低分子肝素和S-腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症的疗效对比

目的:比较和评估低分子肝素(LMWH)和S-腺苷蛋氨酸(SAMe)对妊娠期肝内胆汁淤积症(ICP)的治疗效果。方法:64例ICP患者,随机分成两组:A组用LMWH 1250 IU/d静脉滴注,5天为1疗程;B组用SAMe 1 000 mg/d,静脉滴注,疗程为7天,观察治疗效果。结果:两组患者治疗后瘙痒评分、血清总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TB)及直接胆红素(DB)均有明显下降(P<0.05),下降程度两组间无统计学差异(P>0.05);两组间早产、羊水Ⅱ°～Ⅲ°粪染、胎儿窘迫、新生儿窒息(Apgar≤7)的发生率无明显差异;A组无围生儿死亡,B组有1例死胎。结论:LMWH能缓解ICP患者的症状,改善肝功能,其治疗作用与SAMe相似。

Comparison of curative effects of low-molecular-weight-heparin and S-adenosylmethionine in treatment of intrahepatic cholestasis of pregnancy

Objective:To compare and evaluate the curative effects of low-molecular-weight-heparin(LMWH) and S-adenosylmethionine(SAMe) in treatment of intrahepatic cholestasis of pregnancy(ICP).Methods:Sixty-four patients with ICP were selected,then they were randomly divided into two groups: the patients in group A were treated with intravenous drip of LMWH for 5 days,1 250 IU per day;while the patients in group B were treated with SAMe for 7 days,1 000 mg per day,the curative effects in the two groups were observed.Results:After treatment,pruritus score,the serum levels of total bile acid(TBA),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TB),and direct bilirubin(DB) in the two groups decreased significantly(P<0.05),but there was no significant difference in the degree of decrease between the two groups(P>0.05);there was no significant difference in the incidences of premature delivery,amniotic fluid contamination,fetal distress,and neonatal asphyxia(Apgar score≤7) between the two groups.No perinatal death occurred in group A,one dead fetus occurred in group B.Conclusion:LMWH can relieve symptoms of the patients with ICP and improve hepatic function,and its curative effect is similar to that of SAMe.