S- 腺苷蛋氨酸联合利胆药对妊娠期 肝内胆汁淤积症的疗效分析

Effect of S-adenosylmethionine combined with cholagogic tablets on intrahepatic cholestasis of pregnancy

摘要:

目的 分析S- 腺苷蛋氨酸联合利胆药对妊娠期肝内胆汁淤积症产妇胎盘组织中NF-κB 相关 因子表达水平及Th17/Treg 平衡的影响。方法 选取2012 年12 月-2016 年12 月于南通大学附属医院妇收 治的96 例妊娠期肝内胆汁淤积症产妇，并按随机数字表法分为对照组和观察组。对照组采用利胆药进行治疗； 观察组采用S- 腺苷蛋氨酸联合利胆药治疗。对比两组患者瘙痒症状评分、TNF-α、HIF-1α、TGF-β1、 总胆汁酸（TBA）及IL-17 的含量，并分析患者Th17、Treg 细胞相对数及Th17/Treg 的变化情况。结果 两 组患者血清中TNF-α、HIF-1α、TGF-β1、TBA 及IL-17 比较有差异（P <0.05）。两组患者瘙痒症状评 分、Th17、Treg 细胞相对数及Th17/Treg 比率比较有差异（P <0.05）。两组患者治疗的总有效率比较有差 异（P <0.05）。两组患者早产率、胎儿宫内窘迫率及新生儿窒息率比较有差异（P <0.05）。结论 采用S- 腺 苷蛋氨酸联合利胆药治疗妊娠期肝内胆汁淤积症产妇，能有效改善患者NF-κB 相关因子表达水平及Th17/ Treg 平衡，缓解患者的瘙痒症状，减少新生儿不良反应的发生。

Abstract:

Objective To analyze the influence of S-adenosylmethionine combined with cholagogues on the the balance of of NF-κB-related factors and Th17/Treg in placenta in pregnant women with intrahepatic cholestasis. Methods Ninety-six cases of intrahepatic cholestasis of pregnancy in our hospital from December 2012 to December 2016 were selected, and randomly divided into a control group and an observation group, each group had 48 cases. The patients in the control group were treated with cholagogues; those in the observation group were treated with S-adenosylmethionine combined with cholagogues. The pruritus score, and the content of TNF-α, HIF-1α, TGF-β1, TBA and IL-17 were compared and analyzed, and the changes of Th17, Treg cells and the ratio of Th17/Treg were analyzed. Results The serum levels of TNF-α, HIF-1α, TGF-β1, TBA and IL-17 were significantly different between the two groups (P < 0.05). The score of pruritus symptom, the relative numbers of Th17 and Treg cells and the ratio of Th17/Treg were significantly different between the two groups (P < 0.05). The total effective rates of the two groups were significantly different (P < 0.05). The incidences of preterm birth, fetal distress and neonatal asphyxia were significantly different between the observation group and the control group (P < 0.05). Conclusions S-adenosylmethionine combined with cholagogues for treatment of intrahepatic cholestasis in pregnant women could effectively improve the the balance of NF-κB-related factors and Th17/Treg in the patients, relieved itching, and reduce the incidences of neonatal adverse reactions.