S-腺苷蛋氨酸改善妊娠肝內膽汁淤積癥患者妊娠結局的評價_《中國循證醫學雜志》

作者：

王濤 ¹ , 劉淑蕓 ¹ , 許良智 ¹² , 邢愛耘 ¹ , 劉關鍵 ²

1. 四川大學華西婦女兒童醫院婦產科,成都,6100412. 四川大學華西醫院,中國循證醫學中心,成都,610041;

關鍵詞：

S-腺苷蛋氨酸妊娠肝內膽汁淤積癥系統評價

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目的　評價S-腺苷蛋氨酸改善妊娠肝內膽汁淤積癥患者妊娠結局的作用.
方法　計算機檢索MEDLINE、EMBASE、中國循證醫學數據庫/Cochrane中心數據庫(CEBM/CCD)、Cochrane圖書館(2003年4期)、中國醫院數字圖書館和中國數字化期刊萬方數據庫,手工檢索有關S-腺苷蛋氨酸治療妊娠肝內膽汁淤積癥的中英文隨機和半隨機臨床對照試驗,檢索截止時間為2003年12月.在嚴格質量評價的基礎上,利用RevMan 4.2 軟件進行Meta分析.
結果　共檢索到符合納入標準的文獻8篇,包括隨機對照試驗2篇,半隨機對照試驗6篇,共有研究對象424例.所有納入研究的方法學質量均不高.Meta分析結果顯示,S-腺苷蛋氨酸改善妊娠肝內膽汁淤積癥患者妊娠結局的作用如下:①降低剖宮產率:與安慰劑比較差異無統計學意義[OR=1.00, 95%CI (0.23, 4.33),P=1.00];與地塞米松組及強力寧比較差異有統計學意義,其OR(95%CI)和P值分別為0.44(0.23,0.85),P= 0.01; 0.28 (0.10, 0.75), P=0.01).②延長孕周:與安慰劑比較差異無統計學意義[WMD=0.70,95%CI(=-0.69, 2.10), P=0.32];而與地塞米松、強力寧、肝益靈相比差異有統計學意義,其WMD(95%CI)值和P值分別為1.10 (0.46,1.74), P=0.000 07; 2.50 (1.86,3.14), P≤ 0.000 01; 2.20(1.61,2.79), P≤0.000 01.③增加新生兒體重:與安慰劑比較差異無統計學意義[WMD=-26.27,95%CI(=-338.35,285.82), P=0.87];與地塞米松及苦黃注射液比較差異有統計學意義,其WMD(95%CI)和P值分別為386.86 (134.41,603.31), P=0.02;410.00(321.10,498.90), P≤0.000 01.④胎兒宮內窘迫:與地塞米松和苦黃注射液比較差異無統計學意義,其OR(95%CI)和P值分別為0.47(0.14,1.16),P =0.23;0.44,(0.10,1.97),P =0.29. ⑤降低羊水糞染的發生率:與地塞米松、熊去氧膽酸和苦黃注射液相比差異無統計學意義,其OR(95%CI)和P值分別為0.46(0.21,1.02),P=0.06;0.68(0.20,2.31),P=0.53;0.82(0.24,2.81),P=0.75.⑥新生兒窒息:與地塞米松、苦黃注射液比較差異無統計學意義,其OR(95%CI)和P值分別為0.19 (0.01,4.06),P=0.29和 0.31(0.08,1.13),P=0.08;而與強力寧比較則差異有統計學意義[OR=0.09, 95%CI(0.02,0.42),P=0.002].⑦新生兒Apgar評分:與安慰劑、地塞米松和熊去氧膽酸比較差異無統計學意義,其OR(95%CI)值分別為0.25(0.02,3.04),P=0.28; 2.09(0.70,6.27),P=0.19;1.22 (0.35,4.19),P=0.75.8篇文獻中有 6篇文獻提到了S-腺苷蛋氨酸治療妊娠肝內膽汁淤積癥是否有副作用,其中1篇報道有輕微的胃腸道反應.
結論　S-腺苷蛋氨酸用于治療妊娠肝內膽汁淤積癥可以改善某些妊娠結局,如降低剖宮產率、延長孕周、增加新生兒體重等.但其確切的療效和安全性尚不能肯定,還需要大樣本、高質量的隨機對照試驗加以證實.

引用本文： 王濤,劉淑蕓,許良智,邢愛耘,劉關鍵. S-腺苷蛋氨酸改善妊娠肝內膽汁淤積癥患者妊娠結局的評價. 中國循證醫學雜志, 2005, 05(2): 130-135. doi: 復制

1.	曹澤毅. 《中華婦產科學》[M]. 第1版, 北京: 人民衛生出版社, 1999. p. 500～507.
2.	艾英, 劉淑蕓. 妊娠期肝內膽汁淤積癥的藥物治療[J]. 中國實用婦科與產科雜志, 2002;18(1): 55～56.
3.	王家良, 劉鳴. 循征醫學[M]. 北京: 人民衛生出版社, 2001. p. 177～188.
4.	譚友文, 莊紅仙. 腺苷蛋氨酸對妊娠肝內膽汁淤積癥的臨床觀察[J]. 中國實用婦科與產科雜志, 2001;17(6): 343～345.
5.	周曉宇, 趙蔚, 朱仲建. 思美泰治療妊娠肝內膽汁淤積癥的療效觀察[J]. 浙江臨床醫學, 2002;4(1): 51～52.
6.	李珉. 思美泰治療妊娠肝內膽汁淤積癥30例療效觀察[J]. 蘇州大學學報(醫學版), 2003;23(3): 366～367.
7.	王亞兒, 陳麗萍. 思美泰治療妊娠肝內膽汁淤積癥[J]. 現代實用醫學, 2003;15(6): 379～380.
8.	徐春佳, 陳曉蕓. 思美泰聯合地塞米松治療妊娠肝內膽汁淤積癥的臨床觀察[J]. 貴州醫藥, 2003;27(2): 118～119.
9.	馬健婷. 腺苷蛋氨酸聯合熊去氧膽酸治療妊娠肝內膽汁淤積癥21例[J]. 臨床醫藥, 2003;12(6):64～65.
10.	Cao ZY. Chinese Obstetrics and Gynecology[M]. 1st edition. Beijing:People,medical publishing house, 1999. p. 500-507.
11.	Ai Y, Liu SY. The medicines in treatment of Intrahepatic cholestasis of pregnancy[J]. Journal of Chinese Practical Obsterics and Gynecology, 2002;18(1): 55-56.
12.	Wang JL, Liu M. Evidence-Based Medicine[M]. Beijing: People,medical publishing house, 2001. p. 177-188.
13.	Jadad AR, Moore A, Carroll D. Assessing the quality of reports of randomized clinical trials: Is blinding necessary[J]. Control Clinical Trials, 1996;17(1): 1-12 .
14.	Bonessio L, Ciardo A, Spina V, Morini A. Intrahepatic cholestasis in pregnancy[J]. Clin Ter, 1996;147(7-8): 377-384.
15.	Ribalta J, Reyes H, Gonzalez MC. S-adenosyl-L-methionine in the treatment of patients with intrahepatic cholestasis of pregnancy: a randomized, double-blind, placebo-controlled study with negative results[J]. Hepatology, 1991;13(6): 1 084-1 089.
16.	Frezza M, Pozzato G, Chiesa L. Reversal of intrahepatic cholestasis of pregnancy in women after high dose S-adenosyl-L-methionine administration[J]. Hepatology, 1984;4(2): 274-278.
17.	Floreani A, Paternoster D, Melis A, Grella PV. S-adenosyl-l-methionine versus ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: preliminary results of a controlled trial[J]. Eur J Obstet Gynecol Reprod Biol,1996 ;67(2):109-113.
18.	Frezza M, Tritapepe R, Pozzato G, Di Padova C. Prevention of S-adenosyl-l-methionine of estrogen-induced hepatobiliary toxicity in susceptible women[J]. Am J Gastroenterol,1988;83(10): 1 098-1 102.
19.	Nicastri PL, Diaferia A, Tartagni M, Loizzi P, Fanelli M. A randomised placebo-controlled trial of ursodeoxycholic acid and S-adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy[J]. Br J Obstet Gynaecol, 1998 ;105(11): 1 205-1 207.
20.	Frezza M, Surrenti C, Manzillo G, Fiaccadori F, Bortolini M, Di Padova C. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study[J]. Gastroenterology, 1990;99(1): 211-215.
21.	Almasio P, Bortolini M, Pagliaro L, Coltorti M. Role of S-adenosyl-L-methionine in the treatment of intrahepatic cholestasis[J]. Drugs,1990;40 (Suppl 3): 111-123.
22.	Tan XW, Zhuang XH. The clinical observation of s-adenosyl-L-methionine for Intrahepatic cholestasis of pregnancy[J]. Journal of Chinese Practical Obsterics and Gynecology, 2001;17(6): 343-345.
23.	Zhou XY ,Zhang W, Zhu ZJ. The clinical efficacy of s-adenosyl-L-methionine for the treatment of Intrahepatic cholestasis of pregnancy[J]. Zhejiang Clinical Medicine Journal, 2002;4(1): 51-52.
24.	Li M. The clinical efficacy of s-adenosyl-L-methionine Therapy in the 30 cases of intrahepatic cholestasis of pregnancy[J]. Journal of Suzhou University(Medicine Journal), 2003;23(3): 366-367.
25.	Wang YE, Chen LP. s-adenosyl-L-methionine in treatment of Intrahepatic cholestasis of pregnancy[J]. Journal of Modern Medicine, 2003;15(6): 379-380.
26.	Xu CJ, Chen XY. The clinical observation of S-adenosyl-L-methionine combinated with dexamethasone for the treatment of Intrahepatic cholestasis of pregnancy[J]. Guizhou Medicine Journal, 2003;27(2): 118-119.
27.	Ma JT. The clinical efficacy of s-adenosyl-L-methionine combinated with ursoddeoxycholic Therapy in the 21 cases of Intrahepatic cholestasis of pregnancy[J]. Journal of Clinical Medicine, 2003;12(6): 64-65.

1. 曹澤毅. 《中華婦產科學》[M]. 第1版, 北京: 人民衛生出版社, 1999. p. 500～507.
2. 艾英, 劉淑蕓. 妊娠期肝內膽汁淤積癥的藥物治療[J]. 中國實用婦科與產科雜志, 2002;18(1): 55～56.
3. 王家良, 劉鳴. 循征醫學[M]. 北京: 人民衛生出版社, 2001. p. 177～188.
4. 譚友文, 莊紅仙. 腺苷蛋氨酸對妊娠肝內膽汁淤積癥的臨床觀察[J]. 中國實用婦科與產科雜志, 2001;17(6): 343～345.
5. 周曉宇, 趙蔚, 朱仲建. 思美泰治療妊娠肝內膽汁淤積癥的療效觀察[J]. 浙江臨床醫學, 2002;4(1): 51～52.
6. 李珉. 思美泰治療妊娠肝內膽汁淤積癥30例療效觀察[J]. 蘇州大學學報(醫學版), 2003;23(3): 366～367.
7. 王亞兒, 陳麗萍. 思美泰治療妊娠肝內膽汁淤積癥[J]. 現代實用醫學, 2003;15(6): 379～380.
8. 徐春佳, 陳曉蕓. 思美泰聯合地塞米松治療妊娠肝內膽汁淤積癥的臨床觀察[J]. 貴州醫藥, 2003;27(2): 118～119.
9. 馬健婷. 腺苷蛋氨酸聯合熊去氧膽酸治療妊娠肝內膽汁淤積癥21例[J]. 臨床醫藥, 2003;12(6):64～65.
10. Cao ZY. Chinese Obstetrics and Gynecology[M]. 1st edition. Beijing:People,medical publishing house, 1999. p. 500-507.
11. Ai Y, Liu SY. The medicines in treatment of Intrahepatic cholestasis of pregnancy[J]. Journal of Chinese Practical Obsterics and Gynecology, 2002;18(1): 55-56.
12. Wang JL, Liu M. Evidence-Based Medicine[M]. Beijing: People,medical publishing house, 2001. p. 177-188.
13. Jadad AR, Moore A, Carroll D. Assessing the quality of reports of randomized clinical trials: Is blinding necessary[J]. Control Clinical Trials, 1996;17(1): 1-12 .
14. Bonessio L, Ciardo A, Spina V, Morini A. Intrahepatic cholestasis in pregnancy[J]. Clin Ter, 1996;147(7-8): 377-384.
15. Ribalta J, Reyes H, Gonzalez MC. S-adenosyl-L-methionine in the treatment of patients with intrahepatic cholestasis of pregnancy: a randomized, double-blind, placebo-controlled study with negative results[J]. Hepatology, 1991;13(6): 1 084-1 089.
16. Frezza M, Pozzato G, Chiesa L. Reversal of intrahepatic cholestasis of pregnancy in women after high dose S-adenosyl-L-methionine administration[J]. Hepatology, 1984;4(2): 274-278.
17. Floreani A, Paternoster D, Melis A, Grella PV. S-adenosyl-l-methionine versus ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: preliminary results of a controlled trial[J]. Eur J Obstet Gynecol Reprod Biol,1996 ;67(2):109-113.
18. Frezza M, Tritapepe R, Pozzato G, Di Padova C. Prevention of S-adenosyl-l-methionine of estrogen-induced hepatobiliary toxicity in susceptible women[J]. Am J Gastroenterol,1988;83(10): 1 098-1 102.
19. Nicastri PL, Diaferia A, Tartagni M, Loizzi P, Fanelli M. A randomised placebo-controlled trial of ursodeoxycholic acid and S-adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy[J]. Br J Obstet Gynaecol, 1998 ;105(11): 1 205-1 207.
20. Frezza M, Surrenti C, Manzillo G, Fiaccadori F, Bortolini M, Di Padova C. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study[J]. Gastroenterology, 1990;99(1): 211-215.
21. Almasio P, Bortolini M, Pagliaro L, Coltorti M. Role of S-adenosyl-L-methionine in the treatment of intrahepatic cholestasis[J]. Drugs,1990;40 (Suppl 3): 111-123.
22. Tan XW, Zhuang XH. The clinical observation of s-adenosyl-L-methionine for Intrahepatic cholestasis of pregnancy[J]. Journal of Chinese Practical Obsterics and Gynecology, 2001;17(6): 343-345.
23. Zhou XY ,Zhang W, Zhu ZJ. The clinical efficacy of s-adenosyl-L-methionine for the treatment of Intrahepatic cholestasis of pregnancy[J]. Zhejiang Clinical Medicine Journal, 2002;4(1): 51-52.
24. Li M. The clinical efficacy of s-adenosyl-L-methionine Therapy in the 30 cases of intrahepatic cholestasis of pregnancy[J]. Journal of Suzhou University(Medicine Journal), 2003;23(3): 366-367.
25. Wang YE, Chen LP. s-adenosyl-L-methionine in treatment of Intrahepatic cholestasis of pregnancy[J]. Journal of Modern Medicine, 2003;15(6): 379-380.
26. Xu CJ, Chen XY. The clinical observation of S-adenosyl-L-methionine combinated with dexamethasone for the treatment of Intrahepatic cholestasis of pregnancy[J]. Guizhou Medicine Journal, 2003;27(2): 118-119.
27. Ma JT. The clinical efficacy of s-adenosyl-L-methionine combinated with ursoddeoxycholic Therapy in the 21 cases of Intrahepatic cholestasis of pregnancy[J]. Journal of Clinical Medicine, 2003;12(6): 64-65.

《中國循證醫學雜志》

S-腺苷蛋氨酸改善妊娠肝內膽汁淤積癥患者妊娠結局的評價

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《中國循證醫學雜志》

S-腺苷蛋氨酸改善妊娠肝內膽汁淤積癥患者妊娠結局的評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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