Effects of dexamethasone-assisted ademetionine and ursodeoxycholic acid on pregnancy outcome and expression of serumthyroid peroxidase antibody and interleukin-12 in patients with intrahepatic cholestasis of pregnancy / 中国医师进修杂志

ABSTRACT

Objective:To investigate the effects of dexamethasone-assisted ademetionine and ursodeoxycholic acid on pregnancy outcome and serum thyroid peroxidase antibody (TPOAb) and interleukin-12 (IL-12) expressions in patients with intrahepatic cholestasis (ICP) during pregnancy.Methods:A prospective randomized controlled study of 80 patients with ICP in Pingyang Hospital Affiliated of Wenzhou Medical University from April 2017 to April 2020 was selected. The patients were divided into the observation group and the control group using random number table, with 40 cases in each group. On the basis of conventional treatment, the control group was given ademetionine and ursodeoxycholic acid, and the observation group was given dexamethasone-assisted ademetionine and ursodeoxycholic acid. All patients were treated for 1 week. The efficacy, time of disappearance of symptoms, maternal and infant outcomes and liver function indexes aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bile acid (TBA), immune function indexes immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin G (IgG), serum TPOAb and IL-12 levels before and after treatment were compared between the two groups.Results:After treatment, the total effective rate in the observation group was higher than that in the control group 95.0% (38/40) vs. 80.0%(32/40), the difference was statistically significant ( χ2 = 4.114, P<0.05). The disappearance time of jaundice and itching were shorter than those in the control group ( P<0.05). After treatment, the levels of serum AST, ALT, TBA, TPOAb, and IL-12 in the two groups were lower than before treatment, and the levels of above index in the observation group were lower than those in the control group (57.49 ± 11.45) U/L vs. (83.70 ± 13.57) U/L, (87.61 ± 29.03) U/L vs. (126.24 ± 33.28) U/L, (13.24 ± 5.48) μmol/L vs. (21.39 ± 7.20) μmol/L, (9.18 ± 2.41) kU/L vs. (12.97 ± 2.73) kU/L, (11.37 ± 2.05) ng/L vs. (18.26 ± 2.54) ng/L; the levels of serum IgM, IgA and IgG in two groups were higher than before treatment, the levels of above index in the observation group were higher than those in the control group (1.40 ± 0.09) g/L vs. (1.28 ± 0.11) g/L, (1.96 ± 0.14) g/L vs. (1.82 ± 0.12) g/L, (11.53 ± 2.80) g/L vs. (9.37 ± 2.59) g/L, the differences were statistically significant ( P<0.05). The incidence of cesarean section, premature delivery, postpartum hemorrhage, neonatal asphyxia, and intrauterine distress in the observation group were lower than those in the control group. Conclusions:Dexamethasone-assisted ademetionine and ursodeoxycholic acid treatment of ICP patients can improve liver function and immune function, reduce serum TPOAb and IL-12 levels, alleviate clinical symptoms and improve maternal and infant outcomes.