中西医联合治疗妊娠期肝内胆汁淤积症的临床疗效及其对 Th17／Treg 平衡的影响

摘要

Objective To investigate the clinical efficacy of oriental virgate wormwood decoction in combination with S-adenosyl methionine in treating intrahepatic cholestasis of pregnancy (ICP)and evaluate the influence on Th17 /Treg balance.Methods Forty ICP patients were randomly divided into the integrated Western and Traditional Chinese medicine (group A,n =20)and the Western medicine groups (group B,n =20).In the group A,patients were treated with oriental virgate wormwood decoction plus S-adenosyl methio-nine and those in the group B received S-adenosyl methionine alone.Another 20 healthy pregnant women were chosen as normal controls (group C).The pruritus score and liver function before and after treatment were ob-served in the groups A and B.Changes in the levels of Th17 /Treg-related cytokines,such as IL-17 and TGF-βand pregnant outcomes were statistically compared among three groups.Results After treatment,the pruri-tus score,bile acid,ALT and AST in the group A were significantly lower than those in the group B (all P <0.05).With respect to pregnant outcomes,the premature birth rate,neonatal asphyxia rate and neonatal weight did not significantly differ among three groups (all P >0.05).In groups A and B,IL-17 of peripheral blood was significantly higher whereas the level of TGF-βwere considerably lower compared with those in the control group (both P <0.05).Compared with group B,more significant IL-17 decrease and TGF-βincrease were noted in the group A (both P <0.05).Conclusions Oriental virgate wormwood decoction combined with S-adenosyl methionine is highly efficacious in treating ICP,probably due to the mechanism by alleviating Th17 /Treg ratio imbalance.%目的：探讨茵陈蒿汤联合丁二磺酸腺苷蛋氨酸治疗妊娠期肝内胆汁淤积症（ICP）的临床疗效及其对辅助性 T 细胞17（Th17）／调节性 T 细胞（Treg）平衡的影响。方法选择40例 ICP患者，随机分为中西医联合治疗组（A 组）和单纯西医治疗组（B 组）各20例，B 组单纯给予丁二磺酸腺苷蛋氨酸治疗，A 组在 B 组基础上联合茵陈蒿汤治疗，另选择20名健康孕妇作健康对照组（C 组）。观察 A、B 组 ICP 患者在治疗前、后的瘙痒评分、肝功能，比较 A、B、C 组 Th17／Treg 相关细胞因子 IL-17、TGF-β的变化及妊娠结局。结果治疗后，A 组 ICP 患者瘙痒评分、胆汁酸、ALT、AST 均低于 B 组（P 均＜0．05）；在妊娠结局方面，3组的早产率、新生儿窒息率及新生儿体质量比较差异均无统计学意义（P 均＞0．05）。A、B 组 ICP 患者外周血 IL-17水平均明显高于健康对照组， TGF-β水平均低于健康对照组（P 均＜0．05）；与 B 组相比，治疗后 A 组 IL-17降低及 TGF-β升高更加明显（P 均＜0．05）。结论茵陈蒿汤联合丁二磺酸腺苷蛋氨酸治疗 ICP 疗效显著，其机制可能与改善 Th17／Treg 失衡状态有关。