联合治疗重度妊娠期肝内胆汁淤积症30例临床观察

目的 评估联合治疗重度妊娠期肝内胆汁淤积症(ICP)临床疗效.方法 将60例重度妊娠期肝内胆汁淤积症患者随机分成两组,各30例,观察组予以静脉滴注思美泰(S-腺苷蛋氨酸)1 000mg和易善复465mg,每日1次,同时口服DX(地塞米松)3.75mg,每日3次,3d后减量,每日每次逐日递减0.75mg,第8天停药,7d为1个疗程;对照组单纯静脉滴注思美泰1 000mg,每日1次,7d为1个疗程,观察疗效.结果 用药后观察组的TBA、TB、DB、ALT/AST明显下降,与用药前相比差异有统计学意义(P＜0.01);两组瘙痒评分相比差异有统计学意义(P＜0.01).对照组的TBA、TB、DB下降明显,与用药前相比差异有统计学意义(P＜0.05),但ALT/AST下降不明显,与用药前相比差异无统计学意义(P＞0.05).妊娠结局中观察组瘙痒缓解时间早,延长孕周长,新生儿体重重,阴道分娩机会多,早产和RDS综合征明显减少,差异有统计学意义(P＜0.01).但两组胎儿窘迫、新生儿窒息和羊水粪染发生率比较,差异无统计学意义(P＞0.05).结论 联合治疗与单用思美泰治疗重度妊娠期肝内胆汁淤积症均有好的临床疗效,但联合治疗是更理想的方法,更能提高围生儿的生存质量.

Combined treatment for severe intrahepatic cholestasis of pregnancy:analysis of 30 cases

Objective To evaluate efficacy of the combined treatment for severe intrahepatic cholestasis of pregnancy(ICP).Methods Sixty severe symptomatic patients with intrahepatic cholestasis of pregnancy were randomized to receive either combined treatment:SAMe phosphatidylcholine Dexamtehason daily(n=30);or single SAMe daily(n=30),for 7 days.Results After combined treatment,there were significant decreases on the degree of pruritus and the maternal blood level of biochemical parameters such as TBA,DB/TB,ALT/AST(P<0.01);compared with single treated group,the pregnancy period was significant prolonged;the rate of vagina delivery and the weight of newborns were increased,preterm delivery and RDS were great decreased(P<0.01).However the fetal distress,meconium passage and newborn asphyxia rate had no statistical difference between the two groups(P>0.05).Conclusion The combined treatment is more effective than the single SAMe for severe intrahepatic cholestasis of pregnancy.