熊去氧胆酸联合S-腺苷蛋氨酸治疗妊娠期重度肝内胆汁淤积症的临床疗效

Ursodeoxycholic acid combined with S-adenosylmethionine for treatment of severe intrahepatic cholestasis of pregnancy

目的:观察熊去氧胆酸(ursodeoxycholic acid,UDCA)联合S-腺苷蛋氨酸(S-adenosylmethionine,S-AMe)治疗重度妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)的临床疗效.方法:按照随机数字表法随机将贵州省人民医院妇产科收治的80例重度ICP患者随机分为观察组和对照组.两组患者均行常规治疗,观察组在此基础上联合应用UDCA和S-AMe,对照组在此基础上单纯应用UDCA,7 d为1个疗程.观察对比两组患者的皮肤瘙痒评分情况、肝功能水平变化情况以及围产期不良情况.结果:治疗后,两组患者皮肤瘙痒评分均有明显改善,且观察组改善程度优于对照组,两组比较(0.79分±0.55分vs 1.20分±0.61分),差异有统计学意义(P<0.05);且观察组患者皮肤瘙痒消失时间与对照组相比(3.3 d±0.9 d vs 3.6 d±1.4 d),差异有统计学意义(P<0.05);两组患者总胆汁酸、总胆红素、直接胆红素、谷草转氨酶、谷丙转氨酶等各项肝功能指标水平均有显著下降,且观察组下降程度高于对照组,两组比较差异有统计学意义(P<0.05);两组患者均未发生新生儿死亡,并且患者剖宫产率(30%vs 70%)、新生儿窒息发生率(Apgar评分)(0%vs 20%)、胎儿窘迫发生率(25%vs 70%)、羊水粪染率(35%vs65%)、产后出血发生率(22.5%vs 55%)比较,观察组均明显低于对照组,差异具有显著性(P<0.05或P<0.01).结论:联合应用UDCA和S-AMe治疗重度ICP能有效缓解患者皮肤瘙痒症状,降低血清胆酸浓度,改善妊娠预后,比单纯应用UDCA的疗效更为显著,值得临床推广应用.

AIM： To observe the clinical efficacy of ur- sodeoxycholic acid （UDCA） combined with S-adenosylmethionine （S-AMe） in the treatment of severe intrahepatic cholestasis of pregnancy （ICP）. METHODS： Eighty patients with severe ICP treated at our hospital were randomly divided into either an observation group or a control group. Both groups of patients received con- ventional therapy. The observation group was additionally given UDCA and S-AMe, and the control group was additionally given UDCA only. Pruritus score, liver function changes and perinatal adverse reactions were compared be- tween the two groups.RESULTS： After treatment, skin pruritus scores were significantly improved in both groups, and the improvement was significantly better in the observation group （0.79 ± 0.55 vs 1.20 ± 0.61, P 〈 0.05）. The time to pruritus disappearance was significantly shorter in the observation group than in the control group （3.3 d ± 0.9 d vs 3.6 d ± 1.4 d, P 〈 0.05）. Total bile acid, total bilirubin, direct bilirubin, aspartate aminotransferase, and alanine aminotransfer- ase were significantly decreased in both groups after treatment, and the decreases were more significant in the observation group （P 〈 0.05）. No neonatal death occurred in either group. The percentage of patients with cesarean sec- tion （30% vs 70%） and the incidences of neona- tal asphyxia （0% vs 20%）, fetal distress （25% vs 70%）, meconium stained amniotic fluid （35% vs 65%） and postpartum hemorrhage （22.5% vs 55%） were significantly lower in the observa- tion group than in the control group （P 〈 0.05 or P 〈 0.01）. CONCLUSION： Combined application of UDCA and S-AMe in the treatment of severe ICP can ef- fectively relieve skin itching, reduce serum bile acid concentration, and improve the pregnancy outcome.