妊娠期肝内胆汁淤积症胆汁酸、肝酶指标对妊娠结局的影响

The influences of bile acid and liver enzymes on the pregnancy outcome in patients with intrahepatic cholestasis of pregnancy

目的探讨妊娠期肝内胆汁淤积症(ICP)不同胆汁酸和肝酶水平对围生儿妊娠结局的影响。方法依据胆汁酸和肝酶水平将本院的163例ICP患者分为轻度组、中度组和高度组,分析3组的分娩方式、常规指标(新生儿体重、胎龄、Apgar评分及并发症)和妊娠结局,并与正常孕妇作对照。结果 ICP中度组和重度组的剖宫产率均高于正常孕妇组和轻度组(P<0.01),常规指标差于其余两组,且新生儿死亡、小于胎龄儿、早产和低体重的发生率均高于其余两组(P<0.05);除重度组的常规指标差于中度组外,其余均差异无统计学意义;除1min Apgar评分外,轻度组的常规指标、分娩方式和妊娠结局均与正常孕妇组差异无统计学意义(P<0.05)。结论中重度妊娠期肝内胆汁淤积症行剖宫产的机率较大,新生儿常规指标及妊娠结局较差,应加强预防及治疗。

Objective To explore the influences of bile acid and liver enzymes on the pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy （ICP）. Methods One hundred and sixty-three patients with ICP were divided into mild group, moderate group and severe group according to the levels of bile acid and liver enzymes. The mode of delivery, conventional indicators （newborn weight, gestational age, Apgar score and complications） and pregnancy outcomes were analyzed among three ICP groups. Normal pregnant women were chosen as control group. Results Compared with normal pregnant woman and mild ICP group, there were higher cesarean section rate, worse conventional indicators and higher incidence rate of neonatal death, small for gestational age, premature birth and low birth weight in moderate group and severe ICP group. Only the conventional indicators of severe ICP group were worse than the moderate group. Despite of Apgar score at 1 min, there was no significant difference between normal pregnant woman and mild ICP group on conventional indicators, mode of delivery and pregnancy outcomes （P 〈 0.05）. Conclusion Pregnant woman with moderate and severe ICP were prone to take cesarean section with a worse conventional indicators and pregnancy outcomes. We should pay more attention to the prevention and treatment.