地塞米松与熊脱氧胆酸对妊娠期肝内胆汁淤积患者血清PLTP、IL-18水平的影响

Effect of Dexamethasone Combined with Ursodeoxycholic Acid on Serum PLTP and IL- 18 Levels of Patients with Intrahepatic Cholestasis of Pregnancy

目的：研究地塞米松联合熊脱氧胆酸对妊娠期肝内胆汁淤积症患者血清血清磷脂转移蛋白（phospholipidtransferprotein，PLTP）、白介素-18（interleukin-18，IL-18）水平的影响。方法：选择2014年10月至2016年10月在我院进行治疗的妊娠期肝内胆汁淤积症患者130例，按照治疗方法不同分为观察组和对照组，观察组给予地塞米松联合熊脱氧胆酸治疗，对照组给予地塞米松治疗。比较两组的临床治疗效果、治疗前后肝功能指标、血清PurP、1L-18水平、瘙痒评分的变化及妊娠结局。结果：治疗后，观察组总有效率（93．8％）明显高于对照组（80．0％）（P〈O．05）；观察组血清PulP、IL-18水平均明显低于对照组（P〈O．05），且血清TBA、ALT、AST、TBIL水平、瘙痒评分、剖宫产率均明显的低于对照组（P〈0．05），早产率、胎儿窘迫率、新生儿窒息率均低于对照组，但差异无统计学意义（P〉0．05），Apgar评分明显高于对照组（P〈0．05）。结论：地塞米松联合熊脱氧胆酸治疗妊娠期肝内胆汁淤积症的临床疗效显著优于单用地塞米松治疗，可有效改善患者肝功能和妊娠结局，并降低血清PLTP，IL-18水平。

Objective： To study the effect of dexamethasone with ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy and serum levels of PLTP and IL-18. Methods： 130 patients with intrahepatic cholestasis of pregnancy who were treated in our hospital from October 2014 to October 2016 were selected and divided into the observation group and the control group according to different treatment methods. The patients in observation group were treated with dexamethasone and deoxycholic acid, while the patients in control group were treated with dexamethasone. Then the clinical effect, serum levels of PLTP and IL-18, pruritus score and pregnancy outcomes in the two groups were observed and compared before and after the treatment. Results： After treatment, the total efficacy of ob- servation group was 93.8%, which was obviously higher than that of the control group （80.0%, P〈0.05）; After treatment, the serum levels of PLTP and IL-18 in the observation group were significantly lower than those of the control group （P〈0.05）; After treatment, the levels ofALT, AST and TBIL, and pruritus score of observation group were significantly lower than those of the control group （P〈0.05）. There was no statistically significant difference in the incidence of premature birth, fetal distress and neonatal asphyxia between the two groups （P〉0.05）. The cesarean section rate in the observation group was significantly lower than that of the control group, and the apgar score was higher （P〈0.05）. Conclusion： Dexamethasone and deoxycholic acid had obvious clinical curative effect in the treatment of intrahep- afie cholestasis during pregnancy, which could improve the liver function and pregnancy outcomes, reduce the serum levels of PLTP and IL-18.