茵栀黄颗粒对妊娠期肝内胆汁淤积症糖脂代谢及胆盐载体的影响

Effects of Yinzhihuang Granules on Glucolipid Metabolism in the Patients with Intrahepatic Cholestasis During Gestation Period and the Concentration Changes of MRP in Placental Bile Salts Transporters

目的:评价茵栀黄颗粒对妊娠期肝内胆汁淤积症患者糖脂代谢的影响,并检测治疗前后胎盘中胆盐载体(MRP)的水平。方法:选取2015年1月至2017年1月南阳南石医院将60例妊娠期肝内胆汁淤积症患者纳入研究,随机分为对照组及观察组,每组30例。2组均使用熊去氧胆酸及丁二磺酸腺苷蛋氨酸,观察组在此基础上加用茵栀黄颗粒,比较2组孕妇临床症状、糖脂代谢指标、妊娠结局及胎盘MRP水平。结果:2组瘙痒的症状评分均下降,观察组优于对照组(P<0.05);治疗后2组糖化血红蛋白(Hb Alc)、空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDL-C)均有不同程度改善,其中观察组改善更为明显,与对照组比较差异有统计学意义(P<0.05);观察组新生儿早产率、新生儿窘迫发生率均明显低于对照组,产后24 h出血的总量明显少于对照组,新生儿体重较对照组提高,差异有统计学意义(P<0.05);治疗后2组的胎盘组织MRP1及MRP2水平均有所上调,其中观察组上调的趋势更为明显(P<0.05)。结论:茵栀黄颗粒可明显改善妊娠期肝内胆汁淤积症患者糖脂代谢水平,可通过上调MRP水平促进胎盘胆汁运转,促进病情恢复。

Objective： To evaluate the effects of Yinzhihuang granules on glucolipid metabolism in the patients with intrahepatic cholestasis during gestation period,and to detect the concentration changes of MRP before and after treatment in placental bile salts transporters. Methods： A total of 60 cases of patients with intrahepatic cholestasis during gestation period from January 2015 to January 2017 were included into the study,and randomly divided into the control group and the observation group,with 30 cases in each group. The two groups of patients had ursodesoxycholic acid and Ademetionine 1,4-butanedisulfonate,and the observation group had Yinzhihuang granules on this basis. The clinical symptoms,glucolipid metabolic indexes,the pregnancy outcome and the concentration changes of MRP in placental bile salts transporters were compared. Results： 1） The itching symptom scores decreased in both the two groups of patients,and the observation group was superior to that of control group（ P 〈0. 05）; 2） Hb Alc,fasting plasma glucose（ FPG）,triglycerides（ TG）,total cholesterol（ TC）,high-density lipoprotein（ HDL-C）,low density lipoprotein（ LDL-C） were improved to varying degrees in the two groups of patients after treatment,and the improvement of the observation group was more significantly. Compared with the control group,there were statistically significant differences（ P 〈0. 05）; 3） Neonatal premature birth rate and incidence of neonatal distress in the observation group were significantly inferior to the control group,and the total 24 h postpartum hemorrhage was less than that of the control group. The newborn weight increased than the control group,and the differences were with statistical significance（ P 〈0. 05）; 4） The concentrations of MRP1 and MRP2 in placenta tissue of the patients in the two groups all up-regulated to some extent after treatment,and the rise trend of the observation group was more obviously（ P 〈0. 05）. Conclusion： Yinzhihuang granules can significantly improve glucolipid metabolism in the gestation period patients with intrahepatic cholestasis disease,and can promote the illness recovery by up-regulating the concentration of MRP to promote the placenta bile process.