丁二磺酸腺苷蛋氨酸联合熊去氧胆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 Ademetionine 1,4-Butane Disulfonate Combined with Ursodeoxycholic Acid on Liver Function and Pregnancy Outcome in Patients with Intrahepatic Cholestasis during Pregnancy

目的:探讨丁二磺酸腺苷蛋氨酸联合熊去氧胆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:选取2016年1月至2017年10月我院接诊的96例ICP患者,按照随机数字表法分为观察组和对照组,每组各48例,两组患者均给予常规基础治疗,对照组在此基础上给予熊去氧胆酸治疗,观察组在对照组基础上给予丁二磺酸腺苷蛋氨酸治疗,比较两组患者瘙痒、黄疸改善时间及治疗前后胆酸和肝功能指标检测结果,观察并对比两组母婴预后情况。结果:观察组瘙痒改善时间及黄疸改善时间均低于对照组(P<0.05)。两组患者治疗前总胆汁酸(TBA)、甘胆酸(CG)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBiL)、直接胆红素(DBiL)水平对比差异无统计学意义(P>0.05);两组患者治疗后TBA、CG、ALT、AST、TBiL、DBiL水平均低于治疗前,且观察组低于对照组(P<0.05)。观察组羊水污染、胎儿窘迫、早产、剖宫产及新生儿Apgar评分<7分发生率均低于对照组(P<0.05),两组患者产后出血、死胎发生率对比差异无统计学意义(P>0.05)。结论:丁二磺酸腺苷蛋氨酸联合熊去氧胆酸能够有效改善ICP症状和肝功能,降低不良母婴预后发生风险,可作为优选治疗方案。

Objective： To investigate the effect of ademetionine 1,4-Butane Disulfonate combined with ursodeoxycholic acid on liver function and pregnancy outcome in patients with intrahepatic cholestasis during pregnancy（ICP）. Methods： A total of 96 patients with ICP, who were admitted to Panyu District Central Hospital of Guangzhou from January 2016 to October 2017, were selected and randomly divided into observation group（n=48） and control group（n=48）. The patients in the two groups were given routine basic treatment, on the basis of which, the control group was given ursodeoxycholic acid, and the observation group was given ademetionine 1,4-Butane Disulfonate treatment on the basis of the control group＇s therapy. The improvement time of itching and jaundice and the results of bile acid and liver function indexes before and after treatment in the two groups were compared. The prognosis of maternal and infant in the two groups was observed and compared. Results： The improvement time of the itching and the jaundice in the observation group was less than that in the control group（P〈0.05）. There were no significant differences in the levels of total bile acids（TBA）,glucocholic acid（CG）, alanine aminotransferase（ALT）, aspartate aminotransferase（AST）, total bilirubin（TBiL） and direct bilirubin（DBiL） between the two groups before treatment（P〉0.05）. After treatment, the levels of TBA, CG, ALT, AST, TBiL and DBiL in the two groups were lower than those before treatment, and the observation group was lower than the control group（P〈0.05）. The incidence of amniotic fluid pollution, fetal distress, premature delivery, cesarean section and neonatal Apgar score 〈7 scores of the observation group were lower than those of the control group（P〈0.05）. There was no significant difference in the incidence of postpartum hemorrhage and stillbirth between the two groups（P〉0.05）. Conclusion： Ademetionine 1,4-butanedisulfonate combined with ursodeoxycholic acid can effectively improve the symptoms and liver function of ICP and reduce the risk of poor maternal and infant prognosis, which can be used as a preferred treatment plan.