肝内胆汁淤积症患者妊娠结局与脐带血血液流变学的关系

The Relationship of Pregnancy Outcomes with Hemorheology of Umbilical Cord Blood in Pregnant Women with Intrahepatic Cholestasis

目的:探讨不同程度妊娠期肝内胆汁淤积症(ICP)孕妇的妊娠结局与脐带血血液流变学的关系。方法:测定156例ICP孕妇的血清胆红素、肝转氨酶和甘胆酸水平,按严重程度分为ICP轻度组、重度组,同时选取150例患者作为对照组,采集脐静脉血测定血液流变学指标,对血液流变学、产妇羊水粪染程度及其围产儿结局及妊娠并发症进行比较;并对血液流变学与产妇羊水粪染程度、其围产儿结局及妊娠并发症作相关性分析。结果:(1)ICP轻度组和ICP重度组孕妇脐静脉血血液流变学的指标均高于正常对照组孕妇,且ICP重度组孕妇的脐静脉血血液流变学指标比ICP轻度组高,组间对比差异有统计学意义(P<0.05);(2)ICP组羊水粪染、新生儿窒息的发生率明显高于对照组(P<0.001),ICP组(重度和轻度)羊水粪染、新生儿窒息的发生率相比,差异有统计学意义(P<0.01);ICP组低体重儿、围产儿死亡和产后出血的发生率与对照组比较,差异有统计学意义(P<0.01),ICP轻度组与重度组之间低体重儿、围产儿死亡和产后出血的发生率比较,差异无统计学意义(P>0.05);(3)各组围产儿死亡率与脐血血液流变学指标呈正相关(r=0.31,P<0.05)。结论:不同程度的ICP患者的围产儿预后不同,ICP围产儿的预后与脐带血血液流变学呈正相关。

Objective： To study the relationship between pregnancy outcomes and hemorheology of umbilical cord blood in pregnant women with intrahepatic eholestasis （ICP） of different degree. Meth- ods： Serum bilirubin, liver transaminase and glycocholic acid levels of 156 ICP women were deter- mined, and according to the severity, women were divided into mild group and severe group, and 150 healthy pregnant women were selected as control group. Umbilical cord blood was collected to detect hemorheology indexes. Hemorheology indexes, meconium-stained amniotic fluid degree, pregnant out- comes and complication were compared among the 3 groups, and the relationship among them was de- tected. Results： （1）The hemorheology indexes of umbilical cord blood in mild group and severe group were higher than those in control group, and those in severe group was higher than those in mild group, （ P 〈 0.05 ） ; （2） The incidences of meconium-stained amniotic fluid and neonatal asphyxia of ICP groups was significantly higher than those in control group （ P 〈 0. 001 ） , and there were signifi- cant differences between the two ICP groups （P 〈 0. 01 ）. The incidences of low birth weight infant, perinatal mortality and postpartum hemorrhage of ICP groups were higher than those in control group, （P 〈 0. 01 ）, but no significant difference was found between the two ICP groups （P 〉 0. 05）. （3） The perinatal mortality was positively correlated with hemorheology of umbilical cord blood （ r = 0.38,P 〈 0.05 ）. Conclusions： The perinatal infants of different degree ICP women have different progno- sis which may be correlated with hemorheology of umbilical cord blood.