妊娠合并肝内胆汁淤积症胎儿宫内缺氧预测指标的研究

Study on The Predictive Indexes for Fetal Distress in Intrahepatic Cholestasis of Pregnancy

目的探讨妊娠合并肝内胆汁淤积症（ＩＣＰ）胎儿宫内缺氧的预测指标。方法对１０７例ＩＣＰ患者多项临床及实验室指标进行观察，并将其与围产儿结局进行对照分析。结果皮肤瘙痒持续时间≥３周、血清转氨酶和胆红素同时升高、ＮＳＴ胎心基线率变异消失者羊水胎粪污染率、新生儿窒息率及围产儿病死率，分别高于皮肤瘙痒持续时间＜３周（Ｐ＜００１）、单纯转氨酶升高而胆红素值正常（Ｐ＜００１）、ＮＳＴ胎心基线率变异正常者（Ｐ＜００１）。血清甘胆酸升高的程度与羊水胎粪污染和新生儿Ａｐｇａｒ评分无关。结论皮肤瘙痒持续时间≥３周、血清转氨酶和胆红素同时升高、ＮＳＴ胎心基线率变异消失可作为预测ＩＣＰ胎儿宫内缺氧的指标。

Objective\ To investigate the clinical predictive indexes for fetal distress in intrahepatic cholestasis of pregnancy(ICP).Methods\ Multiple clinical and laboratorial indexes were observed in 107 patients with ICP,and the neonatal outcomes were compared with these indexes.Results\ The risks of meconium passage,neonatal asphyxia and perinatal death were higher in patients with pruritic period persisting over three weeks,elevated level of both serum concentration of transaminase and bilirubin and disappearance of variation of fetal heart rate baseline in NST than those in patients with pruritic period less than three weeks( P <0 01),abnormal serum concentration of transaminase only( P <0 01),and normal variation of fetal heart rate baseline in NST( P <0 01).There is no relationship between serum cholyglycine and meconium passage and neonatal Apgar scores( P >0 05).Conclusions\ They might be the predictive indexes for fetal distress in ICP that the itching period lasting more than three weeks,both serum concentration of transaminase and bilirubin rising abnormally,and NST showing disappearance of variation of fetal heart rate baseline.