不同临床分度妊娠期肝内胆汁淤积症对围产儿结局及分娩方式的影响

Intrahepatic cholestasis of pregnancy: Effect of clinical grading on perinatal outcomes and modes of delivery

目的探讨不同临床分度妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)处理时机与方式,以降低围产儿病率及死亡率。方法根据发病孕周及孕妇血清胆汁酸、丙氨酸转氨酶、门冬氨酸转氨酶、血清总胆红素、直接胆红素水平,将ICP分为轻度与重度,分别予以不同处理,比较其终止妊娠时机和方式与围产儿结局。结果轻度ICP 291例,重度ICP 183例,终止妊娠孕周分别为(38.3±1.5)周和(35.2±1.1)周,两组比较差异有统计学意义(P<0.01);重度组胎儿宫内窘迫、新生儿窒息、早产发生率均明显高于轻度组,差异有统计学意义(P<0.01)。结论产前对ICP进行临床分度及处理,有助于选择终止妊娠时机和分娩方式,从而降低围产儿病率及死亡率。

Objective To discuss the treatment of intrahepatic cholestasis of pregnancy（ICP） in different clinical grades.Methods According to onset date,the serum bile acid,alanine transaminase,aspartic acid transaminase,serum total bilirubin and bilirubin direct,ICP was divided two degrees,mild ICP（mild ICP group） and severe ICP（sever ICP group）.Different treatments were given according to clinical grading.Opportunity of pregnancy termination and perinatal outcome were compared between mild ICP and severe ICP.Results There were 291 cases of mild ICP.The time of pregnancy termination was in the（38.3±1.5）th gestational weeks.There were 183 cases of severe ICP.The time of pregnancy termination was in the（35.2±1.1）th gestational weeks.Difference between the two groups was significant（P0.01）.Fetal distress in uterus,neonatal asphyxia and incidence of premature delivery in sever ICP group were significantly higher than those in mild ICP group（P0.001）.Conclusion It is suggested to determine the opportunity of pregnancy termination and the modes of delivery according to different clinical grades and treatments of ICP.