低分子肝素和S-腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症的疗效对比

Comparison of curative effects of low-molecular-weight-heparin and S-adenosylmethionine in treatment of intrahepatic cholestasis of pregnancy

目的:比较和评估低分子肝素(LMWH)和S-腺苷蛋氨酸(SAMe)对妊娠期肝内胆汁淤积症(ICP)的治疗效果。方法:64例ICP患者,随机分成两组:A组用LMWH 1250 IU/d静脉滴注,5天为1疗程;B组用SAMe 1 000 mg/d,静脉滴注,疗程为7天,观察治疗效果。结果:两组患者治疗后瘙痒评分、血清总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TB)及直接胆红素(DB)均有明显下降(P<0.05),下降程度两组间无统计学差异(P>0.05);两组间早产、羊水Ⅱ°～Ⅲ°粪染、胎儿窘迫、新生儿窒息(Apgar≤7)的发生率无明显差异;A组无围生儿死亡,B组有1例死胎。结论:LMWH能缓解ICP患者的症状,改善肝功能,其治疗作用与SAMe相似。

Objective：To compare and evaluate the curative effects of low-molecular-weight-heparin（LMWH） and S-adenosylmethionine（SAMe） in treatment of intrahepatic cholestasis of pregnancy（ICP）.Methods：Sixty-four patients with ICP were selected,then they were randomly divided into two groups： the patients in group A were treated with intravenous drip of LMWH for 5 days,1 250 IU per day;while the patients in group B were treated with SAMe for 7 days,1 000 mg per day,the curative effects in the two groups were observed.Results：After treatment,pruritus score,the serum levels of total bile acid（TBA）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,total bilirubin（TB）,and direct bilirubin（DB） in the two groups decreased significantly（P〈0.05）,but there was no significant difference in the degree of decrease between the two groups（P〈0.05）;there was no significant difference in the incidences of premature delivery,amniotic fluid contamination,fetal distress,and neonatal asphyxia（Apgar score≤7） between the two groups.No perinatal death occurred in group A,one dead fetus occurred in group B.Conclusion：LMWH can relieve symptoms of the patients with ICP and improve hepatic function,and its curative effect is similar to that of SAMe.