妊娠期肝内胆汁淤积症胎儿缺氧脑损伤的研究

Study of Fetal Brain Hypoxic Injury in Intrahepatic Cholestasis of Pregnancy

目的:探讨妊娠期肝内胆汁淤积症(ICP)患者胆汁酸水平、胎儿缺氧与胎儿脑损伤的关系。方法:选择2006年3月至9月在我院诊治的ICP患者(ICP组)及正常孕妇(正常妊娠组)各30例。采用彩色多普勒超声检测胎儿大脑中动脉收缩期峰值流速/舒张末期流速(S/D)、阻力指数(RI);用全自动生化分析仪测定母血及新生儿脐动脉血清胆汁酸(BA)、乳酸、和pH值;采用酶联免疫吸附试验(ELISA法)测定新生儿脐动脉血清神经元特异性烯醇化酶(NSE)浓度,并对两组的结果进行分析和比较。结果:①ICP组母血及脐血BA水平均高于正常妊娠组(P<0.01),并且ICP组母血与脐血BA呈正相关关系(r=0.937,P<0.01)。②ICP组脐血乳酸水平和NSE值均高于正常妊娠组(P<0.01);而ICP组脐血pH值、大脑中动脉血流S/D值、RI值均低于正常妊娠组(P<0.01);ICP组脐血NSE浓度分别与BA、乳酸水平呈正相关(P<0.01);与RI值、大脑中动脉血流S/D值及脐血pH值呈负相关(P<0.01)。结论:ICP胎儿存在缺氧和脑损伤,ICP胎儿脑损伤与胎儿缺氧及高浓度胆汁酸密切相关,对ICP患者胎儿大脑中动脉血流和脐动脉血pH值、乳酸浓度及NSE的联合检测,可早期诊断ICP胎儿缺氧,早期发现新生儿脑损伤。

Objective：To study the relation of bile acid levels and fetal hypoxia and brain injury in Intrahepatic Cholestasis of Pregnancy （ICP）. Methods： From May. 2006 to Sep.2006, we selected 30 cases of ICP as the study group, and randomly selected 30 cases of normal pregnant women for delivery during the same period as the control group in our hospital. Color Doppler ultrasound was used to measure the peak systolic velocity to end-diastolic velocity （S/D） and the resistive index （RI） of fetal middle cerebral artery, and the automatic biochemical analyzer be used to detect the total bile acid （BA） in maternal blood, and BA, pH as well as lactate in umbilical arterial serum; neuronspecific enolase （NSE） in umbilical artery serum was detected by ELISA. The results were analyzed and compared. Results. （1）The BA concentration in maternal blood and newbom umbilical artery blood of the study group was significantly higher than that of the control group （ P〈0.01 ）. In the study group, the BA in maternal and newbom blood were positively correlated （ r= 0.937, P〈0.01 ） ;（2）Lactate and the NSE Concentration in newborn umbilical artery of the study group was significantly higher than that of the control group （ P 〈 0.01 ）. The pH value in newborn umbilical artery and The S/D, RI value of fetal middle cerebral artery in the study group was significantly lower than those of control group （ P〈0.01 ） ; （3）In the study group, the NSE concentration was positively correlated with BA and lactate concentration in newborn umbilical artery, while negatively correlated with the S/D and RI values of fetal middle cerebral artery and the pH value in newbom umbilical artery （ P〈0.01 ） .Conclusions.Them is the existence of hypoxia and brain injury in fetus of ICP. By measuring the blood flow changes of fetal cerebral artery with Color Doppler and detecting pH, lactate as well as NSE levels in umbilical arterial blood, we could early predict the fetal hypoxia and diagnose the fetal brain injury in ICP.