思美泰联合低分子肝素治疗妊娠期肝内胆汁淤积症的疗效观察

目的探讨思美泰（SAMe）联合低分子肝素（LMWH）治疗妊娠期肝内胆汁淤积症（intrahepatic cholestasisof pregnancy,ICP）的效果。方法回顾性分析47例ICP患者,在常规治疗基础上,其中A组（21例）以思美泰联合低分子肝素治疗,B组以思美泰治疗。观察比较治疗前后肝功能、瘙痒评分、记录孕妇分娩孕周、羊水粪染率、术中出血、Ap-gar评分及胎儿出生体重。结果两组患者治疗后TBA、ALT、AST、TB的水平及瘙痒评分均较治疗前降低（P〈0.01）;A组治疗后瘙痒评分、TBA、ALT、AST、TB的水平较B组下降明显（P〈0.05）。A组羊水Ⅲ度粪染率较B组低（P〈0.01）,差异有统计学意义（P〈0.01）。两组分娩孕周、剖宫产率、分娩出血量、早产率、胎儿出生体重及新生儿窒息率（Apgar评分）比较差异无统计学意义（P〉0.05）。结论SAMe联合LMWH治疗ICP优于常规单纯思美泰的治疗方法,近期使用安全有效。

The efficacy of S-adenosy-L-methionine(SAMe)eombided with LMWH in the treatment of intrahepatic cholestasis of pregnancy

Objective To investigate the efficacy of S-adenosy-L-methionine（SAMe） combided with LMWH in the treatment of intrahepatic cholestasis of pregnancy.Methods 47 patients of ICP were divided into two groups：A group（n=21） receiving a combination of SAMe and LMWH and B group（n=26） receiving only SAMe.The symptom of itching and serum biochemical indexes,including TBA,TB,ALT,and AST were observed after 7days,and the pregnancy outcome between the two groups was compared after delivery.Results All the patients had a significant improvement in pruritus and TBA,TB,ALT,and AST（P0.01）.After7days,there were significant differences in pruritrs,FBA,AST,ALT,in receiving combination of SAMe and LMWH comparing with receiving SAMe alone（P0.05）.The incidences of amniotic fluid pollution was signifiicnatly different between the two groups（P0.01）.Conclusion In women with intrahepatic cholestasis of pregnancy,combination of SAMe and LMWH are safe,efficient,in the near future.