Systematically Review The Effects Of Ursodeoxycholic Acid Conbined With S-adenosyl-l-methionine On Intrahepatic Cholestasis Of Pregnancy

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.