【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。更多还原

【Abstract】 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-β and pregnancy outcome were compared.Spearman rank correlation was used to analyze the correlation between IL-17,IL-35,TGF-β and 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-β between 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-β were 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-β were 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 with premature birth, postpartum hemorrhage, Apgar score and low birth weight infants(all P<0.05);IL-35,TGF-β were negatively correlated with premature birth, postpartum hemorrhage, Apgar score and low birth weight infants(all P<0.05).Conclusion:Yinchenhao decoction combined with ursodeoxycholic acid can significantly improve ICP pregnancy outcome, liver function and Th17/Treg imbalance, and Th17/Treg imbalance is closely related to pregnancy outcome.更多还原