【作者】 王波；

【导师】 刘建；

【作者基本信息】 重庆医科大学 ， 妇产科学， 2013， 硕士

【摘要】 目的:系统评价熊去氧胆酸联合腺苷蛋氨酸与单用熊去氧胆酸对妊娠期肝内胆汁淤积症孕妇改善生化指标及瘙痒症状的效果及其对妊娠结局的影响。方法：利用计算机检索2003年至今维普、万方、CNKI、CBM、PUBMED、EMBASE等数据库，查找关于熊去氧胆酸联合腺苷蛋氨酸与单用熊去氧胆酸治疗妊娠期肝内胆汁淤积症的随机对照研究的文献、筛选后质量评价并提取数据，以Cochrane协作网提供的RevMan5．2软件进行Meta分析。结果：经筛选后符合纳入标准的外文文献1篇、中文文献8篇，9篇均为随机临床对照研究，合并样本量后共651例受试对象，其中联合组331例，单用组320例。META分析结果显示：与单用熊去氧胆酸相比，熊去氧胆酸联合腺苷蛋氨酸改善孕妇瘙痒症状（WMD1.26，95%CI(0.64,1.89)；P＜0.0001）明显，降低血清总胆汁酸（WMD12.44，95%CI(7.17,17.71)；P＜0.00001）、总胆红素（WMD6.51，95%CI(4.14,8.89)；P＜0.00001）、谷丙转氨酶（WMD44.26，95%CI(27.81,60.70)；P＜0.00001）、谷草转氨酶（WMD23.92，95%CI(13.42,34.43)；P＜0.00001）及间接胆红素（WMD2.96，95%CI(0.84,5.07)；P=0.006）效果显著；在改善胎儿宫内窘迫发生率（WMD0.39，95%CI(0.17，0.88)；P=0.02）、剖宫产率（WMD0.49，95%CI(0.31，0.78)；P=0.002）、早产发生率（WMD0.33，95%CI(0.21，0.53)；P＜0.00001）、新生儿Apgar评分≤7分比例（WMD0.27，95%CI0.16，0.46)；P＜0.00001）、羊水粪染发生率（WMD0.33，95%CI(0.21,0.50)；P＜0.00001）及新生儿体重（WMD459.78，95%CI262.07，657.48)；P＜0.00001）等妊娠结局方面优于单用熊去氧胆酸对照组。联合组与单用组在ICP孕妇分娩孕周方面无统计学差异（WMD0.66，95%CI(-0.84,2.16)；P=0.39），在产后出血量方面（WMD-45.38，95%CI(-76.61，-14.15)；P=0.004）单用组低于联合组。结论：熊去氧胆酸联合腺苷蛋氨酸治疗妊娠肝内胆汁淤积症在改善孕妇瘙痒症状、血清生化指标及妊娠结局方面明显优于单用熊去氧胆酸。更多还原

【Abstract】 Background&aims: We performed a meta-analysis to evaluate theeffects of ursodeoxycholic acid (UDCA) conbined withS-Adenosyl-L-methionine(SAMe) on pruritus, liver test results, andoutcomes of fetals to patients with intrahepatic cholestasis of pregnancy(ICP).Meyhods: Such databases as WANFANG、VIP、CNKI、CBM、PUBMED, EMBASE were searched from2003to2011for collectingrandomized controlled trials that compared the effects of UDCA conbinedwith SAMe to UDCA patients with ICP,and their references were alsosearched. After study selection, assess the study and extrac thedata.Meta-analyses were performed by RevMan5.2software fromCochrane.Resukts:9published,randomized controlled trials(one English studyand eight Chinese studies) were included, involving651patients:331received only UDCA and SAMe,320received only UDCA,/ The Meta–analysis showed that compared with SAMe, UDCA conbinedwith SAMe had the advantages in reducing pruritus（WMD1.26，95%CI(0.64,1.89)；P＜0.0001）、total serum levels of bile acids(TBA)（WMD12.44，95%CI(7.17,17.71)；P＜0.00001）、total bilirubin(TB)（WMD6.51，95%CI(4.14,8.89)；P＜0.00001）、serum levels of alanineaminotransferase (ALT)（WMD44.26，95%CI(27.81,60.70)；P＜0.00001）、serum levels of aspartate aminotransferase(AST)（WMD23.92，95%CI(13.42,34.43)；P＜0.00001）、direct bilirubin(DB)（WMD2.96，95%CI(0.84,5.07)；P=0.006）；reduced fetal distress（WMD0.39，95%CI(0.17，0.88)；P=0.02）,reduced cesarean section rate（WMD0.49，95%CI(0.31，0.78)；P=0.002）, fewer premature births（WMD0.33，95%CI(0.21，0.53)；P＜0.00001）, less frequent respiratory distresssyndrome(Apgar≤7)（WMD0.27，95%CI0.16，0.46)；P＜0.00001），reduced meconium-staining amniotic fluid（WMD0.33，95%CI(0.21,0.50)；P＜0.00001），improved birth weight（WMD459.78，95%CI262.07，657.48)；P＜0.00001）.There is no statistical significanceon delivery gestational age（WMD0.66，95%CI(-0.84,2.16)；P=0.39）.But,UDCA have advantage of lesser postpartum bleeding thanUDCA conbined with SAMe.Conclusions: UDCA conbined with SAMe have advantages inreducing pruritus、improving liver test results and benefiting fetaloutcomes in patients with ICP.更多还原