妊娠期肝内胆汁瘀积症并发早产37例临床分析

Clinical characters and treatment of intrahepatic cholestasis of pregnancy: a retrospective study of 37 cases

目的:探讨妊娠期肝内胆汁瘀积症(ICP)患者早产的临床特点及处理方法。方法:对在我院定期产前检查、单胎妊娠、初次确诊时无妊娠合并症及其他并发症的ICP患者157例的临床资料进行回顾性分析,根据妊娠结局分为早产组及足月产组,对两组患者发病孕周、发病时及分娩前的总胆汁酸水平,妊娠期间其他并发症发生情况、分娩孕周、妊娠结局进行分析。结果:ICP患者中医源性早产发生率为75.67%,70.27%的早产发生于孕34周后。早产组ICP发病时间明显早于足月产组,初次确诊时及分娩前胆汁酸水平早产组均明显高于足月产组,且早产组治疗后胆汁酸下降不理想,早产儿不良结局发生率高。结论:血总胆汁酸水平的动态监测可作为判断预后和预测早产的指标。积极有效地治疗与监测可在一定程度上降低早产的临床发生率,改善围产儿预后。

Objective： To explore the clinical characters and treatment of intrahepatic cholestasis of pregnancy （ICP） . Methods： A retrospective study was performed on 157 patients with ICP admitted in our hospital from January 2002 to January 2007. All patients were singleton pregnancy and underwent regular antepartum examination in our clinic. No other pregnancy complications were found when they were firstly diagnosed as ICP. All patients were divided into the premature group and the term delivery group. The gestational week at which ICP occurred, the serum levels of bile acid at diagnosis and before delivery, the other pregnancy complications and the maternal and neonatal outcomes were assessed between two groups. Results： The rate of intervened premature delivery in ICP was 75. 67%. 70. 27% premature delivery occurred after 34 gestational week. The gestational week at which ICP occurred, the bile acid levels at diagnosis and before delivery were significantly higher in the premature group. After regular treatment, the bile acid levels of the premature group decreased much slower than that of term delivery group. And the incidence of adverse neonatal outcomes was higher in the premature group. Conclusion： Dynamic monitoring of the serum levels of bile acid could be a useful index to predict the prognosis of ICP and forecast premature labor. Active and effective management and monitoring may help reduce the incidence of premature delivery and improve the quality of life of the neonates.