中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
10期
1526-1529
,共4页
妊娠期肝内胆汁淤积症%阿司匹林%腺苷蛋氨酸
妊娠期肝內膽汁淤積癥%阿司匹林%腺苷蛋氨痠
임신기간내담즙어적증%아사필림%선감단안산
Intrahepatic cholestasis of pregnancy%Aspirin%Ademetionine
目的 观察阿司匹林联合腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症(ICP)的临床效果及对妊娠结局的影响.方法 将72例ICP患者按随机数字表分为观察组和对照组,各36例.对照组给予腺苷蛋氨酸静脉注射,1 000mg/次,1次/d,连用7d;观察组在对照组用药基础上给予阿司匹林口服治疗,25 mg/次,4次/d,连用7d.治疗结束后观察孕妇症状改善情况,检测生化指标变化及妊娠结局表现.结果 观察组治疗后总胆汁酸、总胆红素、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)、谷氨酰转肽酶(γ-GT)水平、瘙痒评分、胆固醇水平均较治疗前明显降低,差异均有统计学意义[(31±10) μmol/L比(184±43) μmol/L,(35±9)μmol/L比(130±37)μmol/L,(51±9)U/L比(132±16)U/L,(51±10)U/L比(161±37) U/L,(37±11)U/L比(119±19) U/L,(0.47±0.05)分比(2.65±0.36)分,(3.4±2.11) mmol/L比(5.8±2.8) mmol/L](均P＜0.01);凝血酶原活动度与治疗前比较差异无统计学意义(P＞0.05).对照组总胆汁酸、总胆红素、ALT、ALP、γ-GT水平、瘙痒评分、胆固醇水平均较治疗前明显降低,差异均有统计学意义[(53±11) μmol/L比(186±44) μmol/L,(45±10) μmol/L比(129±35) μmol/L,(70±11)U/L比(132±13) U/L,(70±11) U/L比(157±37) U/L,(50±14) U/L比(114±16) U/L,(0.62±0.04)分比(2.49±0.47)分,(3.5±2.3) mmol/L比(5.8±3.0)mmol/L](均P＜0.01);凝血酶原活动度与治疗前比较差异无统计学意义(P＞0.05).2组治疗后总胆汁酸、总胆红素、ALT、ALP、γ-GT比较差异均有统计学意义(均P＜0.01),瘙痒评分2组比较差异有统计学意义(P＜0.01),观察组妊娠结局羊水污染、早产、新生儿窒息发生率均低于对照组[38.9％(14/36)比72.2％(26/36),11.1％(4/36)比33.3％(12/36),5.6％(2/36)比27.5％(8/36)](均P＜0.05),2组剖宫产发生率、胆固醇水平、凝血酶原活动度比较差异无统计学意义(P＞0.05).结论 阿司匹林联合腺苷蛋氨酸可明显改善ICP患者的皮肤瘙痒症状、生化指标和妊娠结局,对凝血机制无明显影响.
目的 觀察阿司匹林聯閤腺苷蛋氨痠治療妊娠期肝內膽汁淤積癥(ICP)的臨床效果及對妊娠結跼的影響.方法 將72例ICP患者按隨機數字錶分為觀察組和對照組,各36例.對照組給予腺苷蛋氨痠靜脈註射,1 000mg/次,1次/d,連用7d;觀察組在對照組用藥基礎上給予阿司匹林口服治療,25 mg/次,4次/d,連用7d.治療結束後觀察孕婦癥狀改善情況,檢測生化指標變化及妊娠結跼錶現.結果 觀察組治療後總膽汁痠、總膽紅素、丙氨痠轉氨酶(ALT)、堿性燐痠酶(ALP)、穀氨酰轉肽酶(γ-GT)水平、瘙癢評分、膽固醇水平均較治療前明顯降低,差異均有統計學意義[(31±10) μmol/L比(184±43) μmol/L,(35±9)μmol/L比(130±37)μmol/L,(51±9)U/L比(132±16)U/L,(51±10)U/L比(161±37) U/L,(37±11)U/L比(119±19) U/L,(0.47±0.05)分比(2.65±0.36)分,(3.4±2.11) mmol/L比(5.8±2.8) mmol/L](均P＜0.01);凝血酶原活動度與治療前比較差異無統計學意義(P＞0.05).對照組總膽汁痠、總膽紅素、ALT、ALP、γ-GT水平、瘙癢評分、膽固醇水平均較治療前明顯降低,差異均有統計學意義[(53±11) μmol/L比(186±44) μmol/L,(45±10) μmol/L比(129±35) μmol/L,(70±11)U/L比(132±13) U/L,(70±11) U/L比(157±37) U/L,(50±14) U/L比(114±16) U/L,(0.62±0.04)分比(2.49±0.47)分,(3.5±2.3) mmol/L比(5.8±3.0)mmol/L](均P＜0.01);凝血酶原活動度與治療前比較差異無統計學意義(P＞0.05).2組治療後總膽汁痠、總膽紅素、ALT、ALP、γ-GT比較差異均有統計學意義(均P＜0.01),瘙癢評分2組比較差異有統計學意義(P＜0.01),觀察組妊娠結跼羊水汙染、早產、新生兒窒息髮生率均低于對照組[38.9％(14/36)比72.2％(26/36),11.1％(4/36)比33.3％(12/36),5.6％(2/36)比27.5％(8/36)](均P＜0.05),2組剖宮產髮生率、膽固醇水平、凝血酶原活動度比較差異無統計學意義(P＞0.05).結論 阿司匹林聯閤腺苷蛋氨痠可明顯改善ICP患者的皮膚瘙癢癥狀、生化指標和妊娠結跼,對凝血機製無明顯影響.
목적 관찰아사필림연합선감단안산치료임신기간내담즙어적증(ICP)적림상효과급대임신결국적영향.방법 장72례ICP환자안수궤수자표분위관찰조화대조조,각36례.대조조급여선감단안산정맥주사,1 000mg/차,1차/d,련용7d;관찰조재대조조용약기출상급여아사필림구복치료,25 mg/차,4차/d,련용7d.치료결속후관찰잉부증상개선정황,검측생화지표변화급임신결국표현.결과 관찰조치료후총담즙산、총담홍소、병안산전안매(ALT)、감성린산매(ALP)、곡안선전태매(γ-GT)수평、소양평분、담고순수평균교치료전명현강저,차이균유통계학의의[(31±10) μmol/L비(184±43) μmol/L,(35±9)μmol/L비(130±37)μmol/L,(51±9)U/L비(132±16)U/L,(51±10)U/L비(161±37) U/L,(37±11)U/L비(119±19) U/L,(0.47±0.05)분비(2.65±0.36)분,(3.4±2.11) mmol/L비(5.8±2.8) mmol/L](균P＜0.01);응혈매원활동도여치료전비교차이무통계학의의(P＞0.05).대조조총담즙산、총담홍소、ALT、ALP、γ-GT수평、소양평분、담고순수평균교치료전명현강저,차이균유통계학의의[(53±11) μmol/L비(186±44) μmol/L,(45±10) μmol/L비(129±35) μmol/L,(70±11)U/L비(132±13) U/L,(70±11) U/L비(157±37) U/L,(50±14) U/L비(114±16) U/L,(0.62±0.04)분비(2.49±0.47)분,(3.5±2.3) mmol/L비(5.8±3.0)mmol/L](균P＜0.01);응혈매원활동도여치료전비교차이무통계학의의(P＞0.05).2조치료후총담즙산、총담홍소、ALT、ALP、γ-GT비교차이균유통계학의의(균P＜0.01),소양평분2조비교차이유통계학의의(P＜0.01),관찰조임신결국양수오염、조산、신생인질식발생솔균저우대조조[38.9％(14/36)비72.2％(26/36),11.1％(4/36)비33.3％(12/36),5.6％(2/36)비27.5％(8/36)](균P＜0.05),2조부궁산발생솔、담고순수평、응혈매원활동도비교차이무통계학의의(P＞0.05).결론 아사필림연합선감단안산가명현개선ICP환자적피부소양증상、생화지표화임신결국,대응혈궤제무명현영향.
Objective To observe the effects of aspirin and ademetionine in the treatment of intrahepatic cholestasis of pregnancy(TCP).Methods Totally 72 women with ICP were divided randomly into observation group(36 cases)and control group(36 cases).The control group was given ademetionine; observation group was given aspirin combined with ademetiomne; the clinical effect of ademetionine and aspirin treating ICP was evaluated.The levels of biochemical indicator,itching score and pregnancy outcomes for both groups were compared.Results The level of total bile acid,total bilirubin,alanine aminotransferase (ALT),alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (gamma GT) in observation group after treatment were significantly reduced [(31 ± 10) μmol/L vs (184 ± 43) μmol/L,(35 ± 9) μmol/L vs (130 ± 37) μmol/L,(51 ± 9) U/L vs (132 ± 16) U/L,(51 ± 10) U/L vs (161 ± 37) U/L,(37 ± 11) U/L vs (119 ± 19) U/L] (all P ＜ 0.01) ; pruritus score showed a significant difference as well [(0.47 ± 0.05) scores vs (2.65 ± 0.36) scores] (P ＜ 0.01) ; after treatment,cholesterol level was significantly lower than that before treatment [(3.4 ± 2.1) mmol/L vs (5.8 ± 2.8) mmol/L] (P ＜ 0.01) ; there was no statistically significant difference in prothrombin activity compared with that before treatment (P ＞ 0.05).Control biochemical indicators,including total bile acid,total bilirubin,ALT,ALP and gamma GT level,were significantly reduced [(53 ± 11) μmol/L vs (186 ±44) μmol/L,(45 ± 10) μmol/L vs (129 ±35)μmol/L,(70 ±11)U/L vs (132 ± 13)U/L,(70 ± 11)U/L vs (157 ±37)U/L,(50 ± 14)U/L vs (114 ± 16) U/L] (all P ＜ 0.01) ; pruritus score had a statistically difference [(0.62 ± 0.04) scores vs (2.49 ± 0.47) scores] (P ＜ 0.01) ; cholesterol level was significantly lower than that before treatment [(3.5 ± 2.3) mmol/L vs (5.8± 3.0)mmol/L] (P ＜ 0.01); there was no statistically difference in prothrombin activity compared with before treatment (P ＞ 0.05).The total bile acid,total bilirubin,ALT,ALP,gamma GT after treatment had a significant difference (all P ＜ 0.01) ; pruritus score in two groups had significant difference (t =13.636,P ＜0.01).The pregnancy outcome of the amniotic fluid pollution,incidence of preterm birth and neonatal asphyxia in observation group were lower than those in control group [38.9％ (14/36) vs 72.2％ (26/36),11.1％ (4/36) vs 33.3 ％ (12/36),5.6％ (2/36) vs 27.5 ％ (8/36)] (all P ＜ 0.05) ; the incidence of cesarean section,cholesterol levels and prothrombin activity for both groups showed no statistically significant difference (P ＞ 0.05).Conclusion The combination of aspirin and ademetionine is effective and can improve the level of biochemical indicator,itching score and pregnancy outcome.
