree ICP is effective and reasonable treatment.