地塞米松治疗妊娠期肝内胆汁瘀积症的临床研究

The clinical study on the treatment of intrahepatic cholestasis in pregnancy(ICP) by Dexamethasone

目的:研究地塞米松治疗妊娠期肝内胆汁瘀积症(ICP)对胎儿垂体、肾上腺功能、肝功能、血糖的影响,以探讨使用地塞米松对胎儿安全性。方法:将孕妇分为A、B、C 3组,A组(30例)为正常孕妇,B组(30例)为ICP孕妇未接受地塞米松治疗,C组(30例)为ICP孕妇接受地塞米松治疗,对3组胎儿脐血ACTH及皮质醇、血糖、脐血肝功能、胆红素、胆汁酸变化进行对比分析。结果:C组胎儿的脐血皮质醇、血糖明显下降明显,有显著性意义(P>0.05);A组胎儿脐血肝功能、胆红素、胆汁酸均低于B和C组,有显著性意义(P>0.05);C组与B组胎儿脐血肝功能、胆红素、胆汁酸变化无显著差异(P<0.01)。结论:塞米松治疗ICP并不能减轻胆汁淤积,不改善胎儿不良的预后,对胎儿垂体-肾上腺功能存在近期影响,可引起胎儿肾上腺功能减退和低血糖,提出地塞米松不宜成为治疗ICP常规用药观点,为今后安全治疗提供更实际依据。

Objective： To study the effect of treating intrahepatic cholestasis in pregnancy （ICP） by Dexamethasone on fetal pitui- tary, adrenal function, liver function, blood sugar, to explore the safety of Dexamethasone for the fetus. Methods： All pregnant women were divided into 3 groups ： 30 pregnant women in group A were normal, 30 pregnant women in group B had ICP and did not receive treatment of Dexamethasone, 30 pregnant women in group C had ICP and received treatment of Dexamethasone. The 3 groups of fetal cord blood ACTH, cortisol, blood sugar, liver function and cord blood, bilirubin, bile acid were analyzed. Results： Cortisol and blood sugar of group C de- creased significantly （ P 〉 0. 05 ） ; liver function and cord blood, bilirubin, bile acid of group A were lower than group B and group C （ P 〉 0. 05 ） , but were was no significant difference between group B and group C （ P 〈 0. 01 ） . Conclusion ： Treating ICP by Dexamethasone con not reduce intrahepatic cholestasis and improve the poor prognosis of the fetus, exists immediate impact for fetal pituitary - adrenal function, can cause fetal adrenal insufficiency and low blood sugar. Dexamethasone should not use for ICP.