熊去氧胆酸、丁二磺酸腺苷蛋氨酸联合多烯磷脂酰胆碱治疗妊娠期肝内胆汁淤积症效果

Effects of ursodeoxycholic acid and adenosylmethionine succinate combined with polyene phosphatidylcholine for treating pregnant women with intrahepatic cholestasis

目的:探讨熊去氧胆酸、丁二磺酸腺苷蛋氨酸联合多烯磷脂酰胆碱治疗妊娠期肝内胆汁淤积症(ICP)效果及对患者妊娠结局、胆汁酸、肝酶指标的影响。方法:选取2018年6月—2019年12月本院治疗的ICP患者120例,随机分为观察组和对照组各60例。两组给予口服熊去氧胆酸片,同时静脉滴注注射用丁二磺酸腺苷蛋氨酸,观察组在此基础上静脉滴注多烯磷脂酰胆碱。治疗1周后,观察两组胆汁酸、肝酶指标水平、不良反应及妊娠结局。结果:治疗后瘙痒评分两组均明显下降且观察组(1.29±0.11分)低于对照组(2.70±0.43分),两组总胆汁酸、ALT、AST、TB和CG水平均明显下降且观察组(12.09±2.14 umol/L、67.93±30.25 U/L、73.49±21.37 U/L、11.29±4.32 umol/L、621.20±73.29μg/L)低于对照组(均P<0.001);观察组发生剖宫产(15.0%)、早产(10.0%)、羊水粪染(1.7%)和胎儿窘迫(11.7%)比例均低于对照组(P<0.05)。治疗期间两组均未见明显不良反应。结论:熊去氧胆酸、丁二磺酸腺苷蛋氨酸联合多烯磷脂酰胆碱能更有效缓解ICP症状,降低患者胆汁酸和肝酶指标水平,改善患者妊娠结局。

Objective: To investigate the effect of ursodeoxycholic acid and adenosylmethionine succinate combined with polyene phosphatidylcholine for treating pregnant women with intrahepatic cholestasis(ICP), and to study its influence on the pregnancy outcomes, bile acid level, and liver enzymes levels of these women. Methods: 120 pregnant women with ICP were selected and were randomly divided into two groups(60 cases in each group) from June 2018 to December 2019. The women in the control group were given oral ursodeoxycholic acid and adenosylmethionine succinate intravenous dripped, and the women in the experimental group were given polyene phosphatidylcholine intravenous dripped except to the treatment of the women in the control group. After 1 weeks of treatment, the bile acid level, liver enzyme level, adverse reaction rate, and pregnancy outcomes of the women in the two groups were observed. Results: After treatment, the pruritus scores of the women in both groups had decreased significantly, and which(1.29±0.11 points) of the women in the experimental group was significant lower than that(2.70±0.43 points) of the women in the control group. The levels of total bile acid, ALT, AST, TB and CG of the women in both groups had decreased significantly, and which(12.09±2.14 umol/L, 67.93±30.25 U/L, 73.49±21.37 U/L, 11.29±4.32 umol/L, and 621.20± 73.29 ug/L) of the women in the experimental group were significant lower than those of the women in the control group(all P<0.001). The rates of cesarean section(15.0%), premature delivery(10.0%), amniotic fluid staining(1.7%), and fetal distress(11.7%) of the women in the experimental group were significant lower than those of the women in the control group(P<0.05).There was no any woman with adverse reaction during treatment in the two groups.Conclusion:Ursodeoxycholic acid and adenosylmethionine succinate combined with polyene phosphatidylcholine for treating pregnant women with ICP can effectively relieve the ICP symptoms,reduce their levels of bile acid and liver enzymes,and improve their pregnancy outcomes.