S-腺苷蛋氨酸联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的临床疗效及对肝功能、炎症因子的影响

Ursodeoxycholic acid combined with S-adenosyl-L-methionine in the treatment of intrahepatic cholestasis of pregnancy and effect on liver function and inflammatory factors

目的探讨S-腺苷蛋氨酸联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症(ICP)的临床疗效及对肝功能、炎症因子的影响。方法将100例ICP患者随机分为2组各50例,对照组仅予熊去氧胆酸单药治疗,观察组在对照组的基础上联用S-腺苷蛋氨酸治疗。比较两组治疗前后的瘙痒评分、肝功能指标、血清白介素-12(IL-12)和IL-18水平变化及妊娠结局。结果治疗后观察组瘙痒评分明显低于对照组,差异有统计学意义(P<0.05)。观察组血清总胆红素(TBIL)、总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平明显低于对照组,差异有统计学意义(P<0.05);白细胞介素(IL)-12、IL-18水平明显低于对照组,差异有统计学意义(P<0.05)。观察组早产、羊水污染Ⅱ度、新生儿Apgar评分≤7分的发生率明显低于对照组,差异有统计学意义(P<0.05)。结论 S-腺苷蛋氨酸联合熊去氧胆酸治疗ICP疗效优越,可显著改善患者的肝功能及血清炎症因子水平,改善妊娠结局。

Objective To explore the effect of Ursodeoxycholic acid（UDCA） combined with S-adenosyl-L-methionine（SAMe） in the treatment of intrahepatic cholestasis of pregnancy（ICP） and its effect on liver function and inflammatory factors.Methods 100 patients with ICP were randomly divided into two groups,50 case in each group,and the control group were only treated with UDCA,and the observation group were treated with SAMe on the basis of the control group.Pruritus score,liver function,serum interleukin-12（IL-12） and IL-18 level before and after treatment and pregnancy outcome in the two groups were compared.Results After treatment,pruritus score of the observation group was significantly lower than that of the control group（P〈0.05）.The levels of TBil,TBA,ALT and AST of the observation group were significantly lower than those in the control group（P〈0.05）,and the levels of IL-12 and IL-18 were significantly lower than those of control group（P〈0.05）.The incidence rates of premature birth,amniotic fluid pollution degree,Apgar score≤7 of the observation group of were significantly lower than those of the control group（P〈0.05）.Conclusions UDCA combined with SAMe in the treatment of ICP is superior,and can improve the liver function and serum inflammatory factors,and improve the outcome of pregnancy.