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目的探讨中西医结合治疗对妊娠肝内胆汁淤积症(ICP)胎盘血管内皮生长因子(VEGF)表达的影响。方法2006年1月至2008年12月在暨南大学第二临床医学院对孕周≥28周,<37周的ICP孕妇48例,其中20例用地塞米松(西药组),28例用中药结合地塞米松治疗(中西药组),同期入院后即分娩的ICP孕妇24例为未治疗组,正常足月孕妇20例为对照组。对比西药组、中西药组治疗前后生化指标的变化。比较各组的围产儿结局。用免疫组化方法检测各组胎盘VEGF的表达水平。结果中西药组治疗后,总胆汁酸、甘氨胆酸及丙氨酸转氨酶均明显下降(P<0.05),中西药组和未治疗组羊水粪染、胎儿窘迫、早产儿发生率分别为7.1%、3.6%、10.7%,33.3%、29.2%、41.7%,两组差异有统计学意义(P<0.05);与西药组早产儿发生率40.0%比较有统计学意义(P<0.05)。西药组治疗后仅总胆汁酸有所下降,围产儿结局与未治疗组相比无统计学意义(P>0.05)。中西药组胎盘VEGF的表达水平为(3.41±0.58)分,明显高于西药组的(2.51±0.44)分和未治疗组的(2.28±0.66)分(P<0.05);但低于对照组的(4.16±0.92)分(P<0.05)。结论中西医结合治疗能明显降低ICP患者的生化指标,改善围产儿结局。在一定程度上提高ICP患者胎盘VEGF的表达水平,可能是其主要的治疗机制。
Objective To investigate the effect of integrated traditional Chinese and western medicine on placental vascular endothelial growth factor (VEGF) expression in intrahepatic cholestasis of pregnancy (ICP). METHODS: From January 2006 to December 2008, 48 pregnant women with gestational age≥28 weeks and <37 weeks were enrolled in the Second Clinical College of Jinan University from January 2006 to December 2008. Among them, 20 cases were treated with dexamethasone (western medicine group) and 28 cases were treated with traditional Chinese medicine Dexamethasone treatment (Chinese and Western medicine group), 24 cases of ICP pregnant women who delivered at the same period of hospitalization were untreated group, 20 cases of normal pregnant women as control group. Compare the changes of biochemical indexes before and after treatment in western medicine group and western medicine group. Perinatal outcomes were compared between groups. Immunohistochemistry was used to detect the expression of VEGF in placenta of each group. Results After treatment, the total bile acid, glycocholic acid and alanine aminotransferase were significantly decreased (P <0.05). The incidences of meconium-stained amniotic fluid, fetal distress and premature infants in Chinese and Western medicine groups were 7.1 %, 3.6%, 10.7%, 33.3%, 29.2% and 41.7%, respectively. The difference between the two groups was statistically significant (P <0.05). The incidence of premature infants in the western medicine group was 40.0% (P <0.05). Only the total bile acid decreased after treatment in the western medicine group, and the perinatal outcome was not statistically significant compared with the untreated group (P> 0.05). The expression of VEGF in the placenta of Chinese and Western medicine groups was (3.41 ± 0.58) points, which was significantly higher than that in the western medicine group (2.51 ± 0.44) and the untreated group (2.28 ± 0.66) points (P <0.05) (4.16 ± 0.92) points (P <0.05). Conclusion The combination of traditional Chinese and Western medicine can significantly reduce the biochemical indicators of ICP patients and improve perinatal outcome. To a certain extent, improve the expression of placental VEGF in ICP patients may be its main therapeutic mechanism.