S-adenosyl-1-methionine In Treatment Of Patients With Intrahepatic Cholestas Of Pregnancy

Objective: To systematically assess the efficacy and safty of S-adenosyl-1-methionine based on strict quality evaluation of reports of randomized controlled trial.Methods: A systematic review of all randomized controlled trails(RCTs) was performed . Electornic and manual retrieve of MEDLINE, Cochrane, Embase, CNKI and Wanfang data with the subject headings "intrahepatic cholestasis of pregnancy S-adenosyl-l-methionine",with the similar paper listed in the references of above papers were also included.Andrelevant medical journal were applied to search RCTs of S-adenosylmethionine, intrahepatic choletasis of pregnancy by hand. And these RCTs were analysed with rev man 4.2.Results: 11 randomized controlled trials were include, blinding method was used only in 2 studies The 11 trial involve 516 cases, Jadad scores of allrails were form 1 to 3. Meta analysis showed that S-adenosyl-1-methionine incline to lower serum ALT, but it was no significant difference compared with control group(1.58umol/l, P=0.48); Obvious degradation serum total-bile-acid(11.98umol/l,p<0.0001); lowered serum ALP(8.43umol/l, P=0.005),total-bilirubin(2.64umol/l,P=0.008),directly-bilirubin(1.94^mol/l,P =0.01);There was no significant difference with pruritus scorts(0.42,P=0.13). Significant reducted cesarean-section ratio(OR=0.43 P=0.001),Prolonged the period of pregnancy(1.87w, P<0.00001), Increased the newborn weight (376.27g, P<0.00001);Apgar scores(1.34,P=0.45,and decrease of fetal distress(OR=0.46,P=0.13) were no significant difference compared with control group(1.34 ,P=0.45); S-adenosyl-1-methionine can also decrease the ratio of newborn stifile(OR=0.17 ,P=0.0002)o Five RCTS mentioned the side effect of S—adenosy-1-methionine ,only one RCT reported it had lightly gastrointestinal indisposition.Asymmetry showed in "Funnel plot" may related to publication biasN low quality of methodology and small-size in sample.Conclusion: S-adenosyl-1-methionine has relatively efficacy in treatment of intrahepatic choletasis of pregnancy.But,the specified efficacy and safety of S-adenosy-1-methionine required a rigorously designed n randomised > double-blined^ placebo-controlled trials to evaluate.