妊娠肝内胆汁淤积综合征相关新生儿肺损伤的危险因素分析

Risk factors of intrahepatic cholestasis of pregnancy-induced neonatal lung injury

目的探讨妊娠肝内胆汁淤积综合征孕妇所娩新生儿发生肺损伤的危险因素。方法将我院妇产科诊断妊娠期肝内胆汁淤积症的产妇及其新生儿30例(ICP组)与同期正常分娩之孕妇及新生儿40例(对照组)列为研究对象,分析新生儿发生肺损伤的发病率及临床特点,比较母亲血清和羊水中总胆汁酸、甘胆酸及其与新生儿肺损伤之间的关系。结果 ICP组新生儿肺损伤发病率增加,新生儿肺损伤以暂时性呼吸过快、新生儿肺炎及新生儿呼吸窘迫综合征为主要类型;孕妇血清与羊水甘胆酸水平在一定范围内相关,且与新生儿肺损伤发病率相关性较好。血清甘胆酸上升至40μg/ml,或当血清总胆汁酸上升至30μmol/L时,羊水甘胆酸及总胆汁酸异常率超过75%,此时新生儿发生肺损伤的概率明显增加。结论母亲患妊娠肝内胆汁淤积综合征可增加新生儿肺损伤的发病机会,母亲血清及羊水中高胆酸(甘胆酸)水平可能是导致新生儿肺损伤的原因。

Objective To investigate the risk factors of lung injury in neonatal infants delivered by women with intrahepatic cholestasis of pregnancy（ICP）.Methods A total of 30 cases of ICP and their newborns were enrolled to ICP group,and another 40 pairs of matched mothers and newborns underwent normal delivery were defined as control group.The incidence and clinical features of neonatal lung injury were analyzed.The relationship of bile acid and glycocholic acid in the serum and amino fluid with lung injury of newborns in the two groups was studied.Results The incidence of neonatal lung injury in ICP group was significantly higher than in control group（P0.01）.Transient tachypnea,neonatal pneumonia and neonate respiratory distress syndrome were the major types of lung injury.There was a good correlation between maternal bile acid and incidence of neonatal lung injury.The incidence of neonatal lung injury was elevated when serum glycocholic acid was over 40 μg/ml or serum bile acid over 30 μmol/L.Conclusion High level of bile acid in the maternal blood and amino fluid might be the cause of neonatal lung injury.