妊娠肝内胆汁淤积症对胎儿结局的影响

Effects of intrahepatic cholestasis of pregnancy on perinatal fetal outcomes

目的了解妊娠肝内胆汁淤积症（ICP）对新生儿出生体重及胎儿结局的影响。方法回顾性调查2001年3月～2003年12月在我院分娩的4112例孕产妇，对其中的237例ICP患者的血清苷胆酸浓度、孕龄、胎儿体重、围产儿宫内窘迫、窒息及死亡等，与同期分娩的非ICP孕妇（3875例）的围产儿结局进行了比较。结果ICP发病率约为5．75％。ICP组平均孕龄和出生体重均明显低于正常组，有统计学意义（P〈0．001）。但两组间的新生儿体重差别主要表现在孕龄37周以上者。双胎和孕龄〈37周者。ICP组与正常组无明显差别。除双胎妊娠外，ICP组和非ICP组巨大儿发生率无明显差别，但ICP组早产儿和足月（≥37周）低体重儿发生率明显高于非ICP组。相关分析结果显示新生儿出生体重与孕龄呈显著正相关，r=0．44，P〈0．0001。而新生儿体重与孕妇血清的苷胆酸浓度无相关性。同时，ICP组剖宫产率明显高于非ICP组，分别为77．22％VS46．33％，有统计学意义P〈0．001。此外。新生儿窒息及新生儿死亡率（分别为3．51％和0．88％）明显高于非ICP组，有统计学意义（P〈0．01），但ICP组胎儿宫内窘迫发生率却明显低于非ICP组，有统计学意义（P〈0．05）．宫内死胎率在两组间无明显差别。结论ICP对围产儿的影响主要是早产儿、剖宫产儿增加及新生儿体重降低，新生儿窒息率和死亡率也可能增加。ICP患者血清苷胆酸水平对新生儿出生体重无明显影响。出生体重降低和早产率增加可能主要与医源性提前终止妊娠有关。通过有效处理和适时终止妊娠，可能降低胎儿宫内窘迫和死亡的发生并改善围产儿结局。

Objective To investigate the effects of intrahepatic eholestasis of pregnancy （ICP） on the birth body weight and the perinatal fetal outcomes. Methods A retrospective case control study was carried out,and serum cholic acid levels, the gestational age,neonatal birth body weight, fetal distress, neonate asphyxia and perinatal mortality of 237 ICP patients and 3 875 pregnant women without ICP（the control group） were investigated from March, 2001 to December, 2003. Those without ICP and other pregnancy complications were as the normal group. Results The morbility of ICP was 5.75 %. The average gestational age and neonatal birth body weight in ICP group were lower than that in normal group ,and the difference mainly existed among women whose the gestational age more than 37 weeks. The neonatal birth body weight of twins or less than 37 week gestation had no significant difference between ICP and the control groups. The fetal macrosomia rates in ICP group also had no marked difference when corn pared with that in control group. However, the rates of premature delivery and fetal growth restriction were significantly higher than those in the control group. There was positive correlation between the neonatal birth body weight and gestational age, but no correlation between the neonatal birth body weight and serum cholic acid levels in pregnant women. In addition, ICP group had higher cesarean rates than the control（respectively 77.22 % vs 46.33 % ） . The neonatal asphyxia rates （3.51% ） and mortality （0.88%） in ICP group were higher than those in the control group. However, the fetal distress rate was lower when compared with that in control group. There was no significant difference of fetal death rates between the two groups. Conclusion The main effects of ICP on perinatal fetuses were that increasing the premature birth rates, cesarean birth rates,neonatal asphyxia rates and the mortality, and decreasing the neonatal birth body weight. The serum cholic acid levels in pregnant women has no effect on the neonatal birth body weight. The lower neonatal birth body weight and the higher premature birth rates in ICP patients may be mainly caused by prematurely terminating the pregnancy. The fetal distress and death rates in uterine may be decreased by the effective treatment and terminating pregnancy at appropriate time.