不同民族妊娠期肝内胆汁淤积症患者血生化检测结果

The Biochemical Results in Cases with Intrahepatic Cholestasis of Pregnancy from Different Nationalities

目的观察新疆乌鲁木齐地区维族、哈族、汉族妊娠期肝内胆汁淤积症(ICP)患者血清生化及围产儿预后、母婴并发症方面有无差异。方法随机选择300例ICP患者按其民族分3组;维族、哈族、汉族各100例。对300例ICP患者检测血清总胆汁酸(TBA)、总胆红素(TB)、直接胆红素(DB)、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)、胆固醇(CHO)及甘油三酯(TG)。并对患者早产、羊水Ⅲ度粪染、胎儿宫内窘迫、新生儿窒息(1 min Apgar评分≤7分)、产后出血等围产儿预后不良及母婴并发症情况进行比较。结果维族、哈族、汉族ICP患者血清TBA(μmol/L)分别为80.7±8.14、78.5±8.5、69.4±7.3;TB(μmol/L)分别为55.9±11.7、55.8±10.4、45.5±13.3;ALP(U/L)分别为454.3±41.6、441.8±40.8、373.9±69.1;CHO(mmol/L)分别为8.7±0.6、7.3±0.7、8.1±0.6;TG(mmol/L)分别为5.8±1.0、5.7±1.1、3.7±0.7。5项生化指标以维族最高、哈族次之、汉族最低。F值分别为10.30、5.07、12.06、24.47、30.17,差异均有统计学意义,P<0.01。DB(μmol/L)分别为63.2±10.7、62.0±10.9、57.6±12.7;ALT(U/L)136.5±26.7、131.4±25.0、119.6±28.6;γ-GT(U/L)分别为22.6±5.9、21.5±9.0、18.5±6.4,3项指标维族及哈族均高于汉族、但3个民族间差异无统计学意义,F=1.29、1.93、1.72,P>0.05。对TBA、TB、ALP、CHO、TG进行两两比较,q值TBA分别为6.26、5.06;TB分别为3.93、3.89;ALP分别为6.69、5.65;CHO分别为10.10、8.51;TG分别为10.18、9.60,表明在维族与汉族、哈族与汉族间差异均有统计学意义,P<0.01。而在维族与哈族间进行比较,差异均无统计学意义。在维族与汉族、哈族与汉族、维族与哈族间分别对DB、ALT、γ-GT进行两两比较,差异均无统计学意义。维族及哈族ICP患者早产、羊水Ⅲ度粪染、胎儿宫内窘迫、Apgar评分≤7分、产后出血发生例数较汉族患者高,早产、羊水Ⅲ度粪染、Apgar评分≤7分在维族、哈族、汉族3个民族间差异均有显统计学意义,P<0.05。而胎儿宫内窘迫、产后出血的差异无显著性。维族与汉族、哈族与汉族ICP患者分别对早产(χ2=6.46、5.01);羊水Ⅲ度粪染(χ2=6.67、5.23)、Apgar评分≤7分(χ2=6.46、5.01)进行两两比较,P<0.05,差异均有统计学意义;但维族与哈族间(χ2=3.75)比较,差异无统计学意义。而维族与汉族、哈族与汉族、维族与哈族ICP患者胎儿宫内窘迫(χ2=3.64、2.56、0.10);产后出血(χ2=2.85、1.91、0.10)进行两两比较差异均无统计学意义。结论维族及哈族ICP患者血清TBA、TB、DB、ALT、ALP、γ-GT、CHO、TG高于汉族患者,维族及哈族ICP患者早产、羊水Ⅲ度粪染、胎儿宫内窘迫、Apgar评分≤7分、产后出血发生的例数均高于汉族患者,为早期、及时、合理的治疗和预防新疆地区少数民族尤其是维族及哈族ICP患者提供了基础资料及理论依据。

Objective To observe the efitieal difference of serum biochemical criterion in patients with ICP from Weiner, Hasak and Hart nationality in Vrwnqi Xinjiang and its difference in predicting the pefinatal pregnosis. Methods 300 cases chosen randomly were divided into three groups according to their nationalities. （ 100 cases from Weiner, 100 eases from Hasak, 100 from Han） .The biochemical criteria including TBA, TB, DB, ALT, ALP, γ - GT, CHO and TG were analysised and correlation between the preinatal prognosis and the companed in 60 cases were compared. Results According to the hne of Weiner, Hasak and Hangroup, theTBA （μmol/L） was80.7±8.14, 78.5±8.5, 69.4±7.3; TB （μmol/L） was55.9± 11.7, 55.8± 10.4, 45.5 ±13.3; ALP （U/L） was454.3±41.6, 441.8±40.8, 373.9±69.1; CHO （mmol/L） was8.7±0.6, 7.3±0.7, 8.1±0.6; TG （retool/L） was 5.8 ± 1.0, 5.7 ± 1.1, 3.7 ± 0.7 and F value of the five biochemical results were 10.31, 5.07, 12.06, 24.47, 30.17, there was significant difference among the three group （ P 〈 0.001）, DB （μmol/L） was 63.2 ± 10.7, 62.0 ± 10.9, 57.6 ± 12.7; ALT （U/L） was 136.5± 26.7, 131.4 ± 25.0, 119.6 ± 28.6; γ- GT （U/L） was 27.6 ± 5.9, 21.5 ± 9.0, 18.5 ± 6.4, and F value of the five biochemical results were 1.29, 1.93, 1.72, there was no significant difference among the flame group.Comparing each other between Weiner and Han, Hasak and Han, q level TBA was 6.26, 5.06, q level of TB was 3.93, 3.89, q level of ALP was 6.69, 5.65, qof CHO was 10.10, 8.51, q of TG was 10.18, 9.60, So there is significant difference between Weiner and Hasak groups. About DB, ALT and γ - GT, the comparision with each other among Weiner, Hasak and Han group was no significant difference. The cases of premature delivery, fetal distress, postpartum he morrhage, Apgar≤7＇ in Weiner or Hasak group were more than the cases of Hart group.There was significant difference in premature delivery,meconium - stained amniotic fluid Ⅲ° and Apgar≤7＇ among the three groups （P 〈 0.05）. There was significant difference in fetal distress and post partum hemorrhage.Compared with other two groups, there was significant difference in premature delivery. （x^2 = 6.46, 5.01）; meconium-stained amniotic fluid Ⅲ° （x^2 = 6.64, 5.23） ; Apgar≤7＇ （x^2 = 6.46, 5.01） of Weiner and Han group or Hasak and Han group.There was no significant difference in cases of Weiner and Hasak （x^2=3.75） and there was no significant difference in fetal distress （x^2 = 3.64, 2.56, 0.10） and postpartum hemorrhage（x^2 = 2.85,1.91,0.10）. Conclusions The serum biochemical criterion in patients with ICP in Weiner and Hasak is higher than the Han nationality. The cases in company with premature delivery meconium - stained amniotic fluid Ⅲ° fetal distress, Apgar≤7＇, postpartum hemorrhage are more alum in Han nationality.Tiffs discovery provides basic material and theoretical foundation in curing and predicting ICP of the minorities in Xinjiang early, timely and reasonably afterwards.