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目的:探讨丁二磺酸腺苷蛋氨酸(SAMe)联合地塞米松治疗对妊娠期肝内胆汁淤积症(ICP)患者肝功能及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-12(IL-12)水平的影响。方法:选取我院2014年10月~2016年10月收治的86例ICP患者,依据随机数字表法均分为两组。对照组予以SAMe治疗,观察组在此基础上予地塞米松治疗。记录比较两组治疗前后皮肤瘙痒评分、肝功能指标、血清TNF-α、IL-12水平,并评价两组用药安全性。结果:与治疗前对比,两组治疗7 d后皮肤瘙痒评分均显著降低(P<0.01);且观察组治疗7 d后皮肤瘙痒评分的改善效果显著优于对照组同期(P<0.01)。两组治疗7 d后血清谷草转氨酶(AST)、谷丙转氨酶(ALT)及总胆汁酸(TBA)水平均显著低于治疗前(P<0.01);与对照组同期相比,观察组治疗7 d后肝功能指标的改善程度均更为显著(P<0.01)。与治疗前相比,两组治疗7 d后血清TNF-α、IL-12水平均显著下降(P<0.01);且观察组治疗7 d后血清促炎性细胞因子水平的改善幅度均显著优于对照组同期(P<0.01)。治疗过程中,两组均未见明显不良反应/事件。结论:丁二磺酸腺苷蛋氨酸联合地塞米松治疗ICP能更有效缓解患者的皮肤瘙痒症状,改善肝功能,疗效显著,且安全性高。
Objective: To investigate the effect of SAMe combined with dexamethasone on hepatic function, serum level of tumor necrosis factor-α (TNF-α), interleukin-12 in patients with intrahepatic cholestasis of pregnancy (ICP) (IL-12) levels. Methods: A total of 86 patients with ICP who were admitted to our hospital from October 2014 to October 2016 were randomly divided into two groups according to random number table. The control group was treated with SAMe. The observation group was treated with dexamethasone on this basis. The pruritus scores, liver function indexes, serum TNF-α and IL-12 levels were compared between the two groups before and after treatment. The safety of the two groups was also evaluated. Results: The pruritus scores of both groups were significantly decreased after 7 days of treatment (P <0.01), and the improvement of pruritus after 7 days of treatment in the observation group was significantly better than that of the control group (P <0.01). Serum AST, ALT and TBA in both groups were significantly lower than those before treatment (P <0.01) after 7 days of treatment. Compared with the control group, the levels of serum AST, ALT, After d, the improvement of liver function indexes were more significant (P <0.01). Compared with those before treatment, the levels of serum TNF-α and IL-12 in both groups decreased significantly after 7 days of treatment (P <0.01), and the levels of serum proinflammatory cytokines improved significantly in the observation group after 7 days of treatment In the control group at the same period (P <0.01). During the course of treatment, no significant adverse events / events were seen in both groups. CONCLUSION: The combination of adenosine methionine butadione and dexamethasone can effectively relieve pruritus symptoms and improve liver function in patients with significant effect and safety.