茵陈丹芍汤治疗中期妊娠妊娠期肝内胆汁淤积症临床观察

目的：观察茵陈丹芍汤治疗中期妊娠妊娠期肝内胆汁淤积症（ICP）的临床疗效,探讨其作用机制。方法：病例组分为三组,均为孕25~28周ICP患者。A组为轻度ICP患者30例,口服茵陈丹芍汤治疗2周。重度ICP患者30例,随机分为两组,B组15例,口服茵陈丹芍汤和思美泰治疗10d;C组15例,口服思美泰治疗10d。观察各组治疗前后的瘙痒评分并用速率法检测血清胆汁酸（TBA）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和尿液总胆汁酸的浓度。结果：A、B组治疗后与治疗前比较,瘙痒评分和血清TBA、ALT显著下降（P〈0.01,P〈0.05）,血清TBA与尿液TBA浓度的比值显著下降（P〈0.01）;B组治疗后较治疗前血清AST浓度亦显著下降（P〈0.05）。治疗后B、C组比较,瘙痒评分、血清TBA的浓度B组显著低于C组（P〈0.05）,血清TBA浓度/尿液TBA浓度比值B组显著低于C组（P〈0.05）。结论：茵陈丹芍汤能有效治疗中期妊娠ICP,其疗效机制可能与增加尿液中总胆汁酸的排泄有关。

Clinical Observation about Treatment on Intrahepatic Cholestasis of Pregnancy in Mid Trimester of Pregnancy with Yinchen Danshao Decoction

Objective ： To observe the clinical therapeutic effect of treatment on lower grade intrahepatic cholestasis of pregnancy in the mid trimester of pregnancy with Yinchen Danshao （ YCDS ） decoction and to explore its mechanism of action. Method ： 30 women （ group A ） whose gestational age was from 25 weeks to 28 weeks were diagnosed as minor ICP and treated with YCDS decoction for 2 weeks.30 women whose gestational age was from 25 weeks to 28 weeks were diagnosed as severe ICP and randomly divided into 2 groups, B group and C group, including 15 women in each group. 15 women in group B were treated with YCDS decoction and transmetil for 10 days, and 15 women in group C were treated with transmetil for 10 days.We observed their pruritus score, detected concentrations of serum total bile acid （ TBA ）, serum alanine aminotransferase （ALT）, serum aspartate transaminase （AST）and urine TBA by velocimetry respectively. Results ： Pruritus score and concentrations of serum TBA and serum ALT in group A and group B were significantly descended compared with those of pretherapy （ P〈0.01, P〈0.05 ）, meanwhile the relative value of concentrations of serum TBA/urine TBA was also significantly descended （ P〈0.01 ）. And concentrations of serum AST in group B was significantly descended compared with those of pretherapy （P〈0.05）.After treatment, pruritus score, concentrations of serum TBA, and the relative value of concentrations of serum TBA/urine TBA in group B were significantly lower than those in group C （ P〈0.05, P〈0.05 ）. Conclusion ： YCDS decoction can treat ICP validly and its mechanism of action may be concerned with increasing excretion of urine TBA.