S-adenosy-L-methionine Combined with Ursodesoxycholic Acid in Treatment of Intrahepatic Cholestasis of Pregnancy: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 CHENHong , ZHANGJu-fang ,  ZHUQi-ying

Obstetrical Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China;

Corresponding?author：

ZHUQi-ying, Email: zhuqiyingxq@sina.com

Keywords：

S-adenosy-L-methionine; Ursodesoxycholic acid; Intrahepatic cholestasis of pregnancy; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140163

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the clinical efficacy and effects on pregnancy outcomes of S-adenosy-L-methionine combined with ursodesoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. Methods Databases such as PubMed, The Cochrane Library, CNKI, VIP, WanFang Data were searched for the studies about the clinical efficacy and effects on pregnancy outcomes of S-adenosy-L-methionine combined with ursodesoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy up to December 31^st, 2013. Two reviewers independently screened literature, extracted data and evaluated methodological quality. Then meta-analysis was conducted using RevMan 5.0.24 software. Results A total of 11 RCTs involving 776 patients were included. The results of meta-analysis showed that, combined medication reduced blood biochemical indexes inlcuding ALT (MD=3.63, 95%CI 0.63 to 6.64, P=0.02), TB (MD=3.70, 95%CI 1.45 to 5.96, P=0.001), and AST (MD=7.61, 95%CI 2.47 to 12.75, P=0.004). Combined therapy significantly decreased the rates of amniotic fluid contamination (OR=0.29, 95%CI 0.19 to 0.45, P=0.000 01), cesarean section (OR=0.53, 95%CI 0.36 to 0.79, P=0.002), postpartum hemorrhage (OR=0.32, 95%CI 0.12 to 0.90, P=0.03), preterm birth (OR=0.36, 95%CI 0.24 to 0.55, P < 0.000 01), fetal distress (OR=0.33, 95%CI 0.19 to 0.58, P=0.000 1) and neonates asphyxia (OR=0.30, 95%CI 0.19 to 0.47, P < 0.000 01). Combined therapy was also beneficial to improving pruritus symptoms (MD=0.20, 95%CI 0.08 to 0.31, P=0.000 08) and benefiting fetus growth (MD=0.45, 95%CI 0.23 to 0.66, P < 0.000 1). Conclusion The combination of S-adenosy-L-methionine and ursodesoxycholic acid is superior to ursodesoxycholic acid alone in improving clinical symptoms and pregnant outcomes of patients with intrahepatic cholestasis of pregnancy.

Citation： CHENHong, ZHANGJu-fang, ZHUQi-ying. S-adenosy-L-methionine Combined with Ursodesoxycholic Acid in Treatment of Intrahepatic Cholestasis of Pregnancy: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(8): 991-998. doi: 10.7507/1672-2531.20140163 Copy

1.	?樂杰, 主編.婦產科學.第7版.北京:人民衛生出版社, 2008: 105-110.
2.	曹澤毅, 主編.中華婦產科學(上冊).北京:人民衛生出版社, 1999: 500-501.
3.	Ribalta J, Reyes H, Gonazfez MC, et al. S-adeno syl-L-methionine in the treatment of patients with in trahepatic cholestsis of pregnancy: a randomized double-blind, placeb-ontrolled study with negative results. Hepatology, 1991, 13(6): 1084-1089.
4.	朱芬芳, 彭美麗. S-腺苷蛋氨酸聯合熊去氧膽酸治療妊娠期肝內膽汁淤積癥的療效觀察.海峽藥學, 2009, 5(21): 119-120.
5.	程志霞, 郭靖.妊娠期肝內膽汁淤積癥治療的臨床分析.中國婦幼健康研究, 2008, 2(19): 124-126.
6.	駱東輝.思美泰聯合熊去氧膽酸治療妊娠期肝內膽汁淤積癥療效觀察.現代中西醫結合雜志, 2008, 17(7): 1011-1012.
7.	程明宇.思美泰聯合熊去氧膽酸治療妊娠期肝內膽汁淤積癥40例療效分析.江西醫學院學報, 2009, 6(49): 103-106.
8.	冉建淑.思美泰聯合熊去氧膽酸治療重度ICP的療效觀察.齊齊哈爾醫學院學報, 2011, 22(32): 3628-3631.
9.	王曉紅, 李芳, 校勤, 等.腺苷蛋氨酸在妊娠期肝內膽汁淤積癥治療中的應用.陜西醫學雜志, 2008, 2(37): 215-216.
10.	劉銳.重度妊娠期肝內膽汁淤積癥的臨床療效觀察.醫學信息, 2013, 26(12): 49.
11.	李曉輝. S-腺苷蛋氨酸和熊去氧膽酸及兩藥聯合治療妊娠期肝內膽汁淤積癥的療效比較.西南軍醫, 2011, 6(13): 1065-1066.
12.	馮玲, 喬福元.三種方案治療妊娠期肝內膽汁淤積癥的療效比較.中國婦幼保健, 2004, 19(19): 49-50.
13.	李麗, 汪光慧.思美泰聯合熊去氧膽酸治療妊娠期肝內膽汁淤積癥的療效觀察.安徽醫學, 2009, 10(30): 1141-1143.
14.	馬建婷.腺苷蛋氨酸聯合熊去氧膽酸治療妊娠期肝內膽汁淤積癥的臨床研究.中國全科醫學, 2004, 6(7): 384-386.
15.	劉淑蕓.妊娠期肝內膽汁淤積癥的發病原因.實用婦產科學雜志, 2002, 18(1): 4-5.
16.	Sopulvedawh, Gonzalez C, Cruzma, et al. Vasocontric-tive effect of bile acids on isolated human placental chorionic veins. Eur J Obstet Gynecol Reprod Biol, 2001, 42 (3): 211-215.
17.	Kraus MR, Scheurlen M. Diagnosis and treatment of intrahepatic cholestasis syndrome. MMW Fortschr Med, 2004, 146(23): 34-37.
18.	艾瑛, 劉淑蕓.妊娠期肝內膽汁淤積癥的藥物治療.中國實用婦科與產科雜志, 2002, 18(1): 55-56.
19.	王濤, 劉淑蕓, 許良智, 等. 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, 5(2): 130-156.
20.	Kondrackiene J, Beuers U, Kupcinskas L, et al. Efficacy and safety of ursodeoxycholic acid versus cholestyramine in intrahepatic cholestasis of pregnancy. Gastroenterology, 2005, 129(3): 894-901.
21.	Pusl T, Beuers U. Intrahepatic cholestasis of pregnancy. Orphanet J Rare Dis, 2007, 29(2): 26.

1. ?樂杰, 主編.婦產科學.第7版.北京:人民衛生出版社, 2008: 105-110.
2. 曹澤毅, 主編.中華婦產科學(上冊).北京:人民衛生出版社, 1999: 500-501.
3. Ribalta J, Reyes H, Gonazfez MC, et al. S-adeno syl-L-methionine in the treatment of patients with in trahepatic cholestsis of pregnancy: a randomized double-blind, placeb-ontrolled study with negative results. Hepatology, 1991, 13(6): 1084-1089.
4. 朱芬芳, 彭美麗. S-腺苷蛋氨酸聯合熊去氧膽酸治療妊娠期肝內膽汁淤積癥的療效觀察.海峽藥學, 2009, 5(21): 119-120.
5. 程志霞, 郭靖.妊娠期肝內膽汁淤積癥治療的臨床分析.中國婦幼健康研究, 2008, 2(19): 124-126.
6. 駱東輝.思美泰聯合熊去氧膽酸治療妊娠期肝內膽汁淤積癥療效觀察.現代中西醫結合雜志, 2008, 17(7): 1011-1012.
7. 程明宇.思美泰聯合熊去氧膽酸治療妊娠期肝內膽汁淤積癥40例療效分析.江西醫學院學報, 2009, 6(49): 103-106.
8. 冉建淑.思美泰聯合熊去氧膽酸治療重度ICP的療效觀察.齊齊哈爾醫學院學報, 2011, 22(32): 3628-3631.
9. 王曉紅, 李芳, 校勤, 等.腺苷蛋氨酸在妊娠期肝內膽汁淤積癥治療中的應用.陜西醫學雜志, 2008, 2(37): 215-216.
10. 劉銳.重度妊娠期肝內膽汁淤積癥的臨床療效觀察.醫學信息, 2013, 26(12): 49.
11. 李曉輝. S-腺苷蛋氨酸和熊去氧膽酸及兩藥聯合治療妊娠期肝內膽汁淤積癥的療效比較.西南軍醫, 2011, 6(13): 1065-1066.
12. 馮玲, 喬福元.三種方案治療妊娠期肝內膽汁淤積癥的療效比較.中國婦幼保健, 2004, 19(19): 49-50.
13. 李麗, 汪光慧.思美泰聯合熊去氧膽酸治療妊娠期肝內膽汁淤積癥的療效觀察.安徽醫學, 2009, 10(30): 1141-1143.
14. 馬建婷.腺苷蛋氨酸聯合熊去氧膽酸治療妊娠期肝內膽汁淤積癥的臨床研究.中國全科醫學, 2004, 6(7): 384-386.
15. 劉淑蕓.妊娠期肝內膽汁淤積癥的發病原因.實用婦產科學雜志, 2002, 18(1): 4-5.
16. Sopulvedawh, Gonzalez C, Cruzma, et al. Vasocontric-tive effect of bile acids on isolated human placental chorionic veins. Eur J Obstet Gynecol Reprod Biol, 2001, 42 (3): 211-215.
17. Kraus MR, Scheurlen M. Diagnosis and treatment of intrahepatic cholestasis syndrome. MMW Fortschr Med, 2004, 146(23): 34-37.
18. 艾瑛, 劉淑蕓.妊娠期肝內膽汁淤積癥的藥物治療.中國實用婦科與產科雜志, 2002, 18(1): 55-56.
19. 王濤, 劉淑蕓, 許良智, 等. 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, 5(2): 130-156.
20. Kondrackiene J, Beuers U, Kupcinskas L, et al. Efficacy and safety of ursodeoxycholic acid versus cholestyramine in intrahepatic cholestasis of pregnancy. Gastroenterology, 2005, 129(3): 894-901.
21. Pusl T, Beuers U. Intrahepatic cholestasis of pregnancy. Orphanet J Rare Dis, 2007, 29(2): 26.

Previous Article
Effectiveness and Safety of Nateglinide for Type 2 Diabetes Mellitus: A Meta-Analysis
Next Article
Effectiveness of Green Tea Extracts for Simple Obesity: A Systematic Review

Chinese Journal of Evidence-Based Medicine

S-adenosy-L-methionine Combined with Ursodesoxycholic Acid in Treatment of Intrahepatic Cholestasis of Pregnancy: A Systematic Review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content