【作者】 夏卫红；

【导师】 李克湘；

【作者基本信息】 湖南中医学院 ， 中西医结合临床， 2004， 硕士

【摘要】 目的：本研究运用以疏肝养血、清热利湿为立法组成的抗淤胆汤配合西医治疗，系统观察其治疗妊娠胆淤症(intrahepatic cholestasis of pregnancy. ICP)的临床疗效并探讨其机理，旨在寻找一个疗效肯定的、新的治疗方法。 方法：1．临床疗效观察：将40例ICP患者随机分为抗淤胆汤组(治疗组)和地塞米松组(对照组)，治疗1-2个疗程后，观察皮肤瘙痒、黄疸、中医证候等临床症状的变化，并监测妊娠结局。2．实验室指标检测：比较治疗前后血液流变学、血清甘胆酸、血清雌三醇、肝功能各项生化指标变化，同时监测安全性指标，如血、尿常规，肝肾功能等。 结果：妊娠胆淤症患者血液呈高粘高凝状态，血清甘胆酸水平明显偏高，血清雌三醇水平偏高，有肝功能的改变；抗淤胆汤组及地塞米松组均能明显改善ICP患者症状，有效率分别达90％及85％，总疗效相当，但抗淤胆汤组在改善中医症候、降低血液粘稠度、降低血中胆红素水平及改善妊娠结局方面，疗效明显优于地塞米松组(P＜0.01)，在降低血清甘胆酸水平及改善肝功能方面，两组疗效相当(P＞0.05)。 结论：血虚湿热是ICP的主要病机，疏肝养血、清热利湿是治疗ICP的有效治疗方法；抗淤胆汤是通过降低血液粘稠度而改善胎盘循环，降低血清胆酸浓度而减少胆酸对母儿的危害而达到治疗目的；抗淤胆汤组治疗ICP疗效肯定，无明显不良反应，能弥补西医治疗的不足，值得临床推广。更多还原

【Abstract】 Objectives: To evaluate the effect of Kang Yu Dan Tang(KYDT) in the treatment of intrahepatic cholestasis of Pregnancy(ICP),based on TCM, modern medicine theory and clinical symptoms,and explore the possible mechanism of curative effect, and put forward a confirmative treatment method according to this study results.Methods: 1.Studies on clinical effect: divia randomly 40 cases of ICP into KYDT Group and Dexamethasone(DXM) Group, both of which are treated for 14 days or 28 days .Then measure major symptom changings such as Skin Pruritis, jaundice, the clinical symptoms of traditional Chinese medicine and the pregnancy frucitify. 2.studies on detection indexes:serum cholyglycine(CG), serum estriol, blood hemorheology, hepatorenal function, safety routine index examination as blood, urine, kidney function. All the dynamic observations of former targets were made before and after treatments.Results: The results shows that ICP patients’s hemorheologic levels were much higher, and serum cholyglycine, serum estriol did, too; KYDT Group and DXM Group could remarkably alleviate the clinical cardinal symptoms, and the total effective rate of them was 90% and 85% respectively. Compared with DXM Group, KYDT Group had similar curative effect. KYDT Group could descend the indexes level of both blood hemorheology and serum bilirubin, and alleviate both the clinical symptoms of traditional Chinese medicine and the pregnancy frucitify, the effect was superior to the DXM Group (P<0.01).KYDT Group could descend the indexes level of serum cholyglycine and alleviate hepatorenal function, the effect was similar to the DXM Group(P>0.05).Conclusion: Xue Xu and Shi re was the cardinal pathogenesis of ICP.KYDT had the comprehensive function of descending the indexes level of both blood hemorheology and serum cholyglycine, to be worthy of exploitated and popularized .Compared with DXM Group, KYDT Group had the superiority of great significant curative effect, and fewer side effects to be safely and efficiently to the treatment of ICP.更多还原