茵陈蒿汤联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症疗效及Th17/Treg失衡对妊娠结局的影响  

Efficacy of Yinchenhao decoction combined with ursodeoxycholic acid in the treatment of ICP and the effect of Th17/Treg imbalance on pregnancy outcome

作　　者：王淑平[1] 李艳芳[1] 孙雪[1] 陈宝艳[1] 李道成[1] 刘志辉[1] WANG Shuping;LI Yanfang;SUN Xue;CHEN Baoyan;LI Daocheng;LIU Zhihui(First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一附属医院,广东广州510405

出　　处：《陕西中医》2023年第8期1074-1077,共4页Shaanxi Journal of Traditional Chinese Medicine

基　　金：广东省科技计划项目(2017ZC0151)。

摘　　要：目的:探究茵陈蒿汤联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症(ICP)疗效及辅助性T细胞17(Th17)/调节性T细胞(Treg)失衡对妊娠结局的影响。方法:选择40例孕周>28周的ICP患者为研究对象,根据治疗方法分为西医组及联合组,西医组予熊去氧胆酸治疗,联合组予茵陈蒿汤联合熊去氧胆酸治疗,另选择孕周>28周正常健康孕妇为对照组。比较各组瘙痒评分、肝功能、白介素-17(IL-17)、白介素-35(IL-35)、转化生长因子-β(TGF-β)及妊娠结局的差异。采用Spearman秩相关性分析ICP患者IL-17、IL-35、TGF-β与妊娠结局的相关性。结果:联合组和西医组治疗前瘙痒评分、总胆汁酸(TBA)、直接胆红素(DBIL)、总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、IL-17、IL-35及TGF-β水平比较差异无统计学意义(均P>0.05)。联合组和西医组患者治疗后瘙痒评分、TBA、DBIL、TBIL、ALT、AST、IL-17较治疗前下降,IL-35、TGF-β水平较治疗前升高(均P<0.05)。联合组治疗后瘙痒评分、TBA、DBIL、TBIL、ALT、AST、IL-17水平低于西医组,IL-35、TGF-β水平高于西医组(均P<0.05)。联合组早产、产后出血、低体重儿发生率低于西医组,Apgar评分高于西医组(均P<0.05)。联合组和对照组早产、产后出血、低体重儿发生率及Apgar评分比较差异无统计学意义(均P<0.05)。IL-17与早产、产后出血、低体重儿发生率及Apgar评分呈正相关(均P<0.05);IL-35、TGF-β与早产、产后出血、低体重儿发生率及Apgar评分呈负相关(均P<0.05)。结论:茵陈蒿汤联合熊去氧胆酸可显著改善ICP妊娠结局、肝功能、Th17/Treg失衡,且Th17/Treg失衡与妊娠结局密切相关。Objective:To study the curative effect of Yinchenhao decoction combined with ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy(ICP)and the effect of Th17/Treg imbalance on pregnancy outcome.Methods:40 patients with ICP were selected as treatment objects,they were divided into western medicine group and combination group according to treatment methods.The western medicine group was treated with ursodeoxycholic acid,and the combination group was treated with Yinchenhao decoction combined with ursodeoxycholic acid.Healthy pregnant women with gestational age greater than 28 weeks were selected as the control group.The differences in pruritus score,liver function,IL-17,IL-35,TGF-βand pregnancy outcome were compared.Spearman rank correlation was used to analyze the correlation between IL-17,IL-35,TGF-βand pregnancy outcome in ICP patients.Results:There was no significant difference in the scores of pruritus,TBA,DBIL,TBIL,ALT,AST,IL-17,IL-35 and TGF-βbetween the combination group and the western medicine group before treatment(all P>0.05).After treatment,the pruritus scores,TBA,DBIL,TBIL,ALT,AST,IL-17 in the combination group and western medicine group were lower than those before treatment,and IL-35 and TGF-βwere higher than those before treatment(all P<0.05).After treatment,the pruritus score,TBA,DBIL,TBIL,ALT,AST and IL-17 in the combined group were lower than those in the western medicine group,while IL-35 and TGF-βwere higher than those in the western medicine group,and the difference was statistically significant(all P<0.05).The incidence of premature birth,postpartum hemorrhage and low birth weight infants in the combined group were lower than those of the western medicine group,and the Apgar score was higher than that of the western medicine group(all P<0.05).There was no significant difference between the combination group and the control group in terms of premature birth,postpartum hemorrhage,Apgar score and low birth weight infants(all P<0.05).IL-17 was positively correlated

关 键 词：妊娠期肝内胆汁淤积症 茵陈蒿汤 熊去氧胆酸 妊娠结局 辅助性T细胞17 调节性T细胞 

分 类 号：R575[医药卫生—消化系统]