S—腺苷蛋氨酸联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的临床效果

李娜

[摘要]目的 探讨S-腺苷蛋氨酸（SAM）联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症（ICP）的临床效果。方法 选取2015年5月～2017年5月我院收治的64例ICP患者作为研究对象，采用随机数字表法将其分为对照组和研究组，每组各32例。两組均予以常规对症治疗，对照组加用熊去氧胆酸治疗，研究组加用SAM联合熊去氧胆酸治疗。比较两组临床治疗效果及母婴结局。结果 ①两组治疗后瘙痒症状评分、肝功能相关指标水平均明显低于治疗前，差异有统计学意义（P<0.05）；研究组治疗后瘙痒症状评分、肝功能相关指标水平均明显低于对照组，差异有统计学意义（P<0.05）；②研究组剖宫产、新生儿窒息、产后出血、胎儿窘迫以及早产发生率均明显低于对照组，差异有统计学意义（P<0.05）。结论SAM联合熊去氧胆酸治疗ICP的临床效果确切，可明显改善患者的瘙痒症状、肝功能指标水平以及母婴结局。

[关键词]S-腺苷蛋氨酸；熊去氧胆酸；妊娠期肝内胆汁淤积症；临床效果

[中图分类号] R714.25 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0115-03

[Abstract] Objective To investigate the clinical efficacy of S-adenosylmethionine（SAM） combined with ursodeoxycholic acid in the treatment of intrahepatic cholestasis during pregnancy（ICP）. Methods A total of 64 patients with ICP from May 2015 to May 2017 in our hospital were selected as study subjects. Random number table method was used to divide them into control group and study group， 32 cases in each group. Both groups were given routine symptomatic treatment. In the control group， ursodeoxycholic acid was added， while in the study group， SAM combined with ursodeoxycholic acid was added. The clinical efficacy and maternal and infant outcomes were compared between the two groups. Results The scores of pruritus symptoms and related indexes of liver function after treatment in both groups were significantly lower than those before treatment （P<0.05）. The scores of pruritus symptoms and related indexes of liver function after treatment in the study group were significantly lower compared with those in the control group with statistical significance （P<0.05）. In the study group， the incidence of cesarean section， neonatal asphyxia， postpartum hemorrhage， fetal distress and preterm birth were significantly lower than those in the control group with statistical significance （P<0.05）. Conclusion The combination of SAM and ursodeoxycholic acid in the treatment of ICP can obtain a definite effect. It can significantly improve the symptoms of pruritus， liver function indicators and maternal and fetal outcomes.

[Key words] S-adenosylmethionine； Ursodeoxycholic acid； Intrahepatic cholestasis of pregnancy； Clinical efficacy

妊娠期肝内胆汁淤积症（ICP）又称产科胆汁淤积症，是一种发病机制尚不明确、对孕妇和围生儿均可产生严重不良影响的妊娠中、晚期特有的并发症，孕晚期发生无皮肤损伤的瘙痒几乎是所有ICP患者的首发症状，随之出现黄疸、肝功能损害等临床表现[1]。因此，不断探索安全有效治疗ICP的方法是学者们与临床医务人员共同努力的目标，以改善患者的临床症状和母婴结局[2]。熊去氧胆酸、S-腺苷蛋氨酸（SAM）、地塞米松等是目前临床上治疗ICP的常用药物，有相关文献提及，联合用药的临床治疗效果较单一用药显著[3]。为此本文通过采用SAM联合熊去氧胆酸治疗ICP患者，探讨两种药物联合治疗对其临床效果的影响。

1资料与方法

1.1一般资料

选取2015年5月～2017年5月我院收治的64例ICP患者作为研究对象，本研究经医院医学伦理委员会批准。采用随机数字表法将其分为对照组和研究组，每组各32例。……