妊娠期肝内胆汁淤积症患者血生化指标及其对围产儿预后的影响

doi:10.3969/j.issn.1672-5069.2017.02.015

摘要/Abstract

摘要： 目的探讨妊娠期肝内胆汁淤积症（ICP）患者血生化指标的变化及其对围产儿预后的影响。方法回顾性分析十堰市妇幼保健院2013年1月～2015年1月产检并分娩的ICP孕妇102例临床资料，根据胆汁酸（TBA）或者甘胆酸（CG）水平将其分为轻度ICP组75例和重度ICP组27例；根据ICP发病孕周不同，分为早发型组（发病孕周<28 w）23例和晚发型组（发病孕周≥28 w）79例。选择同期正常妊娠孕妇50例作为健康孕妇。比较轻度ICP组、重度ICP组及健康孕妇血清TBA、CG及肝功能水平，分析ICP发生时间与病情严重程度的关系，观察各组围产期胎儿的结局。结果轻度ICP组和重度ICP组血清TBA、AST、ALT、总胆红素、γ-谷氨酰转肽酶水平均明显高于健康孕妇（t=6.06～29.13，P<0.01）；重度ICP组上述指标也明显高于轻度ICP组（t=2.23～18.87，P<0.01）；早发型ICP组重度ICP发生率为47.8%，明显高于晚发型ICP组（20.3%，x2=6.96，P<0.01）；与健康孕妇比，轻度ICP组和重度ICP组分娩孕周、新生儿体质量、1分钟Apgar评分明显降低（t=2.63～10.52，P<0.01），产后出血量明显增多（t=7.43，t=10.22，P<0.01）；重度ICP组分娩孕周为（36.2±1.7）w、新生儿体质量为（2876±115）g和1min Apgar评分为（7.86±0.60），均明显低于轻度ICP组【（37.5±1.6）w、（3040±135）g和（9.02±0.58），t=3.56～8.83，P<0.01】；轻度ICP组羊水污染率为25.3%，高于健康孕妇（10.0%，x2=6.96，P<0.01），重度ICP组早产、羊水污染、胎儿窘迫、剖宫产和新生儿病死率分别为37.0%、40.7%、29.6%、63.0%和14.4%，明显高于健康孕妇（6.0%、10.0%、6.0%、16.0%和0.0%，x2=5.09～17.64，P<0.05或P<0.01）；重度ICP组早产、胎儿窘迫和剖宫产率分别为37.0%、29.6%和63.0%，明显高于轻度ICP组（16.0%、12.0%和26.7%，x2=4.44～11.31，P<0.05或P<0.01）。结论 ICP的病重程度与发生时间、血清TBA、甘胆酸和肝功能等相关，增加围产儿风险并影响产儿生长发育。

关键词: 妊娠期肝内胆汁淤积症, 总胆汁酸, 甘胆酸, 肝功能, 围产儿预后

Abstract: Objective To investigate the changes of serum biochemical indexes and its impact on perinatal prognosis neonates in mothers with intrahepatic cholestasis of pregnancy（ICP）.Methods A total 102 women with ICP were recruited in Maternal and Child Health Care Hospital between January 2013 and January 2015 in this study，and the clinical materials were retrospectively analyzed. The patients were divided into mild （n=75） and severe ICP group （n=27） according to the levels of total bile acids （TBA） and cholyglycine （CG），and they were also divided into early-onset （n=23，onset less than 28 gestational weeks） and late-onset ICP group （n=79，onset longer than 28 gestational weeks） according to the onset of ICP. 50 normal pregnant women in the same period were enrolled as controls. The levels of maternal serum TBA，CG and liver function index [aspartate aminotransferase （AST），alanine aminotransferase （ALT），total bilirubin （TBIL），gamma-glutamyl transferase （GGT）] were compared among the mild，severe and control group. The relationship between onset of ICP and severity of the disease was analyzed and the perinatal outcome were assessed.Results Serum levels of TBA，AST，ALT，TBIL and GGT of mothers in mild and severe ICP group were significantly higher than those of mothers in control group （t=6.06～29.13，P<0.01），and the above index in severe ICP group were significantly higher than those of mothers in mild ICP group （t=2.23～18.87，P<0.01）； The incidence rate of severe ICP in mothers of early-onset group was 47.8%，significantly higher than 20.3% of mothers in late onset group（x2=6.96，P<0.01），and the onset time of ICP was closely related to the severity of the disease；Compared with mothers in control group，the pregnant weeks，birth weight，1 min Apgar score were significantly reduced（t=2.63～10.52，P<0.01） and the postpartum hemorrhage amounts were significantly increased（t=7.43，t=10.22，P<0.01） of mothers in mild ICP group and severe ICP group；The pregnant weeks，birth weight，1 min Apgar score in severe ICP group[（36.2±1.7） w，（2876±115） g and （7.86±0.60）] were significantly lower than those of mothers in mild ICP group [（37.5±1.6） w，（3040±135） g and （9.02±0.58），t=3.56～8.83，P<0.01]；The amniotic fluid pollution rate was 25.3% in mothers with mild ICP，much higher than 10.0% （x2=6.96，P<0.01） in mothers in control group，the preterm labor，amniotic fluid pollution，fetal distress，cesarean section and neonatal mortality rates（37.0%，40.7%，29.6%，63.0% and 14.4%） in mothers in severe ICP group were significantly higher than those（6.0%，10.0%，6.0%，16.0% and 0.0%，x2=5.09～17.64，P<0.05 or P<0.01） in control group；The rates of preterm labor，fetal distress and cesarean section（37.0%，29.6% and 63.0%） in mothers in severe ICP group were significantly higher than those（16.0%，12.0% and 26.7%，x2=4.44～11.31，P<0.05 or P<0.01） in mothers in mild ICP group.Conclusions The onset of ICP，levels of maternal TBA，CGA and liver function are related to the severity of ICP，and ICP increases the risk of perinatal birth and affects the growth and development of infants.

Key words: Intrahepatic cholestasis of pregnancy, Total bile acids, Cholyglycine, Liver function, Perinatal prognosis

柯盈月，崔盈盈，李权伦，袁学华. 妊娠期肝内胆汁淤积症患者血生化指标及其对围产儿预后的影响[J]. 实用肝脏病杂志, 2017, 20(2): 187-190.

Ke Yingyue，Cui Yingying，Li Quanlun，et al.. Changes of serum biochemical indexes and its impact on perinatal prognosis of neonates in mothers with intrahepatic cholestasis of pregnancy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(2): 187-190.

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