清瘀利胆汤联合熊去氧胆酸片对妊娠期肝内胆汁淤积症患者的影响

Effect of Qingyu Lidan Decoction(清瘀利胆汤)Combined with Ursodeoxycholic Acid Tablets on ICP Patients

目的探究清瘀利胆汤联合熊去氧胆酸片对妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)患者血清总胆汁酸(total bile acid,TBA)、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)水平及妊娠结局的影响。方法选取2018年2月—2020年12月于武汉市第一医院中医科和妇产科就诊的82例ICP患者,随机数字表法分为熊去氧胆酸组(41例)、联合组(41例)。两组均予以熊去氧胆酸片口服治疗,联合组在此基础上予以清瘀利胆汤治疗,均治疗14 d。比较两组的疗效,瘙痒、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分,血生化指标、新生儿不良事件及妊娠结局。结果联合组总有效率为92.68%(38/41),高于熊去氧胆酸组总有效率为68.29%(28/41)(P<0.05)。治疗后,两组血清TBA、ALT、AST、总胆红素(total bilirubin,TBIL)、间接胆红素(indirect bilirubin,DBIL)水平,瘙痒、PSQI评分均较治疗前降低,且联合组低于熊去氧胆酸组(P<0.05)。联合组分娩孕周长于熊去氧胆酸组,产后出血量低于熊去氧胆酸组(P<0.05);联合组阴道分娩率为60.98%(25/41),高于熊去氧胆酸组的34.15%(14/41)(P<0.05);联合组不良事件发生率为19.51%(8/41),低于熊去氧胆酸组的56.10%(23/41)(P<0.05)。结论清瘀利胆汤联合熊去氧胆酸片可有效降低ICP患者血清TBA、ALT、AST水平,改善其瘙痒、黄疸等症状及妊娠结局,疗效显著,值得推广。

Objective To explore the effect of Qingyu Lidan Decoction(清瘀利胆汤)combined with ursodeoxycholic acid tablets on the levels of serum total bile acid(TBA),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)and pregnancy outcomes in intrahepatic cholestasis of pregnancy(ICP)patients.Methods Eighty-two ICP patients who visited the hospital between February 2018 and December 2020 were randomly divided into the ursodeoxycholic acid group(41 cases)and the combined group(41 cases).Both groups were treated with ursodeoxycholic acid tablets orally,and the combined group was treated with Qingyu Lidan Decoction on this basis.Both groups were treated for 14 days.The curative effect,pruritus,Pittsburgh sleep quality index(PSQI)score,blood biochemical index,adverse events of newborns and pregnancy outcome of the two groups were compared.Results The total effective rate of the combined group was 92.68%(38/41),which was higher than 68.29%(28/41)of ursodeoxycholic acid group(P<0.05).After treatment,the levels of serum TBA,ALT,AST,total bilirubin(TBIL)and indirect bilirubin(DBIL),pruritus and PSQI in the two groups were lower than those before treatment,and the indexes of the combined group were lower than those of the ursodeoxycholic acid group(P<0.05).The gestational week of delivery in the combined group was longer than that in the ursodeoxycholic acid group,and the amount of postpartum hemorrhage was lower than that in the ursodeoxycholic acid group(P<0.05).The vaginal delivery rate in the combined group was 60.98%(25/41),which was higher than 34.15%(14/41)in the ursodeoxycholic acid group(P<0.05).The incidence of adverse events of the combined group was 19.51%(8/41),which was lower than 56.10%(23/41)of the ursodeoxycholic acid group(P<0.05).Conclusion Qingyu Lidan Decoction combined with ursodeoxycholic acid tablets can effectively reduce the levels of TBA,ALT and AST in serum of ICP patients,and improve their symptoms such as pruritus,jaundice and pregnancy outcomes.The curative effect is significant and is worthy of promotion.