S-腺苷蛋氨酸联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的临床研究

摘要/Abstract

摘要： 目的：探讨妊娠期肝内胆汁淤积症患者使用S-腺苷蛋氨酸（S-adenosyl methionine， SAMe）联合熊去氧胆酸（ursodeoxycholic acid，UDCA）治疗的临床效果。方法：选取2018年12月至2020年12月在我院进行治疗的妊娠期肝内胆汁淤积症患者168例，按随机数字表法分为试验组（84例）和对照组（84例），两组患者均进行常规对症支持治疗。对照组在常规治疗基础上使用熊去氧胆酸治疗，试验组在对照组治疗基础上联合使用S-腺苷蛋氨酸治疗，两组患者均连续治疗2周。比较治疗后两组患者的妊娠结局与治疗后2周的临床疗效；比较两组患者治疗前后肝功能指标水平与血清转化生长因子-β（TGF-β）、白细胞介素-17（IL-17）水平。结果：试验组的治疗总有效率为84.52%，高于对照组的69.05%（P<0.05）。治疗后，两组患者血清天门冬氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、IL-17、总胆汁酸（TBA）水平较治疗前均降低，且试验组降低程度均较对照组更明显（P<0.05）；两组患者血清TGF-β水平较治疗前升高，且试验组升高程度较对照组更明显（P<0.05）。试验组的剖宫产率、早产率、胎儿窘迫发生率、新生儿窒息发生率均低于对照组（P<0.05）。结论：妊娠期肝内胆汁淤积症使用S-腺苷蛋氨酸联合熊去氧胆酸治疗可提升患者的治疗效果，减轻患者炎症反应，改善肝功能水平，改善妊娠结局。

关键词: 妊娠期肝内胆汁淤积症, 腺苷蛋氨酸, 熊去氧胆酸, 肝功能；炎症反应

Abstract: Objective：To investigate the clinical effect of S-adenosyl methionine (SAMe) combined with ursodeoxycholic acid (UDCA) in the treatment of intrahepatic cholestasis of pregnancy.Methods： 168 patients with intrahepatic cholestasis of pregnancy who were treated in our hospital from December 2018 to December 2020 were selected. They were divided into the test group (84 cases) and the control group (84 cases) according to the random number table method. All the patients received routine symptomatic and supportive treatment. Patients in the control group were treated with ursodeoxycholic acid on the basis of conventional treatment， and the test group was treated with S-adenosyl methionine combined with the treatment of the control group. Patients in both groups were treated for 2 consecutive weeks. The clinical efficacy， pregnancy outcome， liver function indexes and serum TGF-β and IL-17 levels before and after treatment were compared between the two groups of patients. Results： After treatment， the total clinical effective rate of the test group was 84.52%， which was higher than that of the control group( 69.05%)（P<0.05）. After treatment， the serum AST， ALT， TBA and IL-17 levels of the two groups of patients decreased compared with those before treatment， and the decrease of the test group was more obvious than that of the control group（P<0.05). After treatment， the serum TGF-β levels of the two groups of patients increased， and the increase of the test group was more obvious than that of the control group (P<0.05). The cesarean delivery rate， premature delivery rate， fetal distress rate， and neonatal asphyxia rate of the test group were all lower than those of the control group（P<0.05）. Conclusion： The combination use of S-adenosyl methionine and ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy can improve the therapeutic effect， reduce the inflammatory response and improve the liver function level of the patients， and can improve the pregnancy outcome.

Key words: Intrahepatic cholestasis of pregnancy, Adenosyl methionine, Ursodeoxycholic acid, Liver function;Inflammatory response

中图分类号:

俞海珍, 唐照青, 陈小凤, 艾素贞. S-腺苷蛋氨酸联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的临床研究[J]. 中国医药导刊, 2022, 24(3): 229-233.

YU Haizhen, TANG Zhaoqing, CHEN Xiaofeng, AI Suzhen. Clinical Study on S-Adenosyl Methionine Combined with Ursodeoxycholic Acid in the Treatment of Intrahepatic Cholestasis of Pregnancy[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2022, 24(3): 229-233.

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