Ursodeoxycholic acid therapy in intrahepatic cholestasis of pregnancy: Results in real-world conditions and factors predictive of response to treatment
Ursodeoxycholic acid therapy in intrahepatic cholestasis of pregnancy: Results in real-world conditions and factors predictive of response to treatment
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DOI：
10.1016/j.dld.2016.10.006
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发表时间：
2017-01-01
影响因子：
4.5
通讯作者：
Aubourg, Alexandre
中科院分区：
文献类型：
--
作者：
Bacq, Yannick;le Besco, Matthieu;Aubourg, Alexandre
工作背景：熊去氧胆酸（UDCA）治疗妊娠期肝内胆汁淤积症（ICP）是一种常用的药物。目的：评价UDCA在实际条件下的疗效和耐受性，并寻找预测治疗反应的因素。方法：这项观察性研究包括98名连续的妊娠期瘙痒患者，这些患者与ALT水平或总胆汁酸（TBA）浓度升高相关，没有其他胆汁淤积的原因。结果：所有患者均服用UDCA直至分娩（平均剂量14.0 mg/kg/d;平均持续时间30.4 d）。75/98（76.5%）例患者的瘙痒症状改善，25/98（25.5%）例患者在分娩前完全消失。治疗2-3周后，67/86（77.9%）例患者的ALT水平下降超过基线的50%，34/86（39.5%）例患者恢复正常，28/81（34.6%）例患者的TBA浓度下降。只有一名患者在分娩前停止治疗。多因素分析显示，治疗前ALT >175 IU/l与瘙痒改善（OR 2.97，95%CI 1.12-7.89，P = 0.029）和ALT降低（OR 18.61，95%CI 3.94-87.99，P = 0.0002）相关。ABCB 4基因突变与治疗反应无关。结论：本研究支持UDCA作为ICP的一线治疗。(C)2016 Editrice Gastroenterologica Italiana S.r.l.由爱思唯尔有限公司出版。保留所有权利。
Background: Ursodeoxycholic acid (UDCA) therapy is commonly used in intrahepatic cholestasis of pregnancy (ICP).Aim: To evaluate the efficacy and tolerance of UDCA in real-world conditions and to search for factors predictive of response to treatment.Methods: This observational study included 98 consecutive patients suffering from pruritus during pregnancy associated with increased ALT levels or total bile acid (TBA) concentrations, without other causes of cholestasis. The entire ABCB4 gene coding sequence was analyzed by DNA sequencing.Results: UDCA was prescribed until delivery in all patients (mean dose 14.0 mg/kg/day; mean duration 30.4 days). Pruritus improved in 75/98 (76.5%) patients, and totally disappeared before delivery in 25/98 (25.5%). After 2-3 weeks of treatment, ALT levels decreased by more than 50% of base line in 67/86 (77.9%) patients and normalized in 34/86 (39.5%), and TBA concentrations decreased in 28/81 (34.6%). Only one patient stopped the treatment before delivery. On multivariate analysis, ALT >175 IU/1 before treatment was associated with improvement of pruritus (OR 2.97, 95% CI 1.12-7.89, P = 0.029) and with decreased ALT (OR 18.61, 95% CI 3.94-87.99, P = 0.0002). ABCB4 gene mutation was not associated with response to treatment.Conclusion: This study supports the use of UDCA as first line therapy in ICP. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.