妊娠肝内胆汁淤积症对母婴预后的影响

Effects of Intrahepatic Cholestasis of Pregnancy on Prognosis of Gravida and Fetus

目的:探讨妊娠肝内胆汁淤积症(intrahepatic cholestasis of preganancy,ICP)孕妇肝功能损害及胆汁酸变化与母儿预后的关系。方法:将我院164例ICP孕妇按转氨酶水平分成A1、A2、A3组,按胆红素水平分为B1、B2、B3组;按血清总胆汁酸(TBA)值高低分成C1、C2、C3组。分析各组围生儿及孕产妇预后。结果:血清总胆汁酸值愈高,肝功能损害越严重,胎儿窘迫、新生儿窒息及围生儿死亡率越高,孕产妇瘙痒及产后出血发生率明显增加(P<0.05)。结论:ICP孕妇TBA、TBIL、ALT明显增高者,围生儿预后差,产科并发症增加,应高度重视,适时剖宫产将明显改善母儿预后。

Objective：To explore the relation between liver damaged with intrahepatic cholestasis of pregnancy（ICP） and prognosis of women and fetus.Methods：From June 2004 to June 2007 in our hospital,164 cases with ICP were collected in this study.Level of alanine aminotransferase（ALT）were as follows： group A1,＆lt;40u/L;group A2,（40~200）u/L;group A3,＆gt;200u/L.And participants were assigned in group B1、B2、B3 on basis of level of total bilirubin（TBIL）,as well as group C1、C2、C3 on basis of level of total bile acid（TBA）.The assessment of prognosis of pregnancy women and fetus were performed in the each of group. Results：The incidence rates of fetal distress, perinatal death of fetus and asphyxia of newborn infants increased gradually with increased TBA （ P 〈 0.05）, and so also was in pruritus and postpartum hemorrhage of gravida （ P 〈 0.05 ）. Conclusions： The Women with ICP would have severe fetal prognosis and complication if their serum concentration of bile acids, alanine aminotransferase and total bilirubin were higher in pregnancy period.