妊娠肝内胆汁淤积症胎儿宫内缺氧机理的初步探讨

Study on the Mechanism for Fetal Asphyxia in Intrahepatic Cholestasis of Pregnancy

目的探讨妊娠肝内胆汁淤积症（ＩＣＰ）胎儿宫内缺氧的原因及机理。方法分别测定择期行剖宫产术的正常对照组胎儿４６例及ＩＣＰ组胎儿３７例脐静脉血促红细胞生成素（ＥＰＯ）水平；并利用人离体胎盘小叶双面灌流模型，比较正常胎盘膜及ＩＣＰ胎盘膜对氧的扩散功能。结果ＩＣＰ胎盘小叶对氧的转运速度在各时间点与正常胎盘小叶相似，ＩＣＰ胎儿脐血ＥＰＯ水平（１３．５８±８．８８ＩＵ／Ｌ）明显低于正常对照组胎儿（２０．４３±１４．１５ＩＵ／Ｌ，Ｐ＜０．０５）。结论ＩＣＰ胎盘膜对氧的扩散功能正常；ＩＣＰ胎儿ＥＰＯ水平低下，可能是其缺氧最重要原因之一。

Objective To investigate the cause of fetal asphyxia of mothers with intrahepatic cholestasis of pregnancy(ICP). Methods The cord plasma erythropoietin (EPO) concentrations were measured in 37 infants of mothers with ICP and 46 control infants after elective cesarean section. Furthermore, the transfer of oxygen across the placental membranes in ICP group ( n =7) were compared with controls ( n =8) by dual perfusion of the human placental lobule in vitro. Results The oxygen transfer across the placental membrane in ICP was similar to the controls ( P >0.05). However cord venous EPO was lower in infants delivered by elective cesarean section from women with ICP (13.58±8.88 IU/L, P <0.05) than that in control infants (20.43±14.15 IU/L). Conclusion The transfer of oxygen across the placental membrane in ICP may be normal. The lower cord venous EPO value in ICP may be mainly responsible for the fetal asphyxia.