S-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荟萃分析

Meta- analysis of S- adenosyl- L- methionine Combined with Ursodeoxycholic Acid in the Treatment of Intrahepatic Cholestasis of Pregnancy

目的:评价S-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疗效。方法:计算机检索Cochrane、MEDLINE、EMbase、CBM、维普、万方、CNKI等,用RevMan5.0软件进行荟萃分析。结果:经筛选共纳入10个研究,SAMe联合UDCA治疗ICP较单一用药更能降低总胆汁酸(WMD=-6.07,95%CI为-11.09^-1.04)、谷丙转氨酶(WMD=-46.40,95%CI为-69.44^-23.36)及谷草转氨酶(WMD=-22.66,95%CI为-36.05^-9.28)水平;减轻瘙痒程度(WMD=-0.75,95%CI为-1.23^-0.26);降低剖宫产率(OR=0.54,95%CI为0.33~0.90)及早产率(OR=0.33,95%CI为0.21~0.52),降低胎儿羊水粪染发生率(OR=0.36,95%CI为0.24~0.56),也可降低5分钟Apgar评分≤7分的发生率(OR=0.21,95%CI为0.10~0.43);在分娩孕周(WMD=0.38,95%CI为-0.35~1.12)及新生儿出生体重(WMD=276.62,95%CI为-82.46~635.71)方面比较,两组差异无统计学意义(P>0.05)。结论:SAMe联合UDCA较单一用药更能降低血生化指标,减轻瘙痒程度,改善围产儿结局,但在新生儿出生体重及分娩孕周的比较无优势。

ObjectiVe：To eValuate the efficacy of S-adenosyl -L-methionine（ SAMe）combined with ursodeoXycholic acid（ UDCA）in the treatment of intrahepatic cholestasis of pregnancy（ ICP）. Methods：The published articles about the treat-ment of ICP with S - adenosyl - L - methionine（ SAMe ） combined with UDCA and that with SAMe or UDCA alone were searched in MEDLINE,EMBASE,CBM,Vip,Wanfang,CNKI and Cochrane Library,with the searching results Meta-analyed by software ReVMan5. 0. ResuIts：Meta analysis of total ten articles eligible for criteria showed that the treatment of ICP with SAMe plus UDCA could more effectiVely lower the leVels of total bile acid（WMD= -6. 07,95% CI -11. 09~ -1. 04）,ala-nine aminotransferase（WMD= -46. 40,95% CI -69. 44~ -23. 36）and aspartate aminotransferase（WMD= -22. 66,95%CI -36. 05~ -9. 28）than that with SAMe or UDCA alone,with pruritus relieVed,the rate of cesarean section and the rate of preterm birth lowered,the incidence of fetal meconium-stained amniotic fluid reduced,and with incidence of 5 minutes Apgar score≤7 lowered as well. There was no significant difference in gestational age and birth weight between the two therapies. Con-cIusion：Combination therapy of SAMe and UDCA can more effectiVely lower the leVel of blood biochemical indicators than single drug therapy,relieVing pruritus and improVing perinatal outcomes. Combination therapy of SAMe and UDCA shows no adVantage oVer single drug therapy in the regard of birth weight and gestational age.