丁二磺酸腺苷蛋氨酸与熊去氧胆酸联合治疗妊娠期轻度肝内胆汁淤积症的疗效观察
Efficacy of adenosine-methionine combined with ursodeoxycholic-acid in the treatment of mild intrahepatic cholestasis of pregnancy
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摘要: 目的:观察丁二磺酸腺苷蛋氨酸(SAMe)与熊去氧胆酸(UDCA)联合治疗妊娠期轻度肝内胆汁淤积症(ICP)的疗效。方法:将确诊为轻度ICP的163例患者随机分成2组,A组85例给予SAMe 1 000 mg口服,每天1次,16 d为1个疗程;UDCA300 mg口服,每天3次,20 d为1疗程。B组78例给予UDCA 300 mg口服,每天3次,20 d为1个疗程。2组均结合地塞米松、炉甘石治疗。治疗前后分别检测空腹血丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血清总胆红素(TBiL)、直接胆红素(DBiL)和甘胆酸(CG),记录2组孕妇孕周、胎儿窘迫率、早产率、剖宫产率、瘙痒评分及产后出血情况,并予以比较。结果:治疗后2组患者瘙痒症状评分、血清CG、ALT、TBiL、DBiL水平差异均有统计学意义(P0.05~P0.01)。A组新生儿早产率低于B组(P0.05),而AST、胎儿窘迫、产后出血、剖宫产率与B组差异均无统计学意义(P0.05)。结论:SAMe与UDCA联合治疗轻度ICP患者效果满意。Abstract: Objective: To observe the efficacy of s-adenosy-L-methione (SAMe ) combined with ursodeoxycholic (UDCA) on intrahepatic cholestasis of pregnancy. Methods: One hundred and sixty-three patients with mild intrahepatic cholestasis of pregnancy were randomly divided into two groups. Group A(n = 85) received oral administration of SAMe 1 000 mg once a day for 16 days combined with oral use of UDCA 300 mg 3 times a day for 20 days; group B(n = 78) received oral administration of UDCA 300 mg 3 times a day for 20 days; both groups were given dexamathasone and calamine. The fasting blood alanine aminotransferase (ALT) , aspartate aminotransferase(AST) , serum total bilirubin(TBiL) ,direct bilirubin(DBiL) and cholyglycine(CG) were examined before and after the therapy; the women's gestational weeks, fetal distress rate,premature birth rate,cesarean section rate,pruritus score and postpartum hemorrhage rate were recorded and compared between the two groups. results: After treatment, the pruritrs score, serum CG, ALT,TBiL and DBiL were significantly different between the two groups(P < 0. 05 to P < 0. 01) . The percentage of premature in group A was remarkably reduced compared with that in group B(P < 0. 05) ; the AST, fetal distress rate,postpartum hemorrhage rate,and cesarean section rate had no significant differences between the two groups(P > 0. 05) . Conclusions: UDCA combined with SAMe is effective in treatment of mild intrahepatic cholestasis of pregnancy.