腺苷蛋氨酸联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的系统评价

S-adenosy-L-methionine Combined with Ursodesoxycholic Acid in Treatment of Intrahepatic Cholestasis of Pregnancy: A Systematic Review

目的系统评价腺苷蛋氨酸联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的临床疗效及其对妊娠结局的影响。方法计算机检索PubMed、The Cochrane Library、CNKI、VIP、WanFang Data等数据库,纳入评价腺苷蛋氨酸联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的临床疗效及其对妊娠结局影响的随机对照试验(RCT),检索时限截至2013年12月31日。由两名研究者按照纳入与排除标准独立筛选文献、提取资料、评价质量并交叉核对后,采用RevMan 5.0.24软件进行Meta分析。结果共纳入11个RCT,776例患者。Meta分析结果显示:腺苷蛋氨酸联合熊去氧胆酸较单用熊去氧胆酸可更好地降低血生化指标ALT[MD=3.63,95%CI(0.63,6.64),P=0.02)]、TB[MD=3.70,95%CI(1.45,5.96),P=0.001]和AST[MD=7.61,95%CI(2.47,12.75),P=0.004)]的水平;还可以明显降低羊水污染率[OR=0.29,95%CI(0.19,0.45),P=0.000 01]、剖宫产率[OR=0.53,95%CI(0.36,0.79),P=0.002]、产后出血率[OR=0.32,95%CI(0.12,0.90),P=0.03]、早产率[OR=0.36,95%CI(0.24,0.55),P<0.000 01]、胎儿窘迫发生率[OR=0.33,95%CI(0.19,0.58),P=0.000 1]和新生儿窒息发生率[OR=0.30,95%CI(0.19,0.47),P<0.000 01],改善患者的瘙痒症状[MD=0.20,95%CI(0.08,0.31),P=0.000 08],对胎儿生长更有利[MD=0.45,95%CI(0.23,0.66),P<0.000 1]。结论腺苷蛋氨酸联合熊去氧胆酸用于治疗妊娠肝内胆汁淤积症,可有效改善孕妇临床症状和妊娠结局。

Objective To systematically review the clinical efficacy and effects on pregnancy outcomes of S- adenosy-L-methionine combined with ursodesoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. Methods Databases such as PubMed, The Cochrane Library, CNKI, VIP, WanFang Data were searched for the studies about the clinical efficacy and effects on pregnancy outcomes of S-adenosy-L-methionine combined with ursodesoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy up to December 31st, 2013. Two reviewers independently screened literature, extracted data and evaluated methodological quality. Then meta-analysis was conducted using RevMan 5.0.24 software. Results A total of 11 RCTs involving 776 patients were included. The results of meta-analysis showed that, combined medication reduced blood biochemical indexes inlcuding ALT （MD=3.63, 95%CI 0.63 to 6.64, P=0.02）, TB （MD=3.70, 95%CI 1.45 to 5.96, P=0.001）, and AST （MD=7.61, 95%CI 2.47 to 12.75, P=0.004）. Combined therapy significantly decreased the rates of amniotic fluid contamination （OR=0.29, 95%CI 0.19 to 0.45, P=0.000 01）, cesarean section （OR=0.53, 95%CI 0.36 to 0.79, P=0.002）, postpartum hemorrhage （OR=0.32, 95%CI 0.12 to 0.90, P=0.03）, preterm birth （OR=0.36, 95%CI 0.24 to 0.55, P〈0.000 01）, fetal distress （OR=0.33, 95%CI 0.19 to 0.58, P=0.000 1） and neonates asphyxia （OR=0.30, 95%CI 0.19 to 0.47, P〈0.000 01）. Combined therapy was also beneficial to improving pruritus symptoms （MD=0.20, 95%CI 0.08 to 0.31, P=0.000 08） and benefiting fetus growth （MD=0.45, 95%CI 0.23 to 0.66, P〈0.000 1）. Conclusion The combination of S-adenosy-L-methionine and ursodesoxycholic acid is superior to ursodesoxycholic acid alone in improving clinical symptoms and pregnant outcomes of patients with intrahepatic cholestasis of pregnancy.