中西医结合治疗妊娠期肝内胆汁淤积症临床疗效观察

Observation on Clinical Curative Effect of Intrahepatic Cholestasis of Pregnancy with Combination of Traditional Chinese and Western Medicine

目的:探讨中药联合西药治疗妊娠期肝内胆汁淤积症(ICP)的临床指标及围产结局。方法:对2011年10月—2013年2月在本院诊断为妊娠期肝内胆汁淤积症的168例孕妇收住院,进行前瞻双盲的临床研究。随机分为2组。研究组:选择88例以中药汤剂联合西药(熊去氧胆酸)治疗;对照组:选择80例,单以熊去氧胆酸治疗。比较两组治疗前后的生化指标,甘胆酸(CG)、总胆汁酸(TBA)、丙氨酸转氨酶(ALT)、天冬氨酸转移酶(AST)、总胆红素(T-BIL)等水平变化及围产结局。结果:①治疗后生化指标,研究组比对照组明显改善,CG(4.7±3.6)v(s35.1±27.5)μmol/L、ALT(23.5±14.5)vs(96.1±20.7)U/L、AST(24.7±14.3)vs(90.5±19.8)U/L、TBA(4.6±3.5)vs(7.8±4.9)μmol/L、T-BIL(7.7±4.6)vs(15.7±10.6)μmol/L、D-BIL(4.4±2.3)vs(12.5±7.8)μmol/L,P<0.05;终止妊娠平均孕周:研究组比对照组明显延长(38.1±1.5)vs(35.6±1.7)周,早产率分别为7.9%vs 23.8%,P<0.05;②研究组与对照组胎儿窘迫(9.1%vs 26.3%)、羊水粪染(18.8%vs 41.3%)、新生儿窒息(0%vs 5%)、剖宫产率(29.5%vs 53.8%)、产后出血(2.3%vs 7.5%)比较,研究组均明显低于对照组,P<0.05,差异显著。结论:中药汤剂联合西药治疗妊娠期肝内胆汁淤积症较单西药治疗能明显改善临床经过,延长孕周,降低剖宫产率和改善围产结局。

Objective ： To study the clinical index and perinatal outcome of the treatment combined with traditional Chinese and Western medicine of intrahepatic cholestasis of pregnancy （ ICP ）. Methods ： 168 pregnant women diagnosed as ICP were prospectively studied from October 2011 to February 2013 at Suzhou Hospital of Traditional Chinses Medicine. Patients with ICP were randomly divided into two groups： treated with traditional Chinese medicine decoction combined with Western medicine （ ursodeoxycholic acid ） in 88 cases for study group; and the other was treated with single ursodeoxycholic acid in 80 cases for control group. Comparison of the biochemical index between two groups before and after treatment ： glycocholic acid （ CG ）, total bile acid （ TBA ）, alanine amin0transferase （ ALT ）, aspartate aminotransferase （ AST ）, total bilirubin （ T-BIL ）level changes and perinatal outcome were observed. Results ： ①Biochemical index in the study group after treatment was significantly improved than that of the control group, CG[ （4.7 ±3.6 ）μ mol/L vs （35.1 ± 27.5 ） μ mol/L], ALT[ （ 23.5 ± 14.5 ） U/L vs （96.1 ± 20.7）U/L ） ], AST[ （ 24.7 ± 14.3 ） U/L vs （90.5 ± 19.8 ）U/L] ,TBA[ （ 4.6 ± 3.5 ）μ mol/L vs （7.8 ± 4.9） μ mol/L],T-BIL[ （ 7.7 ± 4.6 ）μ mol/L vs （15.7 ± 10.6） μmol/L], D-BILl（4.4 ± 2.3） μmol/L vs （ 12.5 ± 7.8 ） μ mol/L], P〈0.05. The average gestational week of termination of pregnancy was significantly prolonged in study group than that in control group[（ 38.1 ± 1.5 ） weeks vs （35.6 ± 1.7 ） weeks]. The premature birth rates were 7.9% vs 23.8%, P〈0.05. ② In study group,fetal distress （ 9.1% vs 26.3% ）, meconium stained amniotic fluid （ 18.8% vs 41.3% ）, neonatal asphyxia （ 0% vs 5% ）, the rate of cesarean section （ 29.5% vs 53.8% ） and postpartum hemorrhage （ 2.3% vs 7.5% ）, were significantly lower than that of the control group. There was a significant difference between two groups, P〈0.05. Conclusion ： It is suggested that the traditional Chinese medicine decoction combined with Western medicine could significantly prolong the gestational week, reduce the cesarean section rate and improve the perinatal outcome as compared with single Western medicine in patients with ICP.