Clinical Study On Intrahepatic Cholestasis Of Pregnancy Treated With UDCA And SAMe

Objectives①To evaluate the effect of Ursodeoxycholic acid (UDCA) and S-adenosy-L-methione(SAMe) to be alone and combine treated in intrahepatic cholestasis of pregnancy.②To investigate the the serum bile acids profile and the pregnancy outcomes of intrahepatic cholestasis of pregnancy (ICP) treated with Ursodeoxycholic acid (UDCA).Methods①A retrospective analysis was conducted on 45 cases of ICP admitted to our hospitaI from September 2009 to September 2010.To evaluate the efficacy of Ursodeoxycholic acid(UDCA) and S - adenosy - L - methione(SAMe) to be alone and combine in the treatment of intrahepatic cholestasis of pregnancy(ICP).All clinical data were retrieved,and clinical manifestations , biochemical indicators,mode of delivery, perinatal outcomes were assessed.②Seven types of serum bile acids were detected by high performance liquid chromatography-tandem mass spectrometry (HPLC—MS/MS) in the ICP prior treatment and treated with UDCA for four weeks. Bile acid concentrations were assessed in samples (26-32 weeks of gestation) from women with ICP (n=20) and normal pregnant women (n=15).Results①45 cases of ICP had been chosen and randomly divided into three groups.After two and four weeks, treated with combination of SAMe and UDCA acid group (n=15),have a significant improvement in TBA,ALT,AST,TBIL and DBIL(P<0.01),between the groups of treated with UDCA and SAMe alone have significant differences.In receiving UDCA group (n=15)comparing with another two groups have significant improvement in CG(P<0.01).After four weeks, three groups were no significant differences in average gestations(P>0.05).The preterm birth rate and neonatal asphyxia rate in the combined group were lower than the other groups.(P<0.01).Three groups were no significant differences in cesarean section rate(P>0.05).②ICP was associated with predominant increased abnormal liver function test. After four weeks treatment with UDCA, serum ALT,AST,TBIL and DBIL levels of the patients with ICP were significantly decreased (P<0.01);The serum levels of Cholic acid(CA), Glycocholic acid(GCA), taurocholic acid(TCA),taurolithocholic acid(TLCA) and lithocholic acid(LCA) in the ICP group were significantly higher than the control group (P<0.05);The serum levels of cholic acid (CA),glycocholic acid (GCA),taurolithocholic acid (TLCA) and taurocholic acid(TCA) in the ICP group after treated with UDCA were significantly lower than ICP group before treated with UDCA (P<0.05), while serum UDCA level was significantly higher than ICP group before treated with UDCA (P<0.05);The incidence of amniotic fluid meconium staining in the ICP group treated with UDCA was higher than the control group (P<0.05).There were no differences in the premature delivery rate and Apgar score≤7 between the ICP group treated with UDCA and the control group.Concluslons①UDCA combined with SAMe exerts definite therapeutic effect on patients with intrahepatic cholestasis of pregnancy.The prognosis of their fetus and biochemical indicators can be improved.②The serum bile acids profiles of intrahepatic cholestasis of pregnancy decreased after UDCA treatment, especially CA,GCA,TCA and TLCA.