早发妊娠期肝内胆汁淤积症对产妇及围产儿预后的影响

Impact of early onset intrahepatic cholestasis of pregnancy on maternal and perinatal infant

目的探讨早发妊娠期肝内胆汁淤积症对产妇和胎儿脐动脉血生化指标以及围产儿预后的影响。方法将妊娠28周前发病的45例作为早发组,将妊娠28周及以后发病的163例作为晚发组,另选择同期健康单胎妊娠孕妇100例作为对照组。结果三组血清TBA、TBIL、DBIL、CG、ALT、AST水平及病情严重程度差异显著(P<0.05)。三组血清TBA、TBIL、DBIL、CG、ALT、AST差异显著(P<0.05)。三组脐动脉血清TBA、NSE、cTnI、乳酸、pH值差异显著(P<0.05)。母亲血清TBA与新生儿脐动脉血清TBA、NSE、cTnI呈正相关(P<0.05)。早发组预后较晚发组更差(P<0.05)。结论妊娠28周前发病娠期肝内胆汁淤积症病情更严重,对生化指标的影响更显著,经治疗后分娩前生化指标虽得到改善,但仍显著影响脐动脉胎儿损伤相关指标如NSE、cTnI、乳酸水平,早产率高,围产儿预后差。

Objective To investigate the impact of early onset of intrahepatic cholestasis of pregnancy on maternal and fetal umbilical artery blood biochemical parameters, and the effects of perinatal infant prognosis. Methods Pregnancy before 28 weeks 45 cases of the disease were acted as early-onset group, 163 cases of the disease after 28 weeks of pregnancy as late-onset group, 100 cases of single pregnancy health pregnant women were chose as control group.Results The serum TBA, TBIL, DBIL, CG, ALT, AST levels and the disease severity of three groups were statistically significant（P〈0.05）. The serum TBA, TBIL, DBIL, CG, ALT, AST of three groups were statistically significant（P〈0.05）. Umbilical artery serum TBA, NSE, cTnI, lactic acid, pH value of three groups were statistically significant（P〈0.05）. Maternal serum and neonatal serum TBA umbilical artery, NSE, cTnI were positively correlated（P〈0.05）. Earlyonset group had worse prognosis late-onset group（P〈0.05）. Conclusion Pregnancy 28 weeks pregnant before the onset of intrahepatic cholestasis of more serious illness, the impact on biochemical indicators of more significant biochemical parameters before delivery after treatment, although improved, but still significantly affect fetal umbilical artery injuryrelated indicators such as NSE, cTnI, lactate levels, with higher premature birth rate, poorer prognosis of perinatal children.