自拟清热祛湿方联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的临床研究  

Clinical study of self-prescribed Qingre Qushi recipe combined with ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy

作　　者：赵文斌[1] 王学平 范睿嘉[1] ZHAO Wenbin;WANG Xueping;FAN Ruijia(Department of Obstetrics and Gynecology,Affiliated Hospital of Hangzhou Normal University,Hangzhou310015,China;Department of Obstetrics,Affiliated Hospital of Hangzhou Normal University,Hangzhou310015,China)

机构地区：[1]杭州师范大学附属医院妇产科,浙江杭州310015 [2]杭州师范大学附属医院产科,浙江杭州310015

出　　处：《中国现代医生》2020年第22期59-62,共4页China Modern Doctor

基　　金：浙江省中医药科技计划项目(2018ZA099)。

摘　　要：目的探讨自拟清热祛湿方联合熊去氧胆酸(UDCA)治疗妊娠期肝内胆汁淤积症(ICP)的临床疗效及可能机制。方法选择ICP患者60例,将其随机分为对照组和观察组,每组30例。对照组给予UDCA治疗15 mg/(kg·d),tid口服。观察组在对照组基础上加用自拟清热祛湿方,每天1剂,分2次口服。疗程均为30 d。两组患者均给予左侧卧位休息、营养支持等一般治疗。采用Ribalta标准评价瘙痒情况。采用全自动生化仪检测血清丙氨酸氨基转氨酶(ALT)、天冬氨酸氨基转氨酶(AST)和总胆汁酸(TBA)水平。观察并记录两组患者发生胎儿窘迫、早产、剖宫产等情况。采用酶联免疫吸附法检测血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)的表达水平。采用荧光定量PCR反应检测外周血核因子相关因子2(Nrf2)、血红素加氧酶-1(HO-1)mRNA的相对表达量。结果观察组瘙痒症状评分、ALT、AST、TBA水平均明显低于对照组,差异有统计学意义(P<0.05);观察组胎儿窘迫、早产、剖宫产发生率均显著低于对照组,差异有统计学意义(P<0.05);观察组的TNF-α、IL-6水平均明显低于对照组,而观察组的Nrf2、HO-1 mRNA相对表达水平明显高于对照组,差异有统计学意义(P<0.05)。结论自拟清热祛湿方联合熊去氧胆酸可有效缓解ICP患者的临床症状,保护肝功能,改善妊娠结局;其作用机制可能与通过上调Nrf2/HO-1信号通路,抑制炎症反应有关。Objective To explore the clinical efficacy and possible mechanism of self-prescribed Qingre Qushi recipe combined with ursodeoxycholic acid(UDCA)in the treatment of intrahepatic cholestasis of pregnancy(ICP).Methods Sixty patients with ICP were randomly divided into a control group and an observation group,with 30 patients in each group.The control group was given UCDA treatment of 15mg/(kg·d)and tid orally.On the basis of the control group,the observation group was given additional self-prescribed Qingre Qushi recipe of one dose per day and each dose was taken by oral administration twice.The courses of treatment were both 30 days.Patients in both groups were given general treatment such as resting on the left lateral decubitus position and nutritional support.Ribalta criteria were used to assess pruritus.The serum alanine transaminase(ALT),aspartic transaminase(AST)and total bile acid(TBA)levels were detected with the automatic biochemical analyzer.The incidences of circumstances such as fetal distress,premature delivery and cesarean section in the two groups were observed and recorded.The enzyme linked immunosorbent assay(ELISA)was applied to measure the expression levels of serum tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6).The fluorescent quantitative PCR was applied to detect the relative expression of related factors of peripheral blood nuclear factor 2(Nrf2)and heme oxygenase-1(HO-1)mRNA.Results The pruritus scores,ALT,AST and TBA levels in the observation group were significantly lower than those in the control group,with statistical differences(P<0.05).The incidences of fetal distress,premature delivery and cesarean section in the observation group were all significantly lower than those in the control group,with statistical difference(P<0.05).The expression levels of TNF-αand IL-6 in the observation group were significantly lower than those in the control group,while the relative expression levels of Nrf2 and HO-1 mRNA in the observation group were significantly higher than those in the co

关 键 词：自拟清热祛湿方 熊去氧胆酸 妊娠期肝内胆汁淤积症 Nrf2/HO-1信号通路 

分 类 号：R714.25[医药卫生—妇产科学]