中西医结合治疗妊娠肝内胆汁淤积症疗效观察

Study of integrating Chinese and Western Medicine in patients with intrahepatic cholestasis of pregnancy

目的评估两种方法治疗妊娠肝内胆汁淤积症的效果。方法临床诊断为肝内胆汁淤积症患者45例,随机分为对照组(n=21)与治疗组(n=24),对照组仅用S-腺苷蛋氨酸静滴治疗,治疗组应用S-腺苷蛋氨酸静滴及针刺治疗(肝俞、胆俞、风市、百虫窝、太冲、曲泉)。两组治疗均以10天为1疗程。治疗10天后进行临床瘙痒症状、血中胆汁酸及转氨酶的评价,分娩后观察两组的早产率、新生儿体质量和新生儿窒息率。结果治疗组治疗后皮肤瘙痒评分,血中胆汁酸、天冬氨酸转氨酶和丙氨酸转氨酶降低数值分别为(1.07±0.69),(48.3±2.1)μmol/L,(3.96±0.26)U/L,(1.99±0.21)U/L;早产率、新生儿体质量和新生儿窒息率分别为8.33%、(3.6±0.4)kg、25.0%。对照组皮肤瘙痒评分,血中胆汁酸、天冬氨酸转氨酶和丙氨酸转氨酶降低数值分别为(2.56±0.57),(22.5±3.8)μmol/L,(0.94±0.15)U/L,(0.74±0.15)U/L;早产率、新生儿体质量和新生儿窒息率分别为:38.1%、(3.4±0.3)kg、33.33%。治疗组较对照组皮肤瘙痒评分、血中胆汁酸、转氨酶的浓度明显下降(P<0.05);早产率下降(P<0.05),但新生儿体质量和新生儿窒息率差异无统计学意义(P>0.05)。结论S-腺苷蛋氨酸联合针刺治疗妊娠肝内胆汁淤积症效果确切,可部分改善围产儿的预后。

Objective： To observe the therapeutic effect of integrating Chinese and Western Medicine on intrahepatic cholestasis of pregnancy.Methods： Forty-five patients with intrahepatic cholestasis of pregnancy were randomly divided into the two groups： treated group and control group.The treated group was treaded by s-adenosyl methionine combined acupuncture（Ganshu Ganshu Fengshi Baichongwo Taichong Ququan）,and the control group only by s-adenosyl methionine.After 10 days treatment,the liver function and itch score were observed.After parturition,the incidence of premature delivery,the weight of newboms and the incidence of neonatal asphyxia were studied.Results： In the treated group,the itch score was（1.07±0.69）,and the decrease of TAB,AST and ALT were（48.3±2.1）μmol/L,（3.96±0.26）U/L,（1.99±0.21）U/L respectively.The incidence of premature delivery,the weight of newboms and the incidence of neonatal asphyxia were 8.33%,（3.6±0.4）kg,25.0%.In the control group,the itch score was（2.56±0.57）,and the decrease of TAB,AST and ALT were（22.5±3.8）μmol/L,（0.94 ±0.15）U/L,（0.74 ±0.15）U/L.The incidence of premature delivery,the weight of newboms and the incidence of neonatal asphyxia were 38.1%,（3.4±0.3）kg、33.33%.Compared with the control group,the serum cholic acid,transom inase and score of itch were significantly decreased in the treated group（P〈0.05）.The incidence of premature delivery was also lowered（P〈0.05） but the difference in the weight of newboms and the incidence of neonatal asphyxia was not significant（P〉0.05）.Conclusion： The Method of integratting Chinese and Western exerts definite therapeutic effect on patients with intrahepatic cholestasis of pregnancy.The prognosis of their fetus can somewhat be improved by this treatment.