妊娠期肝内胆汁淤积症90例临床分析

Clinical Analysis of 90 Cases of Intrahepatic Cholestasis of Pregnancy

目的探讨妊娠期肝内胆汁淤积症(ICP)患者临床症状、肝功能损害程度与妊娠结局的关系。方法对90例ICP患者检测肝功能,根据临床症状及检查结果,将ICP患者分为3组:①皮肤瘙痒轻,转氨酶<250 U/L,血清总胆汁酸(TBA)≤30μmol/L;②皮肤瘙痒重,转氨酶≥250 U/L,TBA≤30μmol/L,③皮肤瘙痒重并伴有皮肤、巩膜黄染,转氨酶≥250 U/L,TBA>30μmol/L,胆红素升高;对3组患者均行护肝及对症治疗,并定期查B超、胎心音电子监护。结果症状重,转氨酶、总胆汁酸与胆红素均升高者,其胎儿宫内窘迫、宫内发育迟缓等并发症增加,母亲肝功能恢复也较慢。结论ICP患者可能合并较重的肝功能损害,如果伴有胆汁酸、胆红素的升高,尤其要加强胎儿的监护,预防围生儿并发症发生。

Objective To study the correlation between the clinical symptoms, severity of liver function damage and pregnancy outcome of the patients with intrabepatic cholestasis of pregnancy（ICP）. Methods Ninety cases of ICP were divided into three groups based on clinical symptoms and biochemical examinations： ①Slight skin pruritus, ALT〈150 U/L, TBA≤30μmol/L; ②Severe skin pruritus. ALT≥250U/L, TBA≤30μmol/L; ③Severe skin pruritus with skin and selera starred yellow, ALT≥250U/L. TBA〉30μmol/L. All of the patients were treated through supporting liver and symptom treatment along with periodical B uhrasonography and fetal monitoring. Results The pregnancy complications such as IUGR or fetal distress were increased in the third group patients with severe clinical symptoms, high level of both ALT and TBA. And the liver function of the postpartum patients recovered slowly. Conclusion The patients with ICP maybe have heavy liver function damage. If the levels of both AI.T and TBA are high, the fetal monitoring should especially be strengthened to improve fetal outcome.