2018 年第 2 期 第 13 卷

茵栀黄注射液联合腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症的效果和对妊娠结局的影响

作者：曾权祥陈浩吴振华董颖

英文作者：

单位：525000广东省茂名市人民医院消化一科（曾权祥、吴振华、董颖）；510000广州，广东省人民医院消化科（陈浩）

英文单位：

关键词：妊娠期肝内胆汁淤积症；茵栀黄注射液；腺苷蛋氨酸

英文关键词：

• 摘要：

• 目的    观察茵栀黄注射液联合腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症（ICP）的临床效果和对妊娠结局的影响。方法    选取2011年4月至2013年1月广东省茂名市人民医院收治的ICP患者58例，依照随机数字表法分为对照组和观察组，每组29例。对照组单独给予腺苷蛋氨酸静脉滴注治疗，1 g/次溶于500 ml葡萄糖注射液，1次/d；观察组在对照组的基础上加用5 ml茵栀黄注射液静脉滴注治疗，1次/d；2组均连续治疗10 d。观察比较2组治疗前后血清生化指标、瘙痒评分和妊娠结局。结果    治疗后2组血清总胆汁酸、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、直接胆红素水平和瘙痒评分均较治疗前明显改善［观察组：（13±4）μmol/L比（49±14）μmol/L、（69±14）U/L比（284±91）U/L、（71±14）U/L比（280±69）U/L、（19±6）μmol/L比（46±12）μmol/L、（4.7±1.5）μmol/L比（18.8±3.6）μmol/L、（0.62±0.18）分比（3.29±0.63）分，对照组：（32±9）μmol/L比（49±13）μmol/L、（146±36）U/L比（287±90）U/L、（140±42）U/L比（276±73）U/L、（30±9）μmol/L比（45±12）μmol/L、（9.6±2.9）μmol/L比（18.8±4.6）μmol/L、（1.82±0.54）分比（3.31±0.75）分］；观察组治疗后各项指标均明显低于对照组，差异均有统计学意义（均P＜0.05）。观察组胎儿窘迫发生率、剖宫产率、产后出血量明显低于/少于对照组［6.9%（2/29）比20.7%（6/29）、20.7%（6/29）比 41.4%（12/29）、（199±43）ml比（230±52）ml］，分娩孕周、新生儿体质量明显长于/大于对照组［（38.5±1.0）周比（37.5±0.7）周、（3.3±0.6）kg比（3.0±0.6）kg］，新生儿Apgar评分明显高于对照组［（8.2±2.2）分比（4.8±1.5）分］，差异均有统计学意义（均P＜0.05）。结论    茵栀黄注射液联合腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症的临床效果明显，能有效改善妊娠结局。

• Effect of Yinzhihuang injection combined with ademetionine on intrahepatic cholestasis of pregnancy and pregnancy outcomes

  Zeng Quanxiang, Chen Hao, Wu Zhenhua, Dong Ying

  The First Department of Gastroenterology, Guangdong Maoming People′s Hospital, Guangdong Province, Maoming 525000, China（Zeng QX, Wu ZH, Dong Y）; Department of Gastroenterology, Guangdong General Hospital, Guangzhou 510000, China（Chen H）

  Corresponding author: Zeng Quanxiang, Email: zqx2043@sina.com

  【Abstract】Objective    To observe the effect of Yinzhihuang injection combined with ademetionine on intrahepatic cholestasis of pregnancy（ICP） and pregnancy outcomes. Methods    Fifty-eight women with ICP admitted in Guangdong Maoming People′s Hospital from April 2011 to January 2013 were randomly divided into control group and observation group, with 29 cases in each group. Both groups were treated by intravenous administration of 1 g ademetionine dissolved in 500 ml glucose injection, 1 time/d; the observation group was added 5 ml Yinzhihuang injection 1 time/d. After 10 d of treatment, biochemical indicators, the score of pruritus and pregnancy outcomes were analyzed. Results    Serum levels of total bile acid, alanine aminotransferase, alanine aminotransferase, total bilirubin, direct bilirubin and the score of pruritus were significantly improved after treatment compared to those before treatment［observation group： （13±4）μmol/L vs （49±14）μmol/L, （69±14）U/L vs （284±91）U/L, （71±14）U/L vs （280±69）U/L, （19±6）μmol/L vs （46±12）μmol/L, （4.7±1.5）μmol/L vs （18.8±3.6）μmol/L, （0.62±0.18）points vs （3.29±0.63）points; control group： （32±9）μmol/L vs （49±13）μmol/L, （146±36）U/L vs （287±90）U/L, （140±42）U/L vs （276±73）U/L, （30±9）μmol/L vs （45±12）μmol/L, （9.6±2.9）μmol/L vs （18.8±4.6）μmol/L, （1.82±0.54）points vs （3.31±0.75）points］, and these indicators in observation group were significantly lower than those in control group（P＜0.05). Fetal distress rate, cesarean section rate and postpartum hemorrhage volume in observation group were significantly lower/less than those in control group［6.9%（2/29） vs 20.7%（6/29）, 20.7%（6/29） vs 41.4%（12/29）,（199±43）ml vs （230±52）ml］; gestational weeks and neonatal body mass in observation group were significantly longer/more than those in control group［（38.5±1.0）weeks vs （37.5±0.7）weeks, （3.3±0.6）kg vs （3.0±0.6）kg］; the Apgar score in observation group was significantly higher than that in control group［（8.2±2.2）points vs （4.8±1.5）points］（P＜0.05). Conclusion    Yinzhihuang injection combined with ademetionine is effective in treating ICP and improving pregnancy outcome.

  【Key words】Intrahepatic cholestasis of pregnancy;Yinzhihuang injection;Ademetionine

  【Fund program】National Natural Science Foundation of China（81300279）; National Natural Science Foundation of Guangdong Province（S2013040013549）; China Postdoctoral Science Foundation（2012M521579）