中西医结合治疗妊娠期肝内胆汁淤积的效果

Effect of integrated traditional Chinese medicine and western medicine in the treatment of intrahepatic cholestasis of pregnancy

目的探讨中西医结合治疗妊娠期肝内胆汁淤积(intrahepatic cholestasis of pregnancy,ICP)的效果及安全性。方法回顾性分析2020年1月至2022年6月杭州师范大学附属医院接受治疗的151例ICP患者的临床资料。按照治疗方案的不同,将所有患者分为对照组(100例)和观察组(51例)。对照组患者给予基础疗法,即熊去氧胆酸胶囊+注射用腺苷蛋氨酸;观察组患者在对照组治疗的基础上,给予茵陈蒿汤加减方煎服,疗程为1周。比较两组患者的实验室血清指标、瘙痒情况、母婴结局及安全性。结果治疗后,两组患者的血清总胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、总胆汁酸水平和瘙痒评分均显著低于本组治疗前,且观察组显著低于对照组(P<0.05)。观察组患者的瘙痒缓解率显著高于对照组,瘙痒控制时间显著短于对照组(P<0.05)。观察组患者的剖宫产、羊水浑浊、产后出血发生率均显著低于对照组,终止妊娠时的孕龄显著高于对照组(P<0.05)。治疗后,两组围产儿的脐动脉收缩期峰值和舒张末期流速比值显著低于本组治疗前,且观察组显著低于对照组(P<0.05)。两组患者治疗过程中均未发生药物过敏反应,也无胎盘早剥或死胎等严重并发症出现。结论相较于单一的西医疗法,中西医结合治疗ICP效果更好,可很大程度改善血清胆汁酸、胆红素和肝酶水平,减轻瘙痒,改善母婴结局,副作用小,具有良好安全性。

Objective To explore efficacy and safety of integrated traditional Chinese and western medicine in the treatment of intrahepatic cholestasis of pregnancy(ICP).Methods Clinical data of 151 pregnant women with ICP received treatment at Affiliated Hospital of Hangzhou Normal University from January 2020 to June 2022 were retrospectively analyzed.According to the differences in treatment plans,all patients were divided into control group(100 cases)and observation group(51 cases).Control group received basic therapy,including ursodeoxycholic acid capsules and adenosylmethionine for injection.Observation group was given Yinchenhao decoction with modified for one week on the basis of treatment in control group.Serum indicators of laboratories,itching status,maternal and infant outcomes,and safety between two groups were compared.Results After treatment,serum total bilirubin,alanine transaminase,aspartate transaminase,total bile acid levels,itching score in two groups were significantly lower than those before treatment,and observation group was lower than control group(P<0.05).Itch relief rate in observation group was significantly higher than that in control group,and itch control time in observation group was significantly shorter than that in control group(P<0.05).Incidence rate of cesarean section,amniotic fluid turbidity and postpartum hemorrhage in observation group were significantly lower than those in control group,and gestational age at termination of pregnancy in observation group was significantly higher than that in control group(P<0.05).After treatment,ratio of peak systolic and end diastolic flow velocity of the umbilical artery in two groups were significantly lower than that before treatment,and observation group was lower than control group(P<0.05).No drug allergic reactions occurred during treatment of two groups,and there were no serious complications such as placental abruption or stillbirth.Conclusion Compared to a single western medicine therapy,combination of Chinese and western medicine has a better effect on treating ICP.It can greatly improve levels of serum bile acids,bilirubin and liver enzymes,reduce itching,and improve maternal and infant outcomes.It has minimal side effects,and has good safety.