宫内胎死:高质量的证据揭示,接受安全的后续治疗的胆汁酸小于 40 µmol/L 的患者,胎死宫内风险较低。[3]Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology. 2004 Aug;40(2):467-74.http://www.ncbi.nlm.nih.gov/pubmed/15368452?tool=bestpractice.com[24]Warren JE, Blaylock RC, Silver RM. Plasmapheresis for the treatment of intrahepatic cholestasis of pregnancy refractory to medical treatment. Am J Obstet Gynecol. 2005;192:2088-2089.http://www.ncbi.nlm.nih.gov/pubmed/15970907?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
宫内胎死:高质量的证据揭示,接受安全的后续治疗的胆汁酸小于 40 µmol/L 的患者,胎死宫内风险较低。[3]Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology. 2004 Aug;40(2):467-74.http://www.ncbi.nlm.nih.gov/pubmed/15368452?tool=bestpractice.com[24]Warren JE, Blaylock RC, Silver RM. Plasmapheresis for the treatment of intrahepatic cholestasis of pregnancy refractory to medical treatment. Am J Obstet Gynecol. 2005;192:2088-2089.http://www.ncbi.nlm.nih.gov/pubmed/15970907?tool=bestpractice.com
恢复及分娩:中等级别质量证据表明分娩后胆汁淤积很快消退。 如果未分娩,大多数患者病情将进展。[1]Lammert F, Marschall HU, Glantz A, et al. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 200;33:1012-1021.http://www.ncbi.nlm.nih.gov/pubmed/11131439?tool=bestpractice.com[3]Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology. 2004 Aug;40(2):467-74.http://www.ncbi.nlm.nih.gov/pubmed/15368452?tool=bestpractice.com[5]Reyes H, Simon F. Intrahepatic cholestasis of pregnancy: an estrogen-related disease. Semin Liver Dis. 1993 Aug;13(3):289-301.http://www.ncbi.nlm.nih.gov/pubmed/8235718?tool=bestpractice.com[2]Kenyon AP, Piercy CN, Girling J, et al. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG. 2002;109:282-288.http://www.ncbi.nlm.nih.gov/pubmed/11950183?tool=bestpractice.com[8]Milkiewicz P, Gallagher R, Chambers J, et al. Obstetric cholestasis with elevated gamma glutamyl transpeptidase: incidence, presentation and treatment. J Gastroenterol Hepatol. 2003 Nov;18(11):1283-6.http://www.ncbi.nlm.nih.gov/pubmed/14535985?tool=bestpractice.com[11]Kroumpouzos G, Cohen LM. Specific dermatoses of pregnancy: an evidence-based systematic review. Am J Obstet Gynecol. 2003 Apr;188(4):1083-92.http://www.ncbi.nlm.nih.gov/pubmed/12712115?tool=bestpractice.com[17]Reyes H, Sjovall J. Bile acids and progesterone metabolites in intrahepatic cholestasis of pregnancy. Ann Med. 2000;32:94-106.http://www.ncbi.nlm.nih.gov/pubmed/10766400?tool=bestpractice.com[21]Lopez J, Glasinovic JC, Marinovic I, et al. Clinical and laboratory characterization in 100 cases of pregnancy cholestasis. Rev Chil Obstet Ginecol. 1982;47(4):215-21.http://www.ncbi.nlm.nih.gov/pubmed/6927319?tool=bestpractice.com[22]Glantz A, Marschall HU, Lammert F, et al. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatology. 2005;42:1399-1405.http://onlinelibrary.wiley.com/doi/10.1002/hep.20952/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16317669?tool=bestpractice.com[23]Locatelli A, Roncaglia N, Arreghini A, et al. Hepatitis C virus infection is associated with a higher incidence of cholestasis in pregnancy. Br J Obstet Gynaecol. 1999;106:498-500.http://www.ncbi.nlm.nih.gov/pubmed/10430202?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
恢复及分娩:中等级别质量证据表明分娩后胆汁淤积很快消退。 如果未分娩,大多数患者病情将进展。[1]Lammert F, Marschall HU, Glantz A, et al. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 200;33:1012-1021.http://www.ncbi.nlm.nih.gov/pubmed/11131439?tool=bestpractice.com[3]Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology. 2004 Aug;40(2):467-74.http://www.ncbi.nlm.nih.gov/pubmed/15368452?tool=bestpractice.com[5]Reyes H, Simon F. Intrahepatic cholestasis of pregnancy: an estrogen-related disease. Semin Liver Dis. 1993 Aug;13(3):289-301.http://www.ncbi.nlm.nih.gov/pubmed/8235718?tool=bestpractice.com[2]Kenyon AP, Piercy CN, Girling J, et al. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG. 2002;109:282-288.http://www.ncbi.nlm.nih.gov/pubmed/11950183?tool=bestpractice.com[8]Milkiewicz P, Gallagher R, Chambers J, et al. Obstetric cholestasis with elevated gamma glutamyl transpeptidase: incidence, presentation and treatment. J Gastroenterol Hepatol. 2003 Nov;18(11):1283-6.http://www.ncbi.nlm.nih.gov/pubmed/14535985?tool=bestpractice.com[11]Kroumpouzos G, Cohen LM. Specific dermatoses of pregnancy: an evidence-based systematic review. Am J Obstet Gynecol. 2003 Apr;188(4):1083-92.http://www.ncbi.nlm.nih.gov/pubmed/12712115?tool=bestpractice.com[17]Reyes H, Sjovall J. Bile acids and progesterone metabolites in intrahepatic cholestasis of pregnancy. Ann Med. 2000;32:94-106.http://www.ncbi.nlm.nih.gov/pubmed/10766400?tool=bestpractice.com[21]Lopez J, Glasinovic JC, Marinovic I, et al. Clinical and laboratory characterization in 100 cases of pregnancy cholestasis. Rev Chil Obstet Ginecol. 1982;47(4):215-21.http://www.ncbi.nlm.nih.gov/pubmed/6927319?tool=bestpractice.com[22]Glantz A, Marschall HU, Lammert F, et al. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatology. 2005;42:1399-1405.http://onlinelibrary.wiley.com/doi/10.1002/hep.20952/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16317669?tool=bestpractice.com[23]Locatelli A, Roncaglia N, Arreghini A, et al. Hepatitis C virus infection is associated with a higher incidence of cholestasis in pregnancy. Br J Obstet Gynaecol. 1999;106:498-500.http://www.ncbi.nlm.nih.gov/pubmed/10430202?tool=bestpractice.com
症状改善及胆汁酸减少:高质量的证据表明熊去氧胆酸在改善症状及减少胆汁酸方面比地塞米松更为有效。[22]Glantz A, Marschall HU, Lammert F, et al. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatology. 2005;42:1399-1405.http://onlinelibrary.wiley.com/doi/10.1002/hep.20952/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16317669?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
症状改善及胆汁酸减少:高质量的证据表明熊去氧胆酸在改善症状及减少胆汁酸方面比地塞米松更为有效。[22]Glantz A, Marschall HU, Lammert F, et al. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatology. 2005;42:1399-1405.http://onlinelibrary.wiley.com/doi/10.1002/hep.20952/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16317669?tool=bestpractice.com
产科不良事件:少量证据发现患有妊娠肝内胆汁淤积症的孕妇分娩的新生儿具有较高的呼吸窘迫综合征发生率。[2]Kenyon AP, Piercy CN, Girling J, et al. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG. 2002;109:282-288.http://www.ncbi.nlm.nih.gov/pubmed/11950183?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
产科不良事件:少量证据发现患有妊娠肝内胆汁淤积症的孕妇分娩的新生儿具有较高的呼吸窘迫综合征发生率。[2]Kenyon AP, Piercy CN, Girling J, et al. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG. 2002;109:282-288.http://www.ncbi.nlm.nih.gov/pubmed/11950183?tool=bestpractice.com