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目的:探讨3种临床常用方法治疗妊娠期肝内胆汁淤积症(ICP)的疗效及围产儿预后情况。方法:159例患者随机分为熊脱氧胆酸结合地塞米松组(A组)、地塞米松组(B组)和口服维生素C(C组)各53例。A组给予熊脱氧胆酸300 mg,3次/d,共用14天,地塞米松5 mg,肌内注射2次/d,3天为1个疗程;B组给予地塞米松5 mg,肌内注射2次/d,3天为1个疗程;C组给予口服维生素C 0.2 g,3次/d,连续服用14天。结果:A、B组患者治疗后皮肤瘙痒症状明显减轻(P<0.05),A组治疗后血总胆汁酸,血清谷丙转氨酶均明显下降(P<0.05);A组羊水粪染、胎儿窘迫、早产、新生儿窒息的发生率分别为7.5%、3.7%、11.3%、3.7%,C组发生率分别为32.1%、26.4%、43.3%、15.1%,两组比较差异有统计学意义(P<0.05)。B组治疗后仅血总胆汁酸有所下降,围产儿结局与C组相比无统计学意义(P>0.05),C组瘙痒症状无变化,血总胆汁酸,谷丙氨酸转氨酶稍上升(P>0.05)。结论:熊脱氧胆酸联合地塞米松治疗明显降低妊娠期肝内胆汁淤积症(ICP)患者的生化指标,改善围产儿结局。仅肌内注射地塞米松或口服维生素C不能有效治疗ICP。
Objective: To investigate the curative effect of three kinds of clinically common methods for the treatment of intrahepatic cholestasis of pregnancy (ICP) and the prognosis of perinatal children. Methods: One hundred and fifty-nine patients were randomly divided into two groups: 53 cases in each group (group A), dexamethasone group (group B) and oral vitamin C group (group C). A group was given ursodeoxycholic acid 300 mg three times a day for 14 days, dexamethasone 5 mg, intramuscular injection 2 times / d, 3 days for a course of treatment; group B was given dexamethasone 5 mg, muscle Inject 2 times / d, 3 days for a course of treatment; C group given oral vitamin C 0.2 g, 3 times / d, taking 14 consecutive days. Results: The skin pruritus symptoms in group A and group B were significantly relieved (P <0.05), and the levels of total bile acid and serum alanine aminotransferase in group A were significantly decreased after treatment (P <0.05). In group A, meconium - stained amniotic fluid and fetal distress , The incidence of premature birth and neonatal asphyxia were 7.5%, 3.7%, 11.3% and 3.7% respectively. The incidences of C group were 32.1%, 26.4%, 43.3% and 15.1% respectively. There was significant difference between the two groups P <0.05). Only the blood total bile acid decreased after treatment in group B, and the outcome of perinatal children was not significantly different from that in group C (P> 0.05). There was no change in pruritus symptoms in group B, and blood total bile acid and glutamic acid aminotransferase slightly increased (P> 0.05). Conclusion: Ursodeoxycholic acid combined with dexamethasone treatment can significantly reduce the biochemical indexes in patients with intrahepatic cholestasis of pregnancy (ICP) and improve perinatal outcome. Only intramuscular injection of dexamethasone or oral vitamin C can not effectively treat ICP.