早发型妊娠期肝内胆汁淤积症血清总胆汁酸水平与围产儿结局的关系

The relationship between different bile acid levels and perinatal outcomes in early-onset intrahepatic cholestasis of pregnancy

目的探讨早发型妊娠期肝内胆汁淤积症(ICP)不同血清总胆汁酸(TBA)水平与围产儿结局的关系。方法对重庆医科大学附属第一医院2006年6月至2012年7月收治的57例早发型ICP患者(孕周<28周)病例资料进行回顾性分析。根据ICP患者血清TBA水平,分为轻度组33例(10μmol/L≤TBA<40μmol/L)和重度组24例(TBA≥40μmol/L)。结果早发型ICP占同期产科住院患者总数的0.22%(57/26261),重度组血清总胆红素(TBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)均高于轻度组,两组比较,差异有统计学意义(P<0.05)。重度组与轻度组新生儿平均出生体重分别为(2981±308)g和(3192±327)g,平均分娩孕周分别为(35.1±2.2)周和(36.8±1.4)周,两组比较,差异均有统计学意义(P<0.05)。重度组羊水粪染率[33.3%(8/24)]和剖宫产率[100%(24/24)]均高于轻度组[分别为12.1%(4/33)和84.8%(28/33)],两组比较差异均有统计学意义(P<0.05)。重度组早产、胎死宫内、新生儿窒息发生率分别为50%(12/24)、4.2%(1/24)和29.2%(7/24),均高于轻度组的30.3%(10/33)、3.0%(1/33)和12.1%(4/33),两组比较差异无统计学意义(P>0.05)。结论早发型ICP患者TBA≥40μmol/L者较多,其围产儿不良结局发生率高,应高度重视。

Objective To evaluate the relationship between different serum total bile aeid （TBA） levels and perinatal outcomes in early-onset intrahepatie cholestasis of pregnancy （ICP）. Methods Fifty-seven cases of early-onset ICP, which were diagnosed by our hospital during the last 6 years, were included in this study. Their elinieal data were retrospectively reviewed. Results These 57 early-onset ICP cases occupied 0. 22% （57/26 261 ） of all the maternity inpatients during the study period. The levels of total bilirubin （BIL）, alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in severe group were significantly higher than those in mild group （P 〈 0. 05）. The average neonatal birth weight in severe group was lower than that in mild group [ （2981 ±308） g vs. （3192 ±327） g,P 〈0. 05） ] and the delivery gestational age in severe group was shorter than that in mild group [ （ 35. 1 ±2. 2） weeks vs. （ 36. 8 ±1.4） weeks ,P 〈 0. 051 - Significant difference can be found between severe gruup and mild group in meconium staining of amniotic fluid rate （33.3% vs. 12. 1% , P 〈0. 05） and eaesrean section rate （ 100% vs 84. 8% , P 〈0. 05）. The preterm birth rate （50. 0% vs. 30. 3% ） , neonatal asphyxia rate （29.2% vs. 12.1% ） and intrauterine fetal death rate （4. 2% vs. 3.0% ） showed no significant difference between severe group and mild group. Conclusion Severe ICP is more common in early-onset ICP and the possibility of disadvantageous perinatal outcomes is high, suggesting more attention should be paid to early-onset ICP.