实用肝脏病杂志 ›› 2019, Vol. 22 ›› Issue (4): 530-533.doi: 10.3969/j.issn.1672-5069.2019.04.020

• 妊娠期肝内胆汁淤积症 • 上一篇    下一篇

腺苷蛋氨酸联合多烯磷酯酰胆碱治疗妊娠期肝内胆汁淤积症患者临床疗效初步研究*

严玲玲, 胡东辉, 黄艳芳   

  1. 430000武汉市 武汉大学医学院附属中山医院/湖北省第三人民医院妇产科
  • 收稿日期:2019-01-20 出版日期:2019-07-10 发布日期:2019-07-19
  • 通讯作者: 黄艳芳,E-mail: ling20080812@163.com
  • 作者简介:严玲玲,女,39岁,医学硕士,主治医师。E-mail: 53880647@qq.com
  • 基金资助:
    *武汉市自然科学基金资助项目(编号:2017901)

Influence of ademetionine combined with polyene phosphatidylcholine on clinical efficacy and laboratory index in patients with intrahepatic cholestasis of pregnancy

Yan Lingling, Hu Donghui, Huang Yanfang   

  1. Department of Obstetrics and Gynecology, Third People's Hospital, Affiliated to Wuhan University Medical College, Wuhan 430000,Hubei Province, China
  • Received:2019-01-20 Online:2019-07-10 Published:2019-07-19

摘要: 目的 探讨联合应用腺苷蛋氨酸和多烯磷酯酰胆碱治疗妊娠期肝内胆汁淤积症患者临床疗效及其实验室指标水平的变化。方法 2016年1月~2018年10月我院收治的妊娠期肝内胆汁淤积症患者84例,采用随机数字表法将患者分为对照组42例和试验组42例,分别给予腺苷蛋氨酸单用和在此基础上加用多烯磷酯酰胆碱治疗2周。采用ELISA法检测血清IL-12、TNF-α和细胞因子信号抑制因子3(SOCS3)水平。采用Ribaha评分量表评估瘙痒程度。结果 试验组患者瘙痒和黄疸消失时间分别为(4.3±1.0) d和(6.1±1.4) d,均显著短于对照组的(7.2±1.9) d和(8.4±2.6) d(P<0.05);在治疗2周末,试验组患者Ribaha评分为(0.5±0.1) 分,显著低于对照组的(1.1±0.2)分(P<0.05);试验组患者血清TAB、AST和ALT水平分别为(14.9±3.4) μmol/L、(65.3±14.6) U/L和(75.9±14.4) U/L,均显著低于对照组的(23.3±7.9) μmol/L、(92.04±18.3) U/L和(130.7±18.5) U/L(P<0.05);在治疗后2周,试验组患者血清IL-12和TNF-α水平分别为(13.1±1.4) pg/ml和(44.3±6.0) pg/ml,均显著低于对照组的(28.2±2.9) pg/ml和(69.04±7.3) pg/ml(P<0.05),而血清SOCS3蛋白水平为(420.9±48.4) pg/L,显著高于对照组的(336.7±40.5) pg/L(P<0.05);试验组患者早产、羊水污染、胎儿窘迫和产后出血发生率分别为19.1%、2.4%、0.0%和7.1%,显著低于对照组的45.2%、11.9%、11.9%和21.4%(P<0.05)。结论 联合应用腺苷蛋氨酸和多烯磷酯酰胆碱治疗妊娠期肝内胆汁淤积症可有效促进病情康复,缓解瘙痒症状,保护肝脏功能,并有助于改善妊娠结局,可能与该治疗降低了血清炎性细胞因子水平,升高了血清SOCS3蛋白水平有关。

关键词: 妊娠期肝内胆汁淤积症, 腺苷蛋氨酸, 多烯磷酯酰胆碱, 疗效, 细胞因子信号抑制因子3

Abstract: Objective The aim of this study was to investigate the influence of ademetionine combined with polyene phosphatidylcholine on clinical efficacy and laboratory index in patients with intrahepatic cholestasis of pregnancy.Methods 84 patients with intrahepatic cholestasis of pregnancy were recruited in this study between January 2016 and October 2018,and were randomly divided into control group (n=42 patients),receiving ademetionine alone,and observation group(n=42 patients),receiving combination of ademetionine and polyene phosphatidylcholine for two weeks. The Ribaha score was performed for pruritus estimation,and serum interleukin-1 2(IL-12),tumor necrosis factor-α(TNF-α) and suppressor of cytokine signaling (SOCS3) were detected by ELISA. The pregnant outcomes in the two groups were compared.Results The disappearance times of pruritus and jaundice in observation group were (4.3±1.0) d and (6.1±1.4) d,significantly shorter than(7.2±1.9)d and (8.4±2.6)d,respectively,in the control group(P<0.05);the Ribaha score in the observation group at the end of the treatment was (0.5±0.1) point,significantly lower than (1.1±0.2) point in the control group;serum levels of TAB,AST and ALT in the observation group at the end of the treatment were (14.9±3.4)μmol/L,(65.3±14.6)U/L and (75.9±14.4) U/L,all significantly lower than(23.3±7.9) μmol/L,(92.04±18.3) U/L and(130.7±18.5) U/L,respectively,in the control group(P<0.05);serum levels of IL-12 and TNF-α in the observation group were (13.1±1.4) pg/ml and (44.3±6.0)pg/ml,both significantly lower than (28.2±2.9) pg/ml and (69.04±7.3) pg/ml in the control (P<0.05),while serum SOCS3 level in the observation group after treatment was (420.9±48.4) pg/L,significantly higher than (336.7±40.5) pg/L in the control group(P<0.05);the incidence of premature delivery,amniotic fluid contamination,fetal distress and postpartum hemorrhage in the observation group were 19.1%,2.4%,0.0% and 7.1%,all significantly lower than 45.2%, 11.9%,11.9% and 21.4% in the control group(P<0.05). Conclusion Combined regimen with ademetionine and polyene phosphatidylcholine in treatment of patients with intrahepatic cholestasis of pregnancy could efficiently promote rehabilitation process,relieve itching symptoms, protect liver function and might be helpful to improve pregnancy outcomes. The key mechanism for good efficacy for the treatment of this entity might be closely related to the regulation of inflammatory cytokine and SOCS3 level balance.

Key words: Intrahepatic cholestasis of pregnancy, Ademetionine, Polyene phosphatidylcholine, Clinical efficacy, Suppressor of cytokine signaling