妊娠期肝内胆汁淤积症与熊去氧胆酸病理机制、临床疗效及围产期结局研究进展

Research Progress on Pathological Mechanism, Clinical Efficacy and Perinatal Outcomes of Ursodeoxycholic Acid in Intrahepatic Cholestasis of Pregnancy

摘要: 妊娠期肝内胆汁淤积症(ICP)是妊娠中晚期特有的并发症，以皮肤瘙痒和血清总胆汁酸升高为主要特征，可导致早产、胎儿窘迫甚至死胎等严重围产儿不良结局。熊去氧胆酸(UDCA)作为目前临床治疗ICP的一线药物，其病理机制涉及改善胆汁酸转运体功能、调节核受体活性及抗氧化应激等多个方面。本文系统综述了ICP的病理机制、UDCA的作用机制、临床疗效及对围产期结局的影响，并总结了不同研究之间的争议与共识，以期为临床诊疗提供参考依据。

Abstract: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific complication occurring in the second and third trimesters, characterized by pruritus and elevated serum total bile acid levels, which can lead to severe adverse perinatal outcomes including preterm birth, fetal distress, and even stillbirth. Ursodeoxycholic acid (UDCA), as the first-line therapeutic agent for ICP, exerts its effects through multiple mechanisms including improving bile acid transporter function, regulating nuclear receptor activity, and antioxidant stress. This review systematically summarizes the pathological mechanisms of ICP, the mechanisms of action of UDCA, clinical efficacy, and its impact on perinatal outcomes, while also discussing the controversies and consensus among different studies to provide references for clinical diagnosis and treatment.