熊去氧胆酸改善妊娠期肝内胆汁淤积症患者妊娠结局的Meta分析

Meta-analysis of Ursodeoxycholic Acid for Improving the Outcomes of Intrahepatic Cholestasis of Pregnancy

关键词:  熊去氧胆酸  妊娠期肝内胆汁淤积症  妊娠结局  meta分析

Key words:  ursodeoxycholic acid  intrahepatic cholestasis of pregnancy  pregnancy outcomes  meta-analysis

摘要:

目的 评价熊去氧胆酸对妊娠期肝内胆汁淤积症患者妊娠结局的影响。方法 检索Pubmed、Medline、中国期刊文献数据库、维普中文科技期刊全文数据库、万方数据库及中国生物医学文献数据库，纳入熊去氧胆酸治疗妊娠期肝内胆汁淤积症的随机对照临床试验（RCTs）研究文献并评价其质量，用Stata 12.0统计软件进行分析。结果 共纳入12个随机对照试验，包括664例妊娠期肝内胆汁淤积症患者。Meta分析结果显示：①熊去氧胆酸组在降低早产率[RR=0.49，95%CI=0.28~0.84，P=0.01]和胎儿窘迫发生率[RR=0.45，95%CI=0.20~0.99，P=0.04]方面优于S-腺苷基蛋氨酸组，在剖宫产率、羊水粪染率、5 min Apgar评分<7发生率人数及入住新生儿重症监护室发生率方面无显著性差异；②熊去氧胆酸组在降低早产率[RR=0.50，95%CI=0.34~0.73，P=0.000 1]、胎儿窘迫发生率[RR=0.52，95%CI=0.29~0.94，P=0.02]、5 min Apgar评分<7发生率人数[RR=0.26，95%CI=0.10~0.69，P=0.006]以及入住新生儿重症监护室发生率方面[RR=0.39，95%CI=0.17~0.88，P=0.02]优于安慰剂组，而在降低剖宫产率、羊水粪染率方面无显著性差异；③熊去氧胆酸组在降低早产率方面优于消胆胺组[RR=0.50，95%CI=0.27~0.94，P=0.03]；④熊去氧胆酸组与地塞米松组相比，各项指标均无显著性差异。结论 熊去氧胆酸对改善妊娠期肝内胆汁淤积症患者妊娠结局有一定的效果。

Abstract:

OBJECTIVE To evaluate the effects of ursodeoxycholic acid (UDCA) for pregnancy outcomes of intrahepatic cholestasis of pregnancy. METHODS The Pubmed, Medline, CNKI, VIP and Wan Fang databases were searched to retrieve randomized controlled trials assessing the pregnancy outcomes of UDCA versus control therapy in the treatment of ICP. Meta-analysis was performed by Stata 12.0. RESULTS Twelve studies involving 664 patients were included. The result of meta-analysis showed that:①UDCA was superior to s-adenosyl-methionine on the reduction in total prematurity[RR=0.49, 95%CI=0.28~0.84, P=0.01] and fetal distress[RR=0.45, 95%CI=0.20~0.99, P=0.04], but there was no significant difference in the presence of meconium, caesarean section rate, apgar score<7 at 5 min and hospitalization in neonatal intensive care unit. ②UDCA was superior to placebo on the reduction in total prematurity[RR=0.50, 95%CI=0.34~0.73, P=0.000 1], fetal distress[RR=0.52, 95%CI=0.29~0.94, P=0.02], apgar score<7 at 5 min[RR=0.26, 95%CI=0.10~0.69, P=0.006] and hospitalization in neonatal intensive care unit[RR=0.39, 95%CI=0.17~0.88, P=0.02], but there was no significant difference in the presence of meconium and caesarean section rate. ③UDCA was superior to cholestyramine on the reduction in total prematurity[RR=0.50, 95%CI=0.27~0.94, P=0.03]. ④There was no significant difference on improving the pregnancy outcomes between UDCA and dexamethasone. CONCLUSION UDCA is effective for improving the pregnancy outcomes.