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目的探讨地塞米松联合腺苷蛋氨酸(SAMe)治疗妊娠期肝内胆汁淤积症(ICP)的临床疗效及对患者肝功能、促炎性细胞因子水平的影响。方法选取广元市妇幼保健院2013年6月-2016年6月收治的ICP患者86例,按照随机数字表法将患者分为观察组和对照组各43例。对照组给予SAMe治疗,观察组在对照组的基础上联合地塞米松治疗,比较两组患者治疗前和治疗7 d后皮肤瘙痒评分、肝功能指标谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆汁酸(TBA)和促炎性细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素-12(IL-12)水平,并评价两组用药安全性。结果治疗后,两组患者皮肤瘙痒评分较治疗前均显著降低,差异有统计学意义(P<0.05);且观察组较对照组降低更明显,两组差异有统计学意义(P<0.05)。两组血清AST、ALT、TBA、TNF-α、IL-12水平较治疗前均显著下降,差异有统计学意义(P<0.05);且观察组下降幅度显著优于对照组,两组差异有统计学意义(P<0.05)。两组患者治疗过程中均未见明显不良反应/事件。结论地塞米松和SAMe联合治疗能更有效缓解ICP患者的皮肤瘙痒症状,改善肝功能,降低TNF-α、IL-12水平,安全有效。
Objective To investigate the clinical efficacy of dexamethasone combined with adenosine methionine (SAMe) in the treatment of intrahepatic cholestasis of pregnancy (ICP) and its effect on the level of hepatic function and proinflammatory cytokines. Methods 86 cases of ICP patients who were admitted to Guangyuan MCH from June 2013 to June 2016 were divided into observation group (43 cases) and control group (43 cases) according to random number table method. The control group was given SAMe treatment. The observation group was treated with dexamethasone on the basis of the control group. The pruritus scores, the indexes of hepatic function, aspartate aminotransferase (AST), alanine aminotransferase (ALT) , Total bile acid (TBA) and proinflammatory cytokines such as TNF-α and IL-12 were measured. The safety of the two groups was evaluated. Results After treatment, the pruritus scores of the two groups were significantly lower than those before treatment (P <0.05), and the observation group was more obvious than the control group, the difference was statistically significant (P <0.05) . The serum levels of AST, ALT, TBA, TNF-α, IL-12 in the two groups were significantly lower than those before treatment (P <0.05), and the decrease in the observation group was significantly better than that in the control group Statistical significance (P <0.05). No significant adverse reactions / events were seen during treatment in both groups. Conclusion Combination of dexamethasone and SAMe can effectively relieve skin pruritus, improve liver function and reduce the levels of TNF-α and IL-12 in ICP patients. It is safe and effective.