熊去氧胆酸治疗妊娠期肝内胆汁淤积症患者疗效研究

Clinical efficacy of ursodeoxycholic acid in treatment of patients with intrahepatic cholestasis of pregnancy

目的探讨应用熊去氧胆酸(UDCA)治疗妊娠期肝内胆汁淤积症(ICP)患者的疗效及其安全性。方法2015年3月~2018年4月我院收治的ICP患者70例,被随机分为观察组35例和对照组35例,分别给予常规治疗和UDCA治疗4周。采用高效液相色谱串联质谱法检测血清胆汁酸谱,包括石胆酸(LCA)、UDCA、鹅去氧胆酸(CDCA)、胆酸(CA)、甘氨胆酸(GCA)、牛磺石胆酸(TLCA)和总胆酸(TCA)。结果在治疗结束时,观察组和对照组瘙痒评分分别为(1.1±0.3)对(2.3±0.8),差异显著(P<0.05);血清ALT水平分别为(25.7±10.0)U/L对(85.1±24.3)U/L,AST分别为(22.6±10.3)U/L对(84.3±11.3)U/L,TBIL分别为(21.6±3.8)μmol/L对(30.5±5.4)μmol/L,差异显著(P<0.05);血清UDCA分别为(3.2±0.1)μmol/L对(2.5±0.2)μmol/L,CA水平分别为(1.2±0.1)μmol/L对(2.4±0.2)μmol/L,GCA分别为(1.6±0.2)μmol/L对(2.8±0.5)μmol/L,TCA分别为(1.2±0.3)μmol/L对(4.2±0.9)μmol/L,差异显著(P<0.05);观察组早产、产后出血和新生儿窒息等不良结局发生率显著低于对照组(17.1%对51.4%,P<0.05)。结论应用UDCA治疗ICP患者能显著减轻症状,改善肝功能指标,且无明显的不良后果。

Objective The aim of this study was to investigate the clinical efficacy of ursodeoxycholic acid(UDCA)in treatment of patients with intrahepatic cholestasis of pregnancy(ICP).Methods 70 patients with ICP were recruited in our hospital between March 2015 and April 2018,and were randomly divided into observation and control group with 35 cases in each.The patients in control group were given conventional treatment,and those in the observation were given UDCA treatment for four weeks.Serum lithocholic acid(LCA),UDCA,chenodeoxycholic acid(CDCA),cholic acid(CA),glycocholic acid(GCA),taurocholic acid(TLCA)and total cholic acid(TCA)were assayed by high performance liquid chromatography series mass spectrometry.Results At the end of four-week treatment,the pruritis scores in the observation and control group were(1.1±0.3)vs.(2.3±0.8),respectively(P<0.05);serum alanine aminotransferase levels were(25.7±10.0)U/L vs.(85.1±24.3)U/L(P<0.05),serum aspartate aminotransferase levels were(22.6±10.3)U/L vs.(84.3±11.3)U/L(P<0.05)and serum bilirubin levels were(21.6±3.8)μmol/L vs.(30.5±5.4)μmol/L(P<0.05);serum UDCA levels were(3.2±0.1)μmol/L vs.(2.5±0.2)μmol/L,CA were(1.2±0.1)μmol/L vs.(2.4±0.2)μmol/L,GCA were(1.6±0.2)μmol/L vs.(2.8±0.5)μmol/L and TCA were(1.2±0.3)μmol/L vs.(4.2±0.9)μmol/L,all significantly different(P<0.05);the incidences of premature delivery,postpartum hemorrhage and neonatal asphyxia in the two groups were significantly different(17.1%vs.51.4%,P约0.05).Conclusion The application of UDCA in treatment of patients with ICP has efficacious and safe,which might alleviate the clinical symptoms,and improve liver function tests.