Early Diagnosis and Treatment of Intrahepatic Cholestasis of Pregnancy

Objective To investigate the changes in cholyglycine(CG)levels in intrahepatic cholestasis of pregnancy(ICP)and the factors inducing ICP,and to observe the effects of S-Adenosyl-L-methionine(SAMe)combined with ursodeoxycholic acid(UDCA)on ICP.Methods Sixty-two patients with ICP were randomly treated with UDCA alone(group N,n=31)or in combination with SAMe(group M,n=31)for 2weeks.Furthermore,all patients were given dexamethasone.In addition,31healthy pregnant women were selected as group A.The jaundice subsidence time and changes in pruritus score before and after treatment were compared between group M and group N.Levels of serum total bile acid(TBA),CG,alanine aminotransferase(ALT),aspart aminotransferase(AST),total bilirubin(T-BIL),direct bilirubin(D-BIL)and selenium(Se)were examined before and after treatment.Perinatal outcome,neonatal biochemical indexes and myocardial enzyme spectrum were measured in the three groups.Results The levels of serum Se in ICP patients were significantly lower than those in healthy pregnant women(P0.05).Compared with group A,serum levels of CG,TBA,ALT,AST,T-BIL and D-BIL significantly increased in both group M and group N(P0.05).The levels of CG,TBA,ALT,AST,T-BIL and D-BIL measured after treatment were significantly lower than those measured before treatment in ICP patients(P0.05),and the decrease in group M was more obvious than that in group N(P0.05).Moreover,compared with group N,pruritus score and jaundice subsidence time were significantly improved and fetal distress rate,premature birth rate,pruritus score,proportion of neonates with Apgar score≤7,neonatal asphyxia rate and stillbirth rate were significantly decreased in group M(P0.05).Conclusion The SAMe combined with UDCA can effectively relieve pruritus and jaundice and improve biochemical abnormalities and perinatal prognosis in patients with ICP.The monitoring of serum CG levels contributes to the early diagnosis and treatment of ICP.The decrease in serum Se levels may induce ICP.