• 1. 四川大學(xué)華西婦女兒童醫(yī)院婦產(chǎn)科,成都,6100412. 四川大學(xué)華西醫(yī)院,中國循證醫(yī)學(xué)中心,成都,610041;

目的 　評(píng)價(jià)S-腺苷蛋氨酸改善妊娠肝內(nèi)膽汁淤積癥患者妊娠結(jié)局的作用.
方法 　計(jì)算機(jī)檢索MEDLINE、EMBASE、中國循證醫(yī)學(xué)數(shù)據(jù)庫/Cochrane中心數(shù)據(jù)庫(CEBM/CCD)、Cochrane圖書館(2003年4期)、中國醫(yī)院數(shù)字圖書館和中國數(shù)字化期刊萬方數(shù)據(jù)庫,手工檢索有關(guān)S-腺苷蛋氨酸治療妊娠肝內(nèi)膽汁淤積癥的中英文隨機(jī)和半隨機(jī)臨床對(duì)照試驗(yàn),檢索截止時(shí)間為2003年12月.在嚴(yán)格質(zhì)量評(píng)價(jià)的基礎(chǔ)上,利用RevMan 4.2 軟件進(jìn)行Meta分析.
結(jié)果 　共檢索到符合納入標(biāo)準(zhǔn)的文獻(xiàn)8篇,包括隨機(jī)對(duì)照試驗(yàn)2篇,半隨機(jī)對(duì)照試驗(yàn)6篇,共有研究對(duì)象424例.所有納入研究的方法學(xué)質(zhì)量均不高.Meta分析結(jié)果顯示,S-腺苷蛋氨酸改善妊娠肝內(nèi)膽汁淤積癥患者妊娠結(jié)局的作用如下:①降低剖宮產(chǎn)率:與安慰劑比較差異無統(tǒng)計(jì)學(xué)意義[OR=1.00, 95%CI (0.23, 4.33),P=1.00];與地塞米松組及強(qiáng)力寧比較差異有統(tǒng)計(jì)學(xué)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(tǒng)計(jì)學(xué)意義[WMD=0.70,95%CI(=-0.69, 2.10), P=0.32];而與地塞米松、強(qiáng)力寧、肝益靈相比差異有統(tǒng)計(jì)學(xué)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(tǒng)計(jì)學(xué)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(tǒng)計(jì)學(xué)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(nèi)窘迫:與地塞米松和苦黃注射液比較差異無統(tǒng)計(jì)學(xué)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(fā)生率:與地塞米松、熊去氧膽酸和苦黃注射液相比差異無統(tǒng)計(jì)學(xué)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(tǒng)計(jì)學(xué)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(qiáng)力寧比較則差異有統(tǒng)計(jì)學(xué)意義[OR=0.09, 95%CI(0.02,0.42),P=0.002].⑦新生兒Apgar評(píng)分:與安慰劑、地塞米松和熊去氧膽酸比較差異無統(tǒng)計(jì)學(xué)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(xiàn)中有 6篇文獻(xiàn)提到了S-腺苷蛋氨酸治療妊娠肝內(nèi)膽汁淤積癥是否有副作用,其中1篇報(bào)道有輕微的胃腸道反應(yīng).
結(jié)論 　S-腺苷蛋氨酸用于治療妊娠肝內(nèi)膽汁淤積癥可以改善某些妊娠結(jié)局,如降低剖宮產(chǎn)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(zhì)量的隨機(jī)對(duì)照試驗(yàn)加以證實(shí).

引用本文： 王 濤,劉淑蕓,許良智,邢愛耘,劉關(guān)鍵. S-腺苷蛋氨酸改善妊娠肝內(nèi)膽汁淤積癥患者妊娠結(jié)局的評(píng)價(jià). 中國循證醫(yī)學(xué)雜志, 2005, 05(2): 130-135. doi: 復(fù)制

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國循證醫(yī)學(xué)雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

1. 曹澤毅. 《中華婦產(chǎn)科學(xué)》[M]. 第1版, 北京: 人民衛(wèi)生出版社, 1999. p. 500～507.
2. 艾英, 劉淑蕓. 妊娠期肝內(nèi)膽汁淤積癥的藥物治療[J]. 中國實(shí)用婦科與產(chǎn)科雜志, 2002;18(1): 55～56.
3. 王家良, 劉鳴. 循征醫(yī)學(xué)[M]. 北京: 人民衛(wèi)生出版社, 2001. p. 177～188.
4. 譚友文, 莊紅仙. 腺苷蛋氨酸對(duì)妊娠肝內(nèi)膽汁淤積癥的臨床觀察[J]. 中國實(shí)用婦科與產(chǎn)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(nèi)膽汁淤積癥的療效觀察[J]. 浙江臨床醫(yī)學(xué), 2002;4(1): 51～52.
6. 李珉. 思美泰治療妊娠肝內(nèi)膽汁淤積癥30例療效觀察[J]. 蘇州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2003;23(3): 366～367.
7. 王亞兒, 陳麗萍. 思美泰治療妊娠肝內(nèi)膽汁淤積癥[J]. 現(xiàn)代實(shí)用醫(yī)學(xué), 2003;15(6): 379～380.
8. 徐春佳, 陳曉蕓. 思美泰聯(lián)合地塞米松治療妊娠肝內(nèi)膽汁淤積癥的臨床觀察[J]. 貴州醫(yī)藥, 2003;27(2): 118～119.
9. 馬健婷. 腺苷蛋氨酸聯(lián)合熊去氧膽酸治療妊娠肝內(nèi)膽汁淤積癥21例[J]. 臨床醫(yī)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. 1. 曹澤毅. 《中華婦產(chǎn)科學(xué)》[M]. 第1版, 北京: 人民衛(wèi)生出版社, 1999. p. 500～507.
  2. 2. 艾英, 劉淑蕓. 妊娠期肝內(nèi)膽汁淤積癥的藥物治療[J]. 中國實(shí)用婦科與產(chǎn)科雜志, 2002;18(1): 55～56.
  3. 3. 王家良, 劉鳴. 循征醫(yī)學(xué)[M]. 北京: 人民衛(wèi)生出版社, 2001. p. 177～188.
  4. 4. 譚友文, 莊紅仙. 腺苷蛋氨酸對(duì)妊娠肝內(nèi)膽汁淤積癥的臨床觀察[J]. 中國實(shí)用婦科與產(chǎn)科雜志, 2001;17(6): 343～345.
  5. 5. 周曉宇, 趙蔚, 朱仲建. 思美泰治療妊娠肝內(nèi)膽汁淤積癥的療效觀察[J]. 浙江臨床醫(yī)學(xué), 2002;4(1): 51～52.
  6. 6. 李珉. 思美泰治療妊娠肝內(nèi)膽汁淤積癥30例療效觀察[J]. 蘇州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2003;23(3): 366～367.
  7. 7. 王亞兒, 陳麗萍. 思美泰治療妊娠肝內(nèi)膽汁淤積癥[J]. 現(xiàn)代實(shí)用醫(yī)學(xué), 2003;15(6): 379～380.
  8. 8. 徐春佳, 陳曉蕓. 思美泰聯(lián)合地塞米松治療妊娠肝內(nèi)膽汁淤積癥的臨床觀察[J]. 貴州醫(yī)藥, 2003;27(2): 118～119.
  9. 9. 馬健婷. 腺苷蛋氨酸聯(lián)合熊去氧膽酸治療妊娠肝內(nèi)膽汁淤積癥21例[J]. 臨床醫(yī)藥, 2003;12(6):64～65.
  10. 10. Cao ZY. Chinese Obstetrics and Gynecology[M]. 1st edition. Beijing:People,medical publishing house, 1999. p. 500-507.
  11. 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. 12. Wang JL, Liu M. Evidence-Based Medicine[M]. Beijing: People,medical publishing house, 2001. p. 177-188.
  13. 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. 14. Bonessio L, Ciardo A, Spina V, Morini A. Intrahepatic cholestasis in pregnancy[J]. Clin Ter, 1996;147(7-8): 377-384.
  15. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.