妊娠期肝内胆汁淤积症血清甘胆酸水平对围生儿及孕妇影响

Effects of serum bile acid level on pregnant women with intrahepatic cholestasis of pregnancy and their fetuses

目的 观察妊娠期肝内胆汁淤积症（ICP）孕妇及胎儿结局,分析影响因素.方法 回顾性分析2009年3月～2011年6月河北省邯郸明仁医院ICP孕妇130例为观察组,选择同期无ICP孕妇150例为对照组,检测并比较两组孕妇终止妊娠前血清甘胆酸水平,观察并比较两组产妇产后出血情况、新生儿分娩方式以及产后新生儿窘迫、新生儿窒息等胎儿预后情况.结果 观察组血清甘胆酸水平[（1872.5±837.5）μg/dL]明显高于对照组[（137.6±79.3） μg/dL],差异有高度统计学意义（t=4.27,P＜0.01）.观察组胎儿窘迫、新生儿窒息、早产发生率（44.6％、18.5％、20.8％）均高于对照组（15.3％、6.0％、l2.7％）,差异均有统计学意义（x2=16.673、6.715、4.146;P=0.002、0.001、0.015）;观察组产妇分娩时大出血（≥400 mL）、胎死宫内发生率（22.3％、3.8％）与对照组（12.0％、1.3％）相比较,差异均无统计学意义（x2=1.179、3.436;P=0.053、0.051）.随着血清甘胆酸水平升高,胎儿窘迫、胎儿窒息、早产发生率升高.结论 ICP对孕妇及胎儿均存在不良影响,对新生儿影响更大,且随着孕妇血清甘胆酸水平升高,新生儿预后愈差.临床上,对ICP患者应加强监测,及早采取干预措施.

Objective To explore the effects and influence factors of serum bile acid level of pregnant women with intrahepatic cholestasis of pregnancy （ICP） and the outcome of their fetuses.Methods 130 gravidas with ICP from March 2009 to June 2011 in Mingren Hospital of Handan City were selected as observation group,and the other 150 cases of gravidas who without ICP in the same period were chosen as control group.The amount of postpartum hemorrhage and the serum bile acid values before delivery were detected and compared,and the rate of fetal distress,neonatal asphyxia,premature delivery of two groups were observed and compared.Results The level of serum bile acid in the observation group [（1872.5±837.5） μg/dL] was obviously higher than that in the control group [（137.6±79.3）μg/dL],the difference was statistically significant （t =4.27,P ＜ 0.01）.The incidence of fetal distress,neonatal asphyxia and premature delivery in the observation group （44.6％,18.5％,20.8％） were obviously higher than those in the control group （15.3％,6.0％,12.7％）,the differences were statistically significant （x2=16.673,6.715,4.146; P=0.002,0.001,0.015）; the incidence of postpartum hemorrhage（≥ 400 mL） and stillborn foetusin in observation group （22.3％,3.8％） were higher than those of the control group （12.0％,1.3％）,there were no statistically significant difference （x2=1.179,3.436; P=0.053,0.051）.With the rising of the serum bile acid in the observation group,the rates of fetal distress,neonatal asphyxia and premature delivery raised.Conclusion ICP has adverse effects to both maternal and infants,and with the rising of the serum bile acid in patients,perinatal outcomes become worse,the monitoring of ICP patients should be strengthen in clinical practice,and take active measures timely.