Efficacy of Ursodeoxycholic Acid in Treating Intrahepatic Cholestasis of Pregnancy: A Meta-analysis
Efficacy of Ursodeoxycholic Acid in Treating Intrahepatic Cholestasis of Pregnancy: A Meta-analysis
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DOI：
10.1053/j.gastro.2012.08.004
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发表时间：
2012-12-01
期刊：
影响因子：
29.4
通讯作者：
Di Martino, Vincent
中科院分区：
文献类型：
--
作者：
Bacq, Yannick;Sentilhes, Loic;Di Martino, Vincent
背景与目的：我们进行了一项荟萃分析，以评估熊去氧胆酸（UDCA）对妊娠期肝内胆汁淤积症（ICP）妇女所生婴儿的瘙痒、肝功能检查结果和结局的影响。方法：我们对9项已发表的随机对照试验（3项双盲试验）进行了系统评价，这些试验比较了UDCA与其他药物、安慰剂或无特异性治疗（对照）对ICP患者的影响。我们分析了454例患者的数据：207例仅接受UDCA治疗，70例仅接受安慰剂治疗，42例接受考来烯胺治疗，36例接受地塞米松治疗1周，然后接受安慰剂治疗2周，65例接受S-腺苷甲硫氨酸治疗，34例未接受特异性治疗。为了实现终点之间的一致性，向所有通讯作者发送了一份标准问卷。对于每个终点，我们进行了汇总分析，比较了UDCA与所有对照组以及UDCA与安慰剂组的作用。研究结果：在比较UDCA与所有对照的汇总分析中，UDCA与瘙痒的完全消退相关（比值比[OR]，0.23; 95%置信区间[CI]，0.07-0.74; P <0.01），减少了尿道炎（OR，0.27; 95% CI，0.13-0.55; P < .0001），血清丙氨酸氨基转移酶（ALT）水平正常化（OR，0.23; 95%CI，0.10-0.50; P < .001），血清ALT水平降低（OR，0.24; 95% CI，0.11-0.52; P < .0001），降低血清胆汁酸水平（OR，0.37; 95% CI，0.19-0.75; P < .001），早产率降低（OR，0.44; 95%CI，0.24-0.79; P < .01），胎儿窘迫减少（OR，0.46; 95%CI，0.25-0.86; P < .01），较少发生呼吸窘迫综合征（OR，0.30; 95%CI，0.12-0.74; P <0.01），重症监护室的新生儿较少（OR，0.49; 95%CI，0.25-0.98; P = 0.046）。在比较UDCA与安慰剂作用的汇总分析中，UDCA可减轻瘙痒（OR，0.21; 95%CI，0.07-0.62; P < .01），标准化（OR，0.18; 95% CI，0.06-0.52; P < .001）或血清ALT水平降低（OR，0.12; 95%CI，0.05-0.31; P < .0001），并降低血清胆汁酸水平（OR，0.30; 95%CI，0.12-0.73; P < .01）。结论：基于一项荟萃分析，UDCA可有效减轻ICP患者的瘙痒并改善肝功能检查结果; UDCA治疗也可能有益于胎儿结局。
BACKGROUND & AIMS: We performed a meta-analysis to evaluate the effects of ursodeoxycholic acid (UDCA) on pruritus, liver test results, and outcomes of babies born to women with intrahepatic cholestasis of pregnancy (ICP). METHODS: We performed a systematic review of 9 published, randomized controlled trials (3 double blinded) that compared the effects of UDCA to other drugs, placebo, or no specific treatment (controls) in patients with ICP. We analyzed data from 454 patients: 207 received only UDCA, 70 received only placebo, 42 received cholestyramine, 36 received dexamethasone for 1 week and then placebo for 2 weeks, 65 received S-adenosyl-methionine, and 34 received no specific treatment. To achieve consistency among end points, a standard questionnaire was sent to all corresponding authors. For each end point, we performed pooled analysis that compared the effects of UDCA with those of all controls and UDCA with those of placebos. RESULTS: In pooled analyses that compared UDCA with all controls, UDCA was associated with total resolution of pruritus (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.07-0.74; P < .01), reduced pruritis (OR, 0.27; 95% CI, 0.13-0.55; P < .0001), normalization of serum levels of alanine aminotransferase (ALT) (OR, 0.23; 95% CI, 0.10-0.50; P < .001), decreased serum level of ALT (OR, 0.24; 95% CI, 0.11-0.52; P < .0001), reduced serum levels of bile acids (OR, 0.37; 95% CI, 0.19-0.75; P < .001), fewer premature births (OR, 0.44; 95% CI, 0.24-0.79; P < .01), reduced fetal distress (OR, 0.46; 95% CI, 0.25-0.86; P < .01), less frequent respiratory distress syndrome (OR, 0.30; 95% CI, 0.12-0.74; P < .01), and fewer neonates in the intensive care unit (OR, 0.49; 95% CI, 0.25-0.98; P = .046). In pooled analyses that compared the effects of UDCA with placebo, UDCA reduced pruritus (OR, 0.21; 95% CI, 0.07-0.62; P < .01), normalized (OR, 0.18; 95% CI, 0.06-0.52; P < .001) or decreased serum levels of ALT (OR, 0.12; 95% CI, 0.05-0.31; P < .0001), and reduced serum levels of bile acids (OR, 0.30; 95% CI, 0.12-0.73; P < .01). CONCLUSIONS: Based on a meta-analysis, UDCA is effective in reducing pruritus and improving liver test results in patients with ICP; UDCA therapy might also benefit fetal outcomes.