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