妊娠期肝内胆汁瘀积症血脂改变及其临床意义

The Changes of Serum Lipids in Intrahepatic Cholestasis During Pregnancy and Its Clinical Significance

目的 探讨妊娠期肝内胆汁瘀积症 (ICP)血脂变化的特点及其临床意义。 方法 收集 74例妊娠晚期 ICP患者和 71例正常孕妇空腹血清 ,测定其血脂和载脂蛋白 ,进行比较 ;并观察ICP血脂变化与肝功能异常、母婴并发症及妊娠结局的关系。 结果 (1) ICP组总胆固醇、甘油三酯、低密度脂蛋白、极低密度脂蛋白及载脂蛋白 B分别为 (7.3± 1.6 )、(4.4± 1.6 )、(3.9± 1.8)、(2 .0± 0 .8)和 (1.7± 0 .3) mm ol/ L ,显著高于正常妊娠组 (5 .9± 1.0、3.4± 1.6、2 .9± 1.0、1.6± 0 .8)和(1.0± 0 .3) m m ol/ L,(P均 <0 .0 5 ) ,高密度脂蛋白为 (1.2± 0 .5 ) m m ol/ L,显著低于正常妊娠组 (1.6± 0 .4) mm ol/ L,(P<0 .0 5 ) ;(2 )如将 95 %正常妊娠妇女血脂数值作为正常值范围 ,把 ICP病例分成血脂正常和异常组 ,则 ICP中血脂异常组丙氨酸转氨酶和碱性磷酸酶水平 (190 .3± 15 7.5和 334 .4±147.4) u/ L高于血脂正常组 (12 9.9± 10 7.1)和 (2 81.6± 10 2 .9) u/ L ,(P<0 .0 5 ) ,其羊水污染、胎儿窘迫、早产及新生儿并发症发生率显著增高 ,产后出血及围产儿死亡亦有增多的趋势。 结论 ICP患者血脂多有异常 ,能反映病情的严重性 ,应做为 ICP常规监测指标。

Objective To identify the characteristic and clinical significance of the changes of serum lipids in intrahepatic cholestasis during pregnancy (ICP). Methods The concentrations of serum lipids were measured in 74 cases of ICP and 71 cases of normal pregnant women. The relationships between the serum lipid concentration and the abnormal ities of hepatic function, complications of mother and newborn or pregnant outcome in ICP were analyzed. Results (1)The levels of CHOL,TG,LDL,VLDL and APOB of ICP group (7 3±1 6,4 4±1 6,3 9±1 8,2 0±0 8) and (1 7±0 3)mmol/L,respectively, were significantly higher than those of the normal pregnant group (2.9±1.0, 3.4±1.6, 2.9±1.0, 1.6±0.8) and (1.0±0.3) mmol/L,respectively), P <0.05. The level of HDL (1.2±0.5) mmol/L, was lower than of normal pregnancy group (1.6±0.4) mmol/L, P <0.05 (2)When the serum lipid values of 95% normal pregnant women were taken as the normal ranges and the ICP cases were divided into normal and abnormal serum lipid groups, the levels of ALT (190.3±157.5)μ/L and ALP (334.4±147.4)μ/L in the abnormal serum lipid group were dramatically higher than those (129.9±107.1) and (281.6±102.9) in the normal serum lipid group( P <0.05). The occurrences of meconium stained amnionic fluid, fetal distress, premature delivery and complications of newborn were significantly increased; and the occurrences of postpartum hemorrhage and perinatal death increased in the abnormal serum lipid group. Conclusions The abnormal change of serum lipids in patients with ICP is common and reflects the severity of ICP. So serumlipids and should be examined routinely in ICP.