熊去氧胆酸联合低分子肝素钙注射液与丁二磺酸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 Low Molecular Weight Heparin Calcium Injection and Ademetionine 1,4-Butanedisulfonate in the Treatment of Intrahepatic Cholestasis of Pregnancy

目的:观察熊去氧胆酸联合低分子肝素钙注射液与丁二磺酸腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)患者的临床疗效,分析患者血清胆汁酸(TBA)、谷丙转氨酶(ALT)和谷草转氨酶(AST)水平的变化及妊娠情况。方法:将收治的135例ICP患者按照治疗方法不同分为A、B、C组,各45例,3组均行常规检查。A组口服熊去氧胆酸片;B组口服熊去氧胆酸片基础上注射丁二磺酸腺苷蛋氨酸治疗;C组在B组治疗基础上联合低分子肝素钙治疗。对比3组临床疗效和妊娠情况,检测所有受试者治疗前后外周血TBA、ALT和AST水平。结果:治疗后,C组临床有效率(93.33%)高于A、B组(P<0.05)。治疗前,3组患者瘙痒评分比较差异无统计学意义(P>0.05);治疗后,3组瘙痒评分较组内治疗前均降低(P<0.05),且治疗后C组低于A和B组(P<0.05),B组低于A组(P<0.05)。治疗前,3组TBA、ALT和AST水平差异无统计学意义(P>0.05);治疗后,3组TBA、ALT和AST水平较组内治疗前均降低(P<0.05),且治疗后C组低于A和B组,B组低于A组(P<0.05)。治疗后,C组患者剖宫产、早产、胎儿窘迫和羊水污染发生率均低于A组和B组,且总不良反应发生率明显低于A组和B组(P<0.05)。结论:熊去氧胆酸联合低分子肝素钙注射液与丁二磺酸腺苷蛋氨酸治疗ICP患者的临床疗效显著,能更有效缓解患者的瘙痒程度,降低血清TBA、ALT和AST水平,保护肝脏,减少胎儿窘迫和羊水污染等情况的发生,具有较高临床价值,可作为ICP的治疗方案进一步推广应用。

Objective:To observe the clinical efficacy of ursodeoxycholic acid combined with low molecular weight heparin calcium injection and adenosine methionine methionine in the treatment of intrahepatic cholestasis of pregnancy. The levels of serum bile acid(TBA), alanine aminotransferase(ALT) and aspartate aminotransferase(AST) were analyzed. Methods:According to different treatment methods, 135 patients with ICP were divided into A, B and C group(n=45). The three groups were treated by routine therapy. Group A patients with oral ursodeoxycholic acid tablets. On this basis, group B was injected with adenosylmethionine disulfonate. On group B basis, group C was injected with low molecular weight heparin calcium injection. The clinical efficacy and pregnancy status of the three groups were compared and the levels of TBA, ALT and AST were measured in all subjects before and after treatment. Results:After treatment, the clinical effective rate of group C was93.33% higher than that of group A and B(P<0.05). Before treatment, there was no significant difference in the score of itching between the three groups(P>0.05). After treatment, the scores of the three groups were significantly lower than those before treatment(P<0.05), and group C was lower than group A and B(P<0.05), and group B was lower than group A(P<0.05).Before treatment, there was no significant difference in the levels of TBA, ALT and AST between the three groups( P>0.05).After treatment, the levels of TBA, ALT and AST in the three groups were significantly lower than those before treatment( P<0.05), and group C was lower than group A and B(P<0.05), and group B was lower than group A(P<0.05). After treatment, the incidence of cesarean section, premature birth, fetal distress and amniotic fluid pollution in group C were lower than those in group A and B, and the overall incidence of group C was significantly lower than that of group A and B(P<0.05). Conclusions:Ursodeoxycholic acid combined with low molecular weight heparin calcium injection and adenosine methionine methionine in the treatment of ICP patients with clinical efficacy is significant. And it can be more effective inrelieving the degree of pruritus,reducing serum TBA, ALT and AST levels, protecting the liver, reducing fetal distress and amniotic fluid Pollution and other circumstances, which is the clinical potential of the ideal program.