CAJ | 학술논문

目的：探讨妊娠期肝内胆汁淤积症（ICP）血清甘胆酸（CG）水平的变化及 ICP的诱发因素，观察丁二磺酸腺苷蛋氨酸与熊去氧胆酸联合治疗 ICP的临床疗效。方法将62例 ICP患者随机分成2组：观察组31例（M组）采用丁二磺酸腺苷蛋氨酸与熊去氧胆酸治疗，对照组31例（N组）采用熊去氧胆酸治疗，疗程均为2周，2组均给予地塞米松治疗。另外选择31例健康孕妇为健康组（A组）。比较 M、N组患者黄疸消退时间及治疗前后瘙痒评分的变化；检测 M、N组治疗前后及 A组血清总胆汁酸（TBA）、CG以及肝功能（ALT、AST、T-BIL、D-BIL）、硒（Se）含量；观察3组围产儿结局及新生儿生化、心肌酶谱指标水平。结果 ICP患者血清 Se含量较健康孕妇显著降低（P＜0．05）。M、N组治疗前血清CG、TBA、ALT、AST、T-BIL、D-BIL水平较 A组显著升高（P＜0．05）；与治疗前比较，M、N组血清CG、TBA、ALT、AST、T-BIL、D-BIL水平均有显著下降（P＜0．05），M组较 N组降低更为显著（P＜0．05）。M组治疗后瘙痒评分、黄疸消退时间显著优于 N组（P＜0．05）；胎儿宫内窘迫率、早产率、Apgar≤7分比例、新生儿窒息率及死胎率均明显低于 N 组（P＜0．05）。结论丁二磺酸腺苷蛋氨酸联合熊去氧胆酸治疗ICP，能明显减轻瘙痒和黄疸，改善生化异常，改善围产儿预后。血清甘胆酸水平测定有助于 ICP的早诊断、早治疗。妊娠期血清硒减少可能会引起 ICP。
목적：탐토임신기간내담즙어적증（ICP）혈청감담산（CG）수평적변화급 ICP적유발인소，관찰정이광산선감단안산여웅거양담산연합치료 ICP적림상료효。방법장62례 ICP환자수궤분성2조：관찰조31례（M조）채용정이광산선감단안산여웅거양담산치료，대조조31례（N조）채용웅거양담산치료，료정균위2주，2조균급여지새미송치료。령외선택31례건강잉부위건강조（A조）。비교 M、N조환자황달소퇴시간급치료전후소양평분적변화；검측 M、N조치료전후급 A조혈청총담즙산（TBA）、CG이급간공능（ALT、AST、T-BIL、D-BIL）、서（Se）함량；관찰3조위산인결국급신생인생화、심기매보지표수평。결과 ICP환자혈청 Se함량교건강잉부현저강저（P＜0．05）。M、N조치료전혈청CG、TBA、ALT、AST、T-BIL、D-BIL수평교 A조현저승고（P＜0．05）；여치료전비교，M、N조혈청CG、TBA、ALT、AST、T-BIL、D-BIL수평균유현저하강（P＜0．05），M조교 N조강저경위현저（P＜0．05）。M조치료후소양평분、황달소퇴시간현저우우 N조（P＜0．05）；태인궁내군박솔、조산솔、Apgar≤7분비례、신생인질식솔급사태솔균명현저우 N 조（P＜0．05）。결론정이광산선감단안산연합웅거양담산치료ICP，능명현감경소양화황달，개선생화이상，개선위산인예후。혈청감담산수평측정유조우 ICP적조진단、조치료。임신기혈청서감소가능회인기 ICP。
Objective To investigate the changes in cholyglycine(CG)levels in intrahepatic cholestasis of pregnancy(ICP)and the factors inducing ICP,and to observe the effects of S-Ade-nosyl-L-methionine(SAMe)combined with ursodeoxycholic acid(UDCA)on ICP.Methods Six-ty-two patients with ICP were randomly treated with UDCA alone(group N,n=31)or in combi-nation with SAMe(group M,n=31)for 2 weeks.Furthermore,all patients were given dexametha-sone.In addition,31 healthy pregnant women were selected as group A.The jaundice subsidence time and changes in pruritus score before and after treatment were compared between group M and group N.Levels of serum total bile acid(TBA),CG,alanine aminotransferase(ALT),aspart aminotransferase(AST),total bilirubin(T-BIL),direct bilirubin(D-BIL)and selenium(Se)were examined before and after treatment.Perinatal outcome,neonatal biochemical indexes and myocar-dial enzyme spectrum were measured in the three groups.Results The levels of serum Se in ICP patients were significantly lower than those in healthy pregnant women(P<0.05).Compared with group A,serum levels of CG,TBA,ALT,AST,T-BIL and D-BIL significantly increased in both group M and group N(P<0.05).The levels of CG,TBA,ALT,AST,T-BIL and D-BIL measured after treatment were significantly lower than those measured before treatment in ICP patients(P<0.05),and the decrease in group M was more obvious than that in group N(P<0.05).Moreover,compared with group N,pruritus score and jaundice subsidence time were signif-icantly improved and fetal distress rate,premature birth rate,pruritus score,proportion of neo-nates with Apgar score≤7,neonatal asphyxia rate and stillbirth rate were significantly decreased in group M(P<0.05).Conclusion The SAMe combined with UDCA can effectively relieve pru-ritus and j aundice and improve biochemical abnormalities and perinatal prognosis in patients with ICP.The monitoring of serum CG levels contributes to the early diagnosis and treatment of ICP. The decrease in serum Se levels may induce ICP.