熊去氧胆酸联合腺苷蛋氨酸对妊娠期肝内胆汁淤积症患者肝功能及妊娠结局的影响

Effect of Ursodeoxycholic Acid Combined with Ademetionine on the Liver Function and Preg- nancy Outcome in Patients with Intrahepatic Cholestasis of Pregnancy

【目的】探讨熊去氧胆酸联合腺苷蛋氨酸对妊娠期肝内胆汁淤积症（ICP）患者肝功能及妊娠结局的影响。【方法】抽取2014年2月至2016年10月本院84例ICP患者，根据治疗方案分为两组，各42例。常规治疗基础上对照组给予熊去氧胆酸治疗，观察组给予熊去氧胆酸＋腺苷蛋氨酸治疗。对比两组治疗前后血清总胆汁酸（TBA）、肝功能指标[谷草转氨酶（AST）、丙氨酸转氨酶（ALT）]水平、瘙痒症状（Ribalta）评分、负性情绪[焦虑（HAMA）、抑郁（HAMD）]评分，并统计两组妊娠结局与新生儿Apgar评分。【结果】①血清TBA及肝功能：治疗前，两组血清TBA、AST及ALT水平差异无统计学意义（P〉0．05），治疗后，观察组血清TBA、AST及ALT水平均低于对照组，差异有统计学意义（P〈0．05）；②瘙痒症状：治疗前，两组Ribalta评分差异无统计学意义（P〉0．05），治疗后，两组Ribalta评分均有所降低，且观察组低于对照组，差异有统计学意义（P〈0．05）；③负性情绪：治疗前，两组HAMA、HAMD评分差异无统计学意义（P〉0．05），治疗后，观察组HAMA、HAMD评分低于对照组，差异有统计学意义（P〈0．05）；④妊娠结局及新生儿Apgar评分：观察组剖宫产率、早产、产后出血发生率[28．57％（12／42）、9．52％（4／42）、4．76％（2／42）]均低于对照组[50．00%（21／42）、26．19％（11／42）]，而Apgar评分高于对照组，差异有统计学意义（P〈0．05），两组产后出血、新生儿窒息发生率比较差异无统计学意义（P〉0．05）。[结论]ICP患者给予熊去氧胆酸联合腺苷蛋氨酸治疗，可有效降低血清TBA水平、缓解瘙痒症状、提高患者肝功能并消除负性情绪，进而有利于改善妊娠结局。

[Objective]To investigate the effect of ursodeoxycholic acid combined with methionine on liver function and pregnancy outcome in patients with intrahepatic cholestasis of pregnancy （ICP）.[Methods]A total of 84 patients with ICP from February 2014 to October 2016 in our hospital were divided into two groups according to the treatment plan, each with a total of 42 cases. On the basis of conventional therapy, the control group was given ursodeoxycholic acid treatment, the observation group was given ursodeoxycholic acid ＋ ademetionine treatment. Before and after treatment, serum total bile acid （TBA）, liver function index [aspartate aminotransferase （AST）, alanine aminotransferase （ALT） levels, pruritus （Ribaha） score, negative emotional anxiety （HAMA）, depression （HAMD）] score of the two groups were compared. The pregnancy outcome and the neonatal Apgar score of the two groups were counted. [Results]（1）serum TBA and liver func- tion： before treatment, there was no significant difference in serum TBA, AST and ALT levels between the two groups （P〉0.05）. After treatment, the serum levels of TBA, AST and ALT in the observation group were lower than those in the control group, the difference was statistically significant （P〈0.05） （2）pruritus： before treatment, there was no significant difference in Ribaha score between the two groups （ P 〉0.05）. Af- ter treatment, the Rihaha scores of the two groups were reduced, and the observation group was lower than the control group, the difference was statistically significant （ P 〈0.05）;（3）negative emotion： before treatment, there was no significant difference between the HAMA and HAMD scores of the two groups （ P〉0.05）. After treatment, the scores of HAMA and HAMD in the observation group were lower than those in the control group, the difference was statistically significant （ P 〈0.05） ;（4）pregnancy outcome and neonatal Apgar score： The rate of cesarean section, premature delivery and postpartum hemorrhage in the observation group was [28.57o/oo （12/42）, 9.52~/oo （4/42）, 4.76%o （8/42）, （2/42）], which were lower than those of the control group [50.00~ （21/42）, 26.19~ （11/42）, 19.05^（8/42）], Apgar score was higher than thatofthe control group, the difference was statistically significant （ P ~0.05）, There was no significant difference in the incidence of postpartum hemorrhage and neonatal asphyxia between the two groups （P ~〉0.05）. [Conclu- sion]Ursodeoxycholic acid combined with methionine treatment given for ICP patients can effectively reduce serum TBA levels, relieve itching symptoms, improve liver function and eliminate negative emotions, and thus help improve pregnancy outcomes.