熊去氧胆酸联合腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症的临床研究

Clinical Study of Ursodeoxycholic Acid Combined with Adenosylmethionine in the Treatment of Intrahepatic Cholestasis of Pregnancy

目的探讨研究熊去氧胆酸联合腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症(ICP)的临床疗效和对妊娠结局的影响。方法 104例ICP患者根据随机数字表法分成研究组(52例)和对照组(52例),对照组患者在常规治疗的基础上使用熊去氧胆酸治疗,研究组采用熊去氧胆酸联合腺苷蛋氨酸治疗。比较两组患者的临床疗效和妊娠结局,同时检测和比较两组患者治疗前后肝功能指标以及血清IL-17、TGF-β水平。结果治疗后研究组患者的有效率(88.46%)明显高于对照组(71.15%),差异有统计学意义(P<0.05),且研究组患者的临床疗效与ICP的严重程度并无相关性(P>0.05),对照组轻度ICP患者的临床疗效明显优于重度ICP患者(P<0.05)。治疗后研究组患者的瘙痒评分明显低于对照组,重度ICP患者的瘙痒评分明显高于轻度ICP患者,差异有统计学意义(P<0.05)。治疗后研究组患者妊娠结局明显优于对照组,重度ICP患者的妊娠结局明显优于轻度ICP患者,差异均有统计学意义(P<0.05)。治疗后研究组肝功能指标改善明显优于对照组,且重度ICP患者的肝功能改善情况不及轻度ICP患者,差异均有统计学意义(P<0.05)。治疗后研究组患者的IL-17、TGF-β水平改善情况优于对照组,且重度ICP患者的IL-17、TGF-β水平改善情况不及轻度ICP患者,差异均有统计学意义(P<0.05)。结论熊去氧胆酸联合腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症的临床疗效显著,能够显著改善妊娠结局,提高患者的肝功能,其作用机制可能是改善患者Th17/Treg失衡状态,且疗效情况与ICP的严重程度相关。

Objective To study the clinical efficacy of ursodeoxycholic acid combined with adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy （ICP） and its effect on pregnancy outcomes.Methods One hundred and four patients with ICP were divided into study group （52 cases） and control group （52 cases） according to the random number table. The patients in the control group were treated with ursodeoxycholic acid on the basis of routine treatment. While ursodeoxycholic acid combined with adenosylmethionine in the study group. The levels of serum IL-17 and TGF-β were measured before and after treatment, and the serum levels of IL-17 and TGF-β were measured before and after the treatment in both groups. The clinical efficacy, pregnancy outcome and also the levels of serum IL-17 and TGF-β were measured and compared before and after treatment in both groups.Results The treatment efficiency （88.46%） of the study group was significantly higher than that of the control group （71.15%）, the difference was statistically significant （P〈0.05）. The clinical efficacy of mild ICP patients in the control group was better than that the severe ICP patients （P 〈0.05）, but the clinical efficacy of the study group was not significantly related to the severity of ICP. The score of pruritus in the ICP group was significantly higher than that in the mild ICP group （P〈0.05）, and the score of itching in the study group was significantly lower than that in the control group （P 〈0.05）. The pregnancy outcome of the study group was significantly better than that of the control group （P 〈0.05）. The pregnancy outcome of severe ICP patients was significantly better than that of the mild ICP patients （P 〈0.05）. The improvement of liver function in study group was better than that in control group, and the improvement of liver function in severe ICP patients was less than that in mild ICP group （P 〈0.05）. The improvement of IL-17 and TGF-β levels in the study group was better than that in the control group, and the levels of IL-17 and TGF-β in patients with severe ICP were lower than those in patients with mild ICP （P 〈0.05）.Conclusion Ursodeoxycholic acid combined with adenosylmethionine can significantly improve the outcome of pregnancy and the liver function in patients with intrahepatic cholestasis of pregnancy. The mechanism of which may be to improve the patient＇s Th17/Treg imbalance, the efficacy is related to the severity of ICP.