中西医结合治疗妊娠期肝内胆汁淤积症临床观察

Effect of Integrated Chinese and Western Medicine in Treating Intrahepatic Cholestasis of Pregnancy

目的:观察中西医结合治疗妊娠期肝内胆汁淤积症(ICP)的治疗效果。方法:180例ICP孕妇,随机分为3组,西医治疗组、中药治疗组和中西医结合组,各60例。分析3组患者治疗前后血清甘胆酸(CG)、总胆汁酸(TBA)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、直接胆红素(DBil)、总胆红素(TBil)及游离雌三醇(E3)等指标的变化,并比较各组孕妇的妊娠结局。结果:治疗后,各组的肝功能检测指标较治疗前均明显下降,差异均有统计学意义(P<0.05),血清中游离雌三醇含量出现轻微升高,差异无统计学意义(P>0.05);治疗后,中西医结合组的ALT、AST、CG、TBA较西医治疗组和中医治疗组降低(P<0.05),而西医治疗组和中医治疗组比较,各项指标差异无统计学意义(P>0.05)。中西医结合组的剖宫产率、产后出血量和羊水污染率均低于西医治疗组和中医治疗组,差异均有统计学意义(P<0.05);3组分娩孕周相比较,差异无统计学意义(P>0.05)。结论:中西医结合治疗ICP疗效显著,值得临床推广及应用。

Objective： To explore the therapeutic effect of integrated Chinese and western medicine in treating the pregnant women with intrahepatic cholestasis of pregnancy. Methods= One hundred and eighty cases with intrahepatic cholestasis of pregnancy were averagely divided into three groups, the western medicine treatment （WM）group, the Chinese medicine treatment（CM）group and the integrated Chinese and western medicine treatment（ICWM）group. Changes of pregnancy prognosis and serum levels of biochemical indexes, including glycocholic acid（CG）, total bile acid（TBA）, alanine aminotransferase（ALT）, aspartate amonitransferase（AST）, direct bilirubin （DBil）, bilirubin（TBil） and free estriol（E3） were determined before and after treatment. Results： Levels of biochemical indexes were improved significantly in three groups after treatment（P〈 0.05 compared with those before treatment）, while serum levels of E3 were slightly increased（P〉 0.05 compared with those before treatment）. The levels of ALT, AST, CG and TBA in ICWM group were significantly lower than those in the other two groups, the differences being significant（P 〈 0.05）. There was no significant difference in those indexes between CM group and WM group （P 〉 0.05）.The incidences rate of cesarean section and meconium-stained fluid, postpartum bleeding volume in ICWM group were significantly lower than those in the other two groups（P〈 0.05）. There was no significant difference in the free estriol among three groups（P 〉 0.05）. Conclusion： The integrated Chinese and western medicine shows better effect in treating intrahepatic cholestasis of pregnancy.