目的 评估小剂量低分子肝素(LMWH)对妊娠期肝内胆汁淤积症(ICP)的治疗效果。方法 32例ICP患者用LMWH 1 250 U/d静脉滴注,5 d为1个疗程,治疗前后以瘙痒症状、血清总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TB)、直接胆红素(DB)、活化部分凝血酶时间(APTT)和凝血酶原时间(PT)作为观察指标,评估治疗效果和安全性。结果 患者治疗后瘙痒评分[(1.1±0.4)分]、血清TBA[(12.53±9.95)μmol/L]、ALT[(39.58±19.93)U/L]、AST[(86.28±12.48)U/L]、TB[(15.99±7.05)mg/L]及DB[(18.80±1.67)mg/L]。较治疗前[(2.8±0.4)分、(33.39±8.55)μmol/L、(212.81±27.95)U/L、(151.55±17.97)U/L、(24.78±8.94)mg/L、(15.28±3.29)mg/L]均有明显下降,差异有统计学意义,对母儿无明显不良反应。结论 LMWH是治疗ICP安全有效的药物。

Objective To evaluate the efficacy and safety of low-molecular-weight-heparin (LMWH) in the treatment of intrahepatic cholestasis during pregnancy. Methods Thirty-two patients received LMWH with a dose of 1 250 IU/d for 5 days. Itching, standard liver function tests, serum total bile acids (TBA), activated partial thromboplastin time (APTT) and prothrombin time (PT) were measured before and after the treatment to assess the clinical efficacy and side effects. Results All of the patients had a significant improvement in pruritus, in TBA and in liver function. No adverse effects were observed on mothers or their babies. Conclusion LMWH is effective and safe for patients with intrahepatic cholestasis during pregnancy.