妊娠期肝炎血清总胆汁酸水平转归分析

The analysis of turnover among serum total bile acid levels in hepatitis during pregnancy

目的了解总胆汁酸(TBA)检测值在妊娠各型肝炎对胎儿的影响,以提供诊断及处理参考。方法将妊娠期不同病因肝炎与非妊娠期乙型肝炎比较,妊娠肝炎按妊娠孕周时间分组,对比TBA、肝生化检测值和临床转归;比较TBA异常孕妇与其新生儿的阿氏评分,评价TBA对新生儿的影响。结果妊娠肝炎各孕期组与病毒性肝炎组各项肝生化指标及TBA检测值对照差异均无统计学意义(P>0.05)。妊娠期肝炎与非妊娠期乙型肝炎在TBA检测值、ALT、AST及TBil检测值对照均呈正相关(P<0.01)。TBA≥50μmol/L组新生儿与TBA检测值正常组的新生儿阿氏评分对照,差异具有统计学意义(P<0.01)。新生儿评分低的病例多为产科异常。妊娠慢性乙型肝炎(CHB)ALT及TBA均明显高于无明显病因的妊娠期肝炎(P<0.05)。结论妊娠期肝炎肝功异常病例常伴有TBA增高。新生儿阿氏评分低、TBA≥50μmol/L和肝损害程度相关,但多有产科病因可寻,CHB对母婴健康影响较大。

Objective To observe the impact of value of total bile acid（TBA） on fetus in the different types of hepatitis during pregnancy,and to provide the reference for diagnosis and treatment.Methods Compare liver biochemical test and clinical outcome between the pregnant hepatitis and non pregnant hepatitis B patients.The impact of TBA level on neonatal was evaluated by comparing abnormal TBA in pregnant female and Apgar score.Results All liver biochemical indicators and TBA levels have no statistical differences between the different stages of pregnant hepatitis patients and the viral hepatitis patients（P0.05）.In the pregnant hepatitis and non pregnant hepatitis B patients,the levels of TBA,ALT,AST and TBil were positively correlated（P0.01）.Neonatal Apgar score had significant differences between TBA abnormal（TBA≥50 μmol/L） and TBA normal pregnancy group（P0.01）.Many cases of newborns with low scores were ensured to be obstetric abnormalities.The level of ALT and TBA in pregnancy chronic hepatitis B were significantly higher than those of pregnancy hepatitis without obvious pathogen（P0.05）.Conclusion Hepatitis during pregnancy was always accompanied with abnormal TBA.The lower neonatal Apgar score was associated with TBA abnormality and degree of liver injury,but sometimes it can be inferred from obstetric abnormalities.The maternal and children＇s health was mostly affected by chronic hepatitis B.