熊去氧胆酸联合茵陈制剂治疗妊娠期肝内胆汁淤积症的有效性及母婴结局的Meta分析

A meta-analysis of the efficiency and the maternal and infant outcome by applying ursodeoxycholic acid associate with Yinchen decoction in treatment of intrahepatic cholestasis of pregnancy

目的评价熊去氧胆酸(ursodeoxycholic acid,UDCA)联合茵陈制剂治疗妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)的有效性及母婴结局,为用药提供循证依据。方法用计算机对CNKI、VIP、Cochrane、PubMed等数据库进行检索,筛选出研究组用UDCA联合茵陈制剂,对照组仅用UDCA单药治疗ICP的文献,时间从建库至2018年6月。两名研究员按制定的纳入排除标准独立筛选文献,提取资料并核对、评价文献质量,统计分析采用Rev Man 5.3。结果纳入16篇文献,共1 387例患者,对照组675例,研究组712例。Meta分析结果显示,研究组中谷丙转氨酶[MD=-11.30,95%CI(-13.50,-9.10),P<0.05]、谷草转氨酶[MD=-4.36,95%CI(-5.84,-2.88),P<0.05]、胆汁酸[MD=-3.79,95%CI(-4.47,-3.10),P<0.05、皮肤瘙痒评分[MD=-1.07,95%CI(-1.12,-1.01,P<0.05]、治疗总有效率[OR=4.38,95%CI(2.61,7.34),P<0.05]较对照组更优,新生儿窒息率[OR=0.18,95%CI(0.11,0.30),P<0.05]、胎窘率[OR=0.23,95%CI (0.15,0.36),P<0.05]均低于对照组。结论 UDCA联合茵陈制剂治疗ICP在提高临床治疗有效率、改善母婴结局方面均优于熊去氧胆酸单药治疗。

Objective A meta-analysis was conducted to evaluate the effects and the maternal and infant outcome of ursodeoxycholic acid(UDCA)combined with Yinchen decoction on treatment of intrahepatic cholestasis of pregnancy(ICP)compared with monotherapy of ursodeoxycholic acid,to offer basis for clinical medication decisions.Methods We searched CNKI,VIP,Cochrane Library、PubMed etc.for literatures about the research group adopted ursodeoxycholic acid combined with Yinchen decoction,and the control group used the UDCA monotherapy in treating ICP.The searching period was from the time of building the database to June 2018.Two researchers filtered literatures and extracted the data independently by using the setting standard.The quality of the included literatures was estimated.RevMan 5.3 was used to analyse the data.Results 16 literatures were extracted in all,including 1 387 patients,of which 675 in control group and 712 in research group.The results of meta-analysis showed as follows:Compared with control group,ALT[MD=-11.30,95%CI(-13.50,-9.10),P<0.05],AST[MD=-4.36,95%CI(-5.84,-2.88),P<0.05],TBA[MD=-3.79,95%CI(-4.47,-3.10),P<0.05]and pruritus score[MD=-1.07,95%CI(-1.12,-1.01),P<0.05]were superior after the treatment of using UDCA combined with Yinchen dection,the total effective rate of research group was higher[OR=4.38,95%CI(2.61,7.34),P<0.05],the rate of the neonatal asphyxia[OR=0.18,95%CI(0.11,0.30),P<0.05],and the rate of the fetal distress in uterus[OR=0.23,95%CI(0.15,0.36),P<0.05]were lower.Conclusion UDCA combined with Yinchen decoction for treatment of ICP is superior to ursodeoxycholic acid monotherapy in improving clinical treatment efficiency and improving maternal and infant outcomes.