妊娠期肝内胆汁淤积症药物治疗机制及进展
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摘要
妊娠期肝内胆汁淤积症的药物治疗目的是缓解瘙痒症状,降低血胆汁酸水平,改善肝功能,延长孕周,改善妊娠结局。目前临床常用的药物有熊去氧胆酸、S-腺苷蛋氨酸、多烯磷脂酰胆碱等。该文对妊娠期肝内胆汁淤积症药物治疗机制及进展进行综述。
The purpose of drug treatment for intrahepatic cholestasis of pregnancy(ICP) is to relieve the symptom of itching, reduce blood bile acid level, improve liver function, extend gestational age, and improve pregnancy outcomes. At present, the commonly used drugs in the clinic include ursodeoxycholic acid, S-adenosylmethionine, and polyene phosphatidylcholine. This article reviewed the mechanism and progress of drug therapy for ICP.
The purpose of drug treatment for intrahepatic cholestasis of pregnancy(ICP) is to relieve the symptom of itching, reduce blood bile acid level, improve liver function, extend gestational age, and improve pregnancy outcomes. At present, the commonly used drugs in the clinic include ursodeoxycholic acid, S-adenosylmethionine, and polyene phosphatidylcholine. This article reviewed the mechanism and progress of drug therapy for ICP.
引文
[1]Jessica A, Wei, Micheal. A retrospective cohort review of intrahepatic cholestasis of pregnancy in a South Australian population[J]. Obstetrics and Gynecology and Reproductive Biology, 2017, 218(3): 33-38.
[2]Zhang L, Liu X H, Qi H B,et al. Ursodeoxycholic acid and S-adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy: a multi-centered randomized controlle d trial[J]. Eur Rev Med Pharmacol Sci, 2015, 19(19):3770-3776.
[3]Kong Xiang,Kong Yan,Zhang Fangyuan, et al. Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy A meta-analysis[J]. Medicine, 2016, 95(40):e4949.
[4]Estiu M C, Monte M J, Rivasl, et al. Effect of ursodeoxycholic acid treatment on the altered progesterone and bile acid homeostasis in the mother-placenta-foetus trio during cholestasis of pregnancy[J]. Br J Clin Pharmacol, 2015, 79(2):316-329.
[5]Zhang Y H, Pan Y D, Lin C D, et al. Bile acids evoke placental inflammation by activating Gpbar1/NF-κB pathway in intrahepatic cholestasis of pregnancy[J].Molecular Cell Biology, 2016,8(6):530-541.
[6]Larson S P, Kovilam O, Agrawal D K. Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy[J]. Expert Rev Clin Immunol. 2016, 12(1):39-48.
[7]Zhang W W, Liu Y S, Wang Y, et al. Research on Antidepressant Effects of S-adenosylmethionine in Patients with Liver Diseases[J]. Prog Mod Biom,2015,15(6): 1196-1197.
[8]Liao E, Li Z, Shao Y. Resveratrol regulates the silent information regulator 1-nuclear factor-κB signaling pathway in intrahepatic cholestasis of pregnancy[J]. Hepatol Res,2018,48(12):1031-1044.
[9]Zhao P, Zhang K,Yao Q, et al. Uterine contractility in intrahepatic cholestasis of pregnancy[J].Obstet Gynaecol,2014, 34(3):221-224.
[10]Mei Youwen,Lin Yonghong,Luo Dan, et al. Perinatal outcomes in intrahepatic cholestasis of pregnancy with monochorionic diamniotic twin pregnancy[J]. BMC Pregnancy Childbirth, 2018, 18(1):291.
[11]Marcelo Rodríguez, Alfonso Sprohnle, Javier Muňoz,et al. Treatment of intrahepatic cholestasis of pregnancy with ursodeoxycholic acid associated with improvement of fetal first-degree atrioventricular block[J]. Ultrasound in Obstetrics and Gynecology, 2018,52(6):1-7.
[12]Jing G E,HAN Tao,LI Xiaoqiu, et al. S-adenosyl methionine regulates calcium channels and inhibits uterine smooth muscle contraction in rats with infectious premature delivery through the transient receptor protein 3/protein kinase Cβ/C-kinase-activated protein phosphatase-1 inhibitor of 17 kDa signaling pathway[J]. Exp Ther Med, 2018, 16(1):103-112.
[13]Wu W B, Xu Y Y, Cheng W W,et al. Agonist of farnesoid X receptor protects against bile acid induced damage and oxidative stress in mouse placenta--a study on maternal cholestasis model[J]. Placenta, 2015, 36(5): 545-551.
[14]Huo X K,Liu J,Yu Z L,et al. Alisma orientale extract exerts the reversing cholestasis effect by activation of farnesoid X receptor[J]. Phytomedicine, 2018, 42:34-42.
[2]Zhang L, Liu X H, Qi H B,et al. Ursodeoxycholic acid and S-adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy: a multi-centered randomized controlle d trial[J]. Eur Rev Med Pharmacol Sci, 2015, 19(19):3770-3776.
[3]Kong Xiang,Kong Yan,Zhang Fangyuan, et al. Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy A meta-analysis[J]. Medicine, 2016, 95(40):e4949.
[4]Estiu M C, Monte M J, Rivasl, et al. Effect of ursodeoxycholic acid treatment on the altered progesterone and bile acid homeostasis in the mother-placenta-foetus trio during cholestasis of pregnancy[J]. Br J Clin Pharmacol, 2015, 79(2):316-329.
[5]Zhang Y H, Pan Y D, Lin C D, et al. Bile acids evoke placental inflammation by activating Gpbar1/NF-κB pathway in intrahepatic cholestasis of pregnancy[J].Molecular Cell Biology, 2016,8(6):530-541.
[6]Larson S P, Kovilam O, Agrawal D K. Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy[J]. Expert Rev Clin Immunol. 2016, 12(1):39-48.
[7]Zhang W W, Liu Y S, Wang Y, et al. Research on Antidepressant Effects of S-adenosylmethionine in Patients with Liver Diseases[J]. Prog Mod Biom,2015,15(6): 1196-1197.
[8]Liao E, Li Z, Shao Y. Resveratrol regulates the silent information regulator 1-nuclear factor-κB signaling pathway in intrahepatic cholestasis of pregnancy[J]. Hepatol Res,2018,48(12):1031-1044.
[9]Zhao P, Zhang K,Yao Q, et al. Uterine contractility in intrahepatic cholestasis of pregnancy[J].Obstet Gynaecol,2014, 34(3):221-224.
[10]Mei Youwen,Lin Yonghong,Luo Dan, et al. Perinatal outcomes in intrahepatic cholestasis of pregnancy with monochorionic diamniotic twin pregnancy[J]. BMC Pregnancy Childbirth, 2018, 18(1):291.
[11]Marcelo Rodríguez, Alfonso Sprohnle, Javier Muňoz,et al. Treatment of intrahepatic cholestasis of pregnancy with ursodeoxycholic acid associated with improvement of fetal first-degree atrioventricular block[J]. Ultrasound in Obstetrics and Gynecology, 2018,52(6):1-7.
[12]Jing G E,HAN Tao,LI Xiaoqiu, et al. S-adenosyl methionine regulates calcium channels and inhibits uterine smooth muscle contraction in rats with infectious premature delivery through the transient receptor protein 3/protein kinase Cβ/C-kinase-activated protein phosphatase-1 inhibitor of 17 kDa signaling pathway[J]. Exp Ther Med, 2018, 16(1):103-112.
[13]Wu W B, Xu Y Y, Cheng W W,et al. Agonist of farnesoid X receptor protects against bile acid induced damage and oxidative stress in mouse placenta--a study on maternal cholestasis model[J]. Placenta, 2015, 36(5): 545-551.
[14]Huo X K,Liu J,Yu Z L,et al. Alisma orientale extract exerts the reversing cholestasis effect by activation of farnesoid X receptor[J]. Phytomedicine, 2018, 42:34-42.