中西医联合治疗妊娠期肝内胆汁淤积症的临床疗效及其对Th17/Treg平衡的影响  

Clinical efficacy of oriental virgate wormwood decoction combined with S-adenosyl methionine in treatment of intrahepatic cholestasis of pregnancy and effect on Th17/Treg balance

作　　者：王淑平[1] 陈宝艳[1] 刘志辉[2] 李艳芳[1] 李道成[1] 孙晓峰[1] 

机构地区：[1]广州中医药大学第一附属医院产科,广州510405 [2]广州中医药大学第一附属医院检验科,广州510405

出　　处：《新医学》2015年第5期308-311,共4页Journal of New Medicine

基　　金：广东省中医药管理局建设中医药强省科研课题(20131230)

摘　　要：目的探讨茵陈蒿汤联合丁二磺酸腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症(ICP)的临床疗效及其对辅助性T细胞17(Th17)/调节性T细胞(Treg)平衡的影响。方法选择40例ICP患者,随机分为中西医联合治疗组(A组)和单纯西医治疗组(B组)各20例,B组单纯给予丁二磺酸腺苷蛋氨酸治疗,A组在B组基础上联合茵陈蒿汤治疗,另选择20名健康孕妇作健康对照组(C组)。观察A、B组ICP患者在治疗前、后的瘙痒评分、肝功能,比较A、B、C组Th17/Treg相关细胞因子IL-17、TGF-β的变化及妊娠结局。结果治疗后,A组ICP患者瘙痒评分、胆汁酸、ALT、AST均低于B组(P均<0.05);在妊娠结局方面,3组的早产率、新生儿窒息率及新生儿体质量比较差异均无统计学意义(P均>0.05)。A、B组ICP患者外周血IL-17水平均明显高于健康对照组,TGF-β水平均低于健康对照组(P均<0.05);与B组相比,治疗后A组IL-17降低及TGF-β升高更加明显(P均<0.05)。结论茵陈蒿汤联合丁二磺酸腺苷蛋氨酸治疗ICP疗效显著,其机制可能与改善Th17/Treg失衡状态有关。Objective To investigate the clinical efficacy of oriental virgate wormwood decoction in combination with S-adenosyl methionine in treating intrahepatic cholestasis of pregnancy （ICP）and evaluate the influence on Th17 /Treg balance.Methods Forty ICP patients were randomly divided into the integrated Western and Traditional Chinese medicine （group A,n =20）and the Western medicine groups （group B,n =20）.In the group A,patients were treated with oriental virgate wormwood decoction plus S-adenosyl methio-nine and those in the group B received S-adenosyl methionine alone.Another 20 healthy pregnant women were chosen as normal controls （group C）.The pruritus score and liver function before and after treatment were ob-served in the groups A and B.Changes in the levels of Th17 /Treg-related cytokines,such as IL-17 and TGF-βand pregnant outcomes were statistically compared among three groups.Results After treatment,the pruri-tus score,bile acid,ALT and AST in the group A were significantly lower than those in the group B （all P 〈0.05）.With respect to pregnant outcomes,the premature birth rate,neonatal asphyxia rate and neonatal weight did not significantly differ among three groups （all P 〉0.05）.In groups A and B,IL-17 of peripheral blood was significantly higher whereas the level of TGF-βwere considerably lower compared with those in the control group （both P 〈0.05）.Compared with group B,more significant IL-17 decrease and TGF-βincrease were noted in the group A （both P 〈0.05）.Conclusions Oriental virgate wormwood decoction combined with S-adenosyl methionine is highly efficacious in treating ICP,probably due to the mechanism by alleviating Th17 /Treg ratio imbalance.

关 键 词：清热利胆法 妊娠期肝内胆汁淤积症 临床疗效 辅助性T细胞17 调节性T细胞 

分 类 号：R714.255[医药卫生—妇产科学]