茵栀黄联合腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症患者疗效观察及其对母婴结局的影响

doi:10.3969/j.issn.1672-5069.2020.05.017

摘要/Abstract

摘要： 目的观察茵栀黄联合腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症(ICP)患者的疗效及其对母婴结局的影响。方法 2016年7月~2019年5月我院收治的ICP患者74例,被随机分为对照组37例和观察组37例,分别给予熊去氧胆酸和腺苷蛋氨酸治疗和在此基础上加用茵栀黄口服液治疗,两组均大约治疗4周至分娩。采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)、白介素-17(IL-17)、IL-18、转化生长因子-β(TGF)水平。采用艾瑛制定的瘙痒评分标准行瘙痒程度评分,采用匹兹堡睡眠质量指数量表(PSQI)行睡眠质量评分。结果在分娩前,观察组血清谷丙转氨酶水平为(39.7±6.2)U/L,显著低于对照组【(58.5±7.4)U/L,P<0.05】,谷草转氨酶水平为(42.9±6.6)U/L,显著低于对照组【(63.1±8.3)U/L,P<0.05】,总胆红素(TBIL)水平为(15.4±4.8)μmol/L,显著低于对照组【(19.7±6.5)μmol/L,P<0.05】,TBA水平为(13.2±3.7)μmol/L,显著低于对照组【(21.2±4.1)μmol/L,P<0.05】,瘙痒评分为(1.2±0.3)分,显著低于对照组【(1.6±0.4)分,P<0.05】,PSQI评分为(8.9±2.5)分,显著低于对照组【(11.2±3.1)分,P<0.05】;观察组血清TNF-α水平为(29.4±5.3)ng/L,显著低于对照组【(38.2±6.1)ng/L,P<0.05】,IL-18水平为(38.2±6.7)ng/L,显著低于对照组【(45.6±7.8)ng/L,P<0.05】,TGF-β水平为(4.2±1.5)ng/L,显著低于对照组【(5.9±1.7)ng/L,P<0.05】;两组不良妊娠结局和新生儿不良结局发生率无显著性差异(分别为32.5%对35.5%和11.7%对12.9%,P>0.05)。结论应用茵栀黄联合腺苷蛋氨酸治疗ICP患者能显著改善肝功能,降低血清细胞因子水平,改善睡眠质量,缓解瘙痒症状,疗效良好。

关键词: 妊娠肝内胆汁淤积症, 茵栀黄, 腺苷蛋氨酸, 治疗, 预后 , ,

Abstract: Objective The aim of this study was to analyze the short-term efficacy of yinzhihuang, a herbal medicine, and adenosine methionine combination in the treatment of patients with intrahepatic cholestasis of pregnancy (ICP) . Methods 74 patients with ICP were admitted to our hospital between July 2016 and May 2019, and were randomly divided into control (n=37) and observation group (n=37) . The patients in the control group were treated with UDCA and adenosine methionine, and those in the observation group were treated with yinzhihuang at the base of UDCA and adenosine methionine. The regimen continued about four weeks until delivery. Serum tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17), IL-18 and transforming growth factor-β (TGF) were detected by ELISA, and itch score was assessed by Ai Ying modified criteria and sleeping was by Pittsburgh sleep quality index (PSQI). Results At about four week treatment before delivery, serum alanine aminotransferase level was (39.7±6.2) U/L, significantly lower than [(58.5±7.4) U/L, P<0.05) , serum aspertate aminotransferase level was (42.9±6.6) U/L, significantly lower than [(63.1±8.3) U/L, P<0.05), total serum bilirubin level was (15.4±4.8) μmol/L, significantly lower than [(19.7±6.5) μmol/L, P<0.05), serum total bile acid level was (13.2±3.7) μmol/L, significantly lower than , the itch score was (1.2±0.3) points, significantly lower than , and the PSQI score was (8.9±2.5) points, significantly lower than in the control; serum TNF-α levels was (29.4±5.3) ng/L, significantly lower than [(38.2±6.1) ng/L, P<0.05), serum IL-18 level was (38.2±6.7) ng/L, significantly lower than [(45.6±7.8) ng/L, P<0.05), and serum TGF-β levels was (4.2±1.5) ng/L, significantly lower than in the control; the incidence of adverse pregnancy outcomes and neonatal adverse outcomes in the two groups were not significantly different (32.5% vs. 35.5%, and 11.7% vs. 12.9%,respectively, P>0.05). Conclusion The application of Yinzhihuang conpound and adenosine methionine combination in the treatment of patients with ICP have a good efficacy, which might significantly improve liver function tests, reduce serum cytokine levels, relieve pruritus symptoms and improve sleep.

Key words: Intrahepatic cholestasis of pregnancy, Yinzhihuang, herbal medicine, Adenosine methionine, Therapy, Prognosis

邢晓燕, 黄良苗, 符爱仙, 李兴钦, 韩向阳. 茵栀黄联合腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症患者疗效观察及其对母婴结局的影响[J]. 实用肝脏病杂志, 2020, 23(5): 670-673.

Xing Xiaoyan,Huang Liangmiao, Fu Aixian,et al.. Short-term observation of yinzhihuang and adenosine methionine in treatment of patients withintrahepatic cholestasis of pregnancy[J]. Journal of Practical Hepatology, 2020, 23(5): 670-673.

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