妊娠期肝内胆汁瘀积症脂质过氧化作用与围产儿预后关系的探讨

A STUDY ON THE CORRELATION BETWEEN LIPID PEROXIDATION OF INTRAHEPATIC CHOLESTASIS DURING PREGNANCY AND THE OUTCOME OF PERINATAL INFANTS

目的:探讨脂质过氧化作用与ICP围产儿预后的关系。方法:分别用硫代巴比妥酸荧光测定法和邻苯三酚自氧法测定同期正常晚期妊娠妇女102例(对照组)及妊娠期肝内胆汁瘀积症(ICP)患者126例(观察组)的血浆和脐静脉血脂质过氧化物(LPO)和红细胞超氧化物歧化酶(RBC-SOD)活性;比较新生儿出生体重、Apgar评分和羊水状况。结果:ICP组宫内发育迟缓(IUGR)、羊水异常和新生儿窒息率均明显高于对照组(P<001)。ICP组母儿血LPO浓度均明显高于对照组(P<001);母血RBC-SOD活性明显高于对照组(P<001),脐血RBC-SOD活性与对照组无显著性差异(P>005)。在ICP组,IUGR、新生儿窒息和羊水异常时,脐血LPO浓度均明显增高,而脐血RBC-SOD活性均明显下降。ICP组脐血LPO与新生儿出生体重和Apgar评分呈明显负相关(r=-0584,P<001;r=-0475,P<005)。结论:脂质过氧化作用与ICP的IUGR、新生儿窒息和胎儿宫窘迫等围产儿不良预后密切相关。

To study the correlation of lipid peroxidation of intrahepatic cholestasis during pregnancy (ICP) and the outcome of perinatal infants.Methods:In 126 cases of ICP group and 102 cases of the control group, maternal plasma, the concentration of lipid peroxidate (LPO) in umbilical cord vein and the amount of superoxide dismutase in red blood cell (RBC-SOD) were measured with thiobarbituric acid fluorimetry and catechol self-oxidation determination respectively. The fetal outcomes were assessed by the neonatal weight at delivery, Apgar scores and the quality and quantity of amniotic fluid.Results:(1) The rate of the abnormal quality and quantity of amniotic fluid, the intrauterine growth retardation (IUGR) and the neonatal asphyxia in ICP were significantly higher than those in the control group ( P <0.01, respectively). (2) Maternal plasma and the LPO levels in umbilical cord vein in ICP group were significantly higher than those in the control group ( P <0.01, respectively). (3)The level of RBC-SOD of maternal plasma in ICP group was significantly higher than that in the control group ( P <0.01). There was no significant difference of the level of RBC-SOD in umbilical cord vein between ICP group and the control group ( P >0.05). (4) In ICP group, the LPO level in umbilical cord vein in the subgroup of adverse perinatal outcomes was significantly higher than that in the subgroup of good perinatal outcomes, and the RBC-SOD level was significantly lower. (5) There was a negative correlation between the LPO in umbilical cord vein and the neonatal weight at delivery and Apgar scores in ICP group ( r =-0.584, P <0.01; r =-0.475, P <0.05). Conclusions: Lipid peroxidation has a significant relationship with adverse perinatal outcomes in ICP.