思美泰联合熊去氧胆酸对妊娠期肝内胆汁淤积症患者的影响

Effect of Transmetil combined with Ursodeoxycholic Acid on the Patients with Intrahepatic Cholestasis of Pregnancy

目的:探讨思美泰联合熊去氧胆酸对妊娠期肝内胆汁淤积症患者的影响。方法:选取我院2015年2月至2016年2月收治妊娠期肝内胆汁淤积症患者共94例,按随机法分为观察组(47例)对照组(47例)。对照组采用思美泰+地塞米松,观察组采用思美泰+熊去氧胆酸。观察两组患者治疗前后血清总胆汁酸(TBA)、总胆红素(TB)、丙氨酸转氨酶(ALT)、门冬氨酸转氨酶(AST)、瘙痒评分及妊娠结局、围生儿情况。结果:治疗后,两组患者TBA、TB、ALT及AST、瘙痒评分水平均较治疗前下降,观察组下降更明显,差异具有统计学意义(P<0.05);观察组患者早产率19.15%(9/47)、剖宫产率27.66%(13/47)、羊水污染率10.64%(5/47)及胎儿窘迫率12.77%(6/47)均分别显著低于对照组40.43%(19/47)、57.45%(27/47)、21.28%(10/37)、19.15%(9/47),其中早产率及剖宫产率比较差异具有统计学意义(P<0.05)。结论:思美泰联合熊去氧胆酸能明显改善妊娠期肝内胆汁淤积症患者胆汁酸、肝酶水平及妊娠结局。

Objective： To study the effect of transmetil combined with ursodeoxycholic acid on the patients with intrahepatic cholestasis of pregnancy（ICP）. Methods： 94 patients with intrahepatic cholestasis of pregnancy admitted in our hospital from February2015 to February 2016 were selected and randomly divided into the observation（47 cases） and control groups（47 cases）. The control group was treated by using transmetil＋dexamethasone, while the observation group was treated by transmetil combined with ursodeoxycholic acid. The TBA（total bile acid）, TB（total bilirubin）, ALT（alanine aminotransferase）, AST（aspartate aminotransferase）, pruritus score before and after the treatment and pregnancy outcome as well as perinatal outcome were compared between two groups. Results：After treatment, the TBA, TB, ALT and AST levels and pruritus score of both groups were lower than those before treatment, but the observation group decreased more significantly（P〈0.05）, the rate of premature labor 19.15%（9/47）, cesarean section rate27.66%（13/47）,amniotic fluid pollution rate10.64%（5/47） and fetal distress rate12.77%（6/47） of observation group were lower than the control group40.43%（19/47）, 57.45%（27/47）, 21.28%（10/37）, 19.15%（9/47） there were significant differences in the rates of preterm labor and the rate of cesarean section（P〈0.05）. Conclusion： Transmetil combined ursodeoxycholic acid could significantly improve the bile acid, liver enzyme levels and pregnancy outcome of patients with ICP.