摘要
目的观察丁二磺酸腺苷蛋氨酸(SAMe)联合熊去氧胆酸(UDCA)治疗妊娠期肝内胆汁淤积症(ICP)的临床疗效及安全性。方法将80例ICP患者随机分为治疗组和对照组各40例。对照组静脉滴注SAMe 1.0 g,qd,治疗组联合口服UDCA 250 mg,tid。两组治疗前后分别进行瘙痒评分,检测总胆红素(TB)、血清总胆汁酸(TBA)、甘胆酸(CG)、天门冬酸氨基转移酶(AST)和丙氨酸氨基转移酶(ALT)的血清浓度,记录两组终止妊娠孕周、剖宫产率、早产率、胎儿窘迫发生率、羊水粪染率。结果治疗后两组患者的瘙痒评分均明显降低,治疗组TB、TBA、AST、ALT的含量分别由治疗前的(27.83±9.34),(45.62±18.30)μmol·L-1及(195.98±30.22),(188.69±29.11)U·L-1降低至治疗后的(11.81±4.91),(11.88±2.23)μmol·L-1及(73.59±21.53),(67.94±30.53)U·L-1,对照组TB、TBA、AST、ALT的含量分别由治疗前的(27.49±7.87),(49.12±10.39)μmol·L-1及(211.93±34.97),(210.40±43.39)U·L-1降低至治疗后的(16.08±6.23),(23.88±6.63)μmol·L-1及(87.20±32.52),(81.77±35.16)U·L-1(P<0.05)。治疗组肝功能改善程度、新生儿早产率、胎儿窘迫率、剖宫产率与对照组比较均差异无统计学意义(P>0.05),但治疗组在TB、TBA、CG降低方面优于对照组(P<0.05)。结论单用SAMe在瘙痒症状、肝功能指标改善、妊娠结局方面可以取得与UDCA联用相似的效果,而联合UDCA可以更有效降低甘胆酸和胆汁酸水平。
Objective To observe the clinical effects and the safety of S-adenosy-L-methionine （SAMe） associated with ursodeoxycholic acid （UDCA） in treating intrahepatic cholestasis of pregnancy （ICP）. Methods Eighty patients with ICP were randomly divided into treatment group （treated with UDCA orally, 250 mg, TID and simultaneously with intravenous SAMe 1.0 g, qd） and control group （treated with intravenous SAMe 1.0 g, qd）.Pruritus degree, serum total bilirubin （TB）, total bile acid （TBA）, glycocholic acid （CG）, alanine aminotransferase （ALT） and aspartate aminotransferase （AST） were analyzed before and after the treatment, and the pregnancy outcomes, such as the rate of premature, uterine-incision delivery and fetal distress were recorded. Results After treatment, the pruritus degree and the levels of TB, TBA, CG, ALT AST were decreased significantly compared with pretreatment in both groups.TB, TBA, AST and ALT of the treatment group decreased from （27.83±9.34）, （45.62±18.30） μmol·L^-1, （195.98±30.22）, （188.69±29.11） U. L^-1 to （11.81±4.91）, （11.88±2.23） μmol·L^-1 , （73.59±21.53）, （67.94±30.53） U · L^- 1, respectively, and TB, TBA, AST, ALT of the control group decreased from （27.49±7.87）, （49.12±10.39） μmol·L^-1, （211.93±34.9）, （210.40±43.39） U· L^-1 to （16.08±6.23）, （23.88± 6.63） μmol·L^-1, （87.20±32.52）, （81.77±35.16） U · L^-I, respectively （P〈0.05）.Compared with control group, improvements of liver function, the rates of premature delivery, fetal distress and uterine-incision delivery were not significantly different in the treatment group （P〉0.05）, but the declines of TB, TBA and CG in treatment group were superior to those of the control group （P〈0.05）. Conclusion In terms of improving pruritus, liver function and pregnancy outcome, single SAMe application could obtain similar effects compared with SAMe combined with UDCA, but SAMe combined with UDCA is more effective
出处
《医药导报》
CAS
2015年第8期1040-1043,共4页
Herald of Medicine
