多烯磷脂酰胆碱联合地塞米松治疗妊娠期肝内胆汁淤积症的效果及对胎儿生长的影响

Therapeutic effects of polyene phosphatidylcholine combined with dexamethasone on intrahepatic cholestasis of pregnancy and their effects on fetus growth

目的研究多烯磷脂酰胆碱联合地塞米松治疗妊娠期肝内胆汁淤积症的效果及对胎儿生长的影响。方法选取2017年1月至2018年12月收治的妊娠期肝内胆汁淤积症患者100例,按照随机数字表法将所有患者随机分为单药组和联合组,每组50例。单药组患者使用地塞米松进行治疗,联合组患者使用多烯磷脂酰胆碱联合地塞米松进行治疗。对2组患者临床症状改善情况、治疗效果、妊娠结局进行统计,并检测2组患者治疗前后血清总胆汁酸(TBA)、总胆红素(TBil)、直接胆红素(DBil)、丙氨酸氨基转氨酶(ALT)、天冬氨酸氨基转氨酶(AST)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平及胎盘组织中核因子-E2相关因子2(Nrf2)、增殖细胞核抗原(PCNA)、Ki67蛋白表达量。结果联合组患者瘙痒消失时间、黄疸消失时间均短于单药组(P<0.05)。治疗后2组患者瘙痒评分、TBA、TBil、DBil、ALT、AST、IL-8、TNF-α水平低于治疗前(P<0.05);治疗后联合组患者瘙痒评分、TBA、TBil、DBil、ALT、AST、IL-8、TNF-α水平低于单药组(P<0.05)。联合组患者胎盘组织中Nrf2、PCNA、Ki67蛋白表达量均高于单药组(P<0.05)。联合组患者治疗总有效率高于单药组(P<0.05)。联合组早产率、剖宫产率、胎儿窘迫率、新生儿窒息率均低于单药组(P<0.05)。结论运用多烯磷脂酰胆碱联合地塞米松对妊娠期肝内胆汁淤积症患者进行治疗,可显著改善患者临床症状,通过抑制母体炎症反应,促进胎盘组织中Nrf2、PCNA、Ki67的表达,抑制胎儿生长受限,促进胎儿生长。

Objective To investigate the therapeutic effects of polyene phosphatidylcholine combined with dexamethasone on intrahepatic cholestasis of pregnancy and their effects on fetus growth.Methods One hundred patients with intrahepatic cholestasis of pregnancy who were admitted and treated in our hospital from January 2017 to December 2018 were enrolled in the study,who were randomly divided into single drug group and combined medication group according to random number table method,with 50 cases in each group.The patients in single-drug group were treated by oral dexamethasone,however,the patients in combined medication group were treated by polyene phosphatidylcholine combined with dexamethasone.The improvement status of clinical symptoms,therapeutic effects and pregnancy outcomes were observed and compared between the two groups.The serum levels of total bile acid(TBA),total bilirubin(TBil),direct bilirubin(DBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)and placenta were detected before and after treatment.Moreover the expression levels of nuclear factor-E2-related factor 2(Nrf2),proliferating cell nuclear antigen(PCNA)and Ki67 protein in tissues were detected.Results The disappearance time of pruritus and jaundice in combined medication group was significantly shorter than that in single drug group(P<0.05).After treatment,the itching scores,TBA,TBil,DBil,ALT,AST,IL-8 and TNF-αlevels in both groups were significantly lower than those before treatment(P<0.05),moreover,which in combined medication group were significantly lower than those in single drug group(P<0.05).The expression levels of Nrf2,PCNA and Ki67 protein in placenta in combined medication group were significantly higher than those in single drug group(P<0.05).The total effective rate in combined medication group was significantly higher than that in ingle drug group(P<0.05).However the premature birth rate,cesarean section rate,fetal distress rate and neonatal asphyxia rate in combined medication group were significantly lower than those in single drug group(P<0.05).Conclusion The polyene phosphatidylcholine combined with dexamethasone in treatment of intrahepatic cholestasis of pregnancy can significantly improve the clinical symptoms of patients by inhibiting maternal inflammatory response,which can promote the expression levels of Nrf2,PCNA,Ki67 in placenta tissue,inhibit fetal growth restriction and promote fetus growth.