妊娠期胆汁淤积综合征的中西医疗效观察

尹桂珍1,2， 周惠芳1

(1南京中医药大学， 南京210000；2江苏省仪征市妇幼保健所， 江苏仪征211400)

摘要:目的探讨补肾清利方联合熊去氧胆酸(UDCA)治疗妊娠期胆汁淤积综合征(ICP)的临床疗效和安全性，为优化治疗方案提供依据。方法选取产科门诊符合条件的ICP孕妇60例，随机分为两组：使用补肾清利方联合UDCA治疗30例(Ⅰ组)，单用UDCA治疗30例(Ⅱ组)。两组均以7 d为1个疗程，连续使用2个疗程，比较两组临床疗效和安全性。结果Ⅰ组总有效率为93.3%，Ⅱ组总有效率为73.3%，两组差异有统计学意义(P<0.05)。在改善瘙痒和失眠症状，降低总胆汁酸(TBA)、甘胆酸(CG)、谷丙转氨酶(ALT)水平，减少胎儿窘迫、早产、羊水粪染及新生儿窒息发生率，提升顺产率方面，Ⅰ组明显优于Ⅱ组(P<0.05),而S/D值、Manning评分及改善黄疸症状方面，两组差异无统计学意义(P>0.05)。结论补肾清利方联合UDCA治疗ICP，能在安胎的基础上，改善症状，疗效显著，且无毒副作用。

关键词:胆汁淤积； 补肾清利； 联合治疗； 肝胆酸

中图分类号：R714.5文献标识码：A

doi:10.3969/j.issn.1009-5551.2015.05.019

[收稿日期：2015-01-21]

基金项目：新疆维吾尔自治区自然科学基金(2013211A101)

作者简介：朱江(1973-)，男，主任医师，在读硕士，研究方向：微创外科。

Efficacy of cholestasis syndrome of pregnancy by Chinese and

western medical treatment

YIN Guizhen1， ZHOU Huifang2

(1NanjingUniversityofChineseMedicine,Nanjing210000,China;2MaternalandChild

HealthCareinYizhengCityofJiangsuProvice,Yizheng211400,China)

Abstract:ObjectiveTo investigate the clinical curative effect and safety in the treatment of cholestasis syndrome of pregnancy by Bushen Qingli decoction combined with ursodeoxycholic acid (UDCA) and to provide the optimization of the treatment. Methods60 pregnant women with pregnancy cholestasis syndrome (ICP) were selected and randomly divided into two Group Ⅰ (30 cases) and Group Ⅱ(30 cases): Group Ⅰ was treated with Bushen Qingli decoction combined with ursodeoxycholic acid (UDCA); Group Ⅱ was treated with the single use of ursodeoxycholic acid (UDCA). The two groups were treated for 2 periods of 14 day, (7 days was a course of treatment), and their clinical efficacy and safety were compared. ResultsThe total effective rate in group Ⅰ was 93.3%, and in group Ⅱ was 73.3%, with statistically significant differences (P<0.05). There were effectively improvement in the symptoms of itching and insomnia in Group Ⅰ, with the decline of the total bile acid (TBA), glycocholic acid (CG), alanine aminotransferase (ALT), fetal distress, premature delivery, meconium and incidence of neonatal asphyxia, and the rise of birth rates. There were no statistically significant difference in S/D, Manning scores and the jaundice symptoms improvement in two groups (P>0.05). ConclusionBushen Qingli decoction with UDCA therapy ICP was proved to help miscarriage prevention and improve symptoms, with no toxic side effect.

Key words: cholestasis； bushen Qingli decoction； combination therapy； hepatic bile acid

妊娠期胆汁淤积综合征(ICP)是妊娠中晚期特有的并发症，临床表现为皮肤瘙痒、黄疸，对孕妇和胎儿危害大，尤其易引起胎儿早产、宫内窘迫及死胎、死产等，严重影响妊娠结局，使围生儿发病率和死亡率增高。其发病率为0.1%～15.6%[1]，但是确切病因尚不清楚。国外有研究报道，孕激素的代谢产物有导致肝内胆汁淤积的作用[2]。祖国医学认为ICP为妊娠病，病因病机与肝肾不足、湿热郁结有关，治法应以治疗与安胎并重为准则。结合“肾主生殖、肝主疏泄”的理论，本研究对补肾清利方联合熊去氧胆酸(UDCA)的治疗方法展开了研究，现报道如下。……