熊脱氧酸治疗妊娠期肝内胆汁淤积症的临床效果分析

Analysis of the Clinical Effect of Ursodeoxycholic Acid on the Intrahepatic Cholestasis of Pregnancy

目的:探讨熊脱氧酸治疗妊娠期肝内胆汁淤积症(ICP)的临床效果及其可能机制。方法:选择2013年8月到2018年2月在我院诊治的ICP患者105例作为研究对象,根据治疗方法分为对照组50例和研究组55例,对照组给予腺苷蛋氨酸治疗,研究组给予腺苷蛋氨酸联合熊脱氧酸治疗,检测和比较两组的临床总有效率,治疗前后的血清肿瘤坏死因子α(TNF-α)、白细胞介素12(IL-12)、甘胆酸(CG)和总胆汁酸(TBA)水平的变化及妊娠结局。结果:所有患者都顺利分娩,无死亡产妇与胎儿。研究组的总有效率为98.2%,显著高于对照组(88.0%),差异有统计学意义(P<0.05)。两组治疗后的血清CG、TBA、IL-12及TNF-α水平均显著低于治疗前(P<0.05),且研究组以上指标均明显低于对照组(P<0.05)。研究组的剖宫产、早产、新生儿窒息、产后出血、羊水粪染等发生率显著低于对照组(P<0.05)。结论:熊脱氧酸治疗ICP能有效提高治疗效果,改善妊娠结局,这可能与其降低血清患者TNF-α、IL-12、CG、TBA水平有关。

Objective: To investigate the clinical effect and its possible mechanism of ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy(ICP). Methods: 105 cases of ICP patients treated in our hospital from August 2013 to February 2018 were selected and divided into the control group(50 cases) and the study group(55 cases) according to different treatment methods.The control group was treated with adenosylmethionine, and the study group was treated with adenosylmethionine combined with ursodeoxycholic acid. The total clinical efficiency, the level of tumor necrosis factor-alpha(TNF-α), interleukin-12(IL-12), Cholyglycine(CG), total bile acid(TBA) before and after treatment and the pregnancy outcome were examined and compared between two groups.Results: All the patients were smoothly delivery and there was no dead parturients and fetus, the total effective rates in the study group was 98.2%, which was significantly higher than that of the control group(88%)(P<0.05). The serum levels of CG, TBA, TNF-α and IL-12 after treatment were significantly lower than those before treatment(P<0.05), which were lower in the study group than those in the control group(P <0.05). The incidence of caesarean section, premature delivery, neonatal asphyxia, postpartum hemorrhage and meconium stained amniotic fluid in the study group were significantly lower than those in the control group(P <0.05). Conclusion:Ursodeoxycholic acid can effectively improve the therapeutic effect and the pregnancy outcome in the treatment of ICP, which may be related to the reduction of TNF-α, IL-12, CG and TBA levels in the serum.