熊去氧胆酸对妊娠期肝内胆汁淤积症疗效的影响因素

Influencing Factors of Ursodeoxycholic Acid in the Treatment of Intrahepatic Cholestasis of Pregnancy

目的探讨影响熊去氧胆酸(ursodeoxycholic acid,UDCA)对妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)疗效的相关因素。方法选取2018年1月—2019年6月在广东省妇幼保健院分娩的ICP孕妇共201例作为研究对象,给予201例ICP孕妇正规疗程的UDCA治疗。分析糖尿病、高血脂等因素与疗效间的关系,再利用二元Logistic回归确定疗效的独立影响因素。结果UDCA治疗ICP的有效率为70.15%。肝酶升高或高血脂患者的治疗有效率明显低于正常患者(P=0.000);总胆汁酸(total bile acid,TBA)≥40µmol/L患者治疗有效率明显低于TBA<40µmol/L患者(P=0.000)。肝酶升高、高血脂和TBA水平均是UDCA对ICP疗效的独立影响因素。通过肝酶升高、高血脂及TBA≥40µmol/L预测UDCA治疗ICP无效的准确率达到73.96%。结论对肝酶升高、高血脂或重度病情的ICP患者,UDCA的疗效欠佳。该三项指标可作为疗效预判的参考因素。

Objective To investigate the influencing factors on the curative effect of ursodeoxycholic acid(UDCA)in patients with intrahepatic cholestasis of pregnancy(ICP).Methods A total of 201 ICP pregnant women who gave birth in Guangdong Maternal and Child Health Hospital from January 2018 to June 2019 were selected as the research object.A total of 201 pregnant women with ICP were treated with normal UDCA.The relationship between the diabetes,hyperlipidemia and other factors and the curative effect was analyzed.The independent influencing factors of the curative effect were determined by two yuan Logistic regression.Results The effective rate of UDCA for ICP was 70.15%.The effective rate of patients with elevated liver enzymes or hyperlipidemia was evidently lower than that in normal patients(P=0.000).The effective rate of patients with total bile acid(TBA)≥40μmol/L was obviously lower than that of patients with TBA<40μmol/L(P=0.000).The elevated liver enzymes,hyperlipidemia and TBA level were independent influencing factors of UDCA on the Curative effect of ICP.The accuracy rate of predicting the ineffectiveness of UDCA in the treatment of ICP by elevated liver enzymes,hyperlipidemia and TBA≥40μmol/L was 73.96%.Conclusion For ICP patients with elevated liver enzymes,hyperlipidemia or severe disease,the curative effect of UDCA is not good.The three indexes can be used as reference factors for prediction of curative effect.