妊娠期肝内胆汁淤积症患者血清胆汁酸及血液流变学指标变化及其临床意义

Clinical significance of serum total bile acid and hemorheology indexes in intrahepatic Cholestasis of pregnancy

目的探讨妊娠期肝内胆汁淤积症(ICP)患者血清胆汁酸(TBA)和血液流变学指标变化及其临床意义。方法选择单胎妊娠ICP患者30例为ICP组、单胎正常妊娠妇女18例为正常妊娠组,并根据胎儿是否出现胎内窘迫将ICP组分为ICP缺氧组(14例)和ICP正常组(16例)。测试每组母血及胎儿脐带血的TBA值及脐带血血液流变学指标,包括全血还原黏度(RV)、血浆黏度(PV)、全血比黏度高切(HS)、全血比黏度低切(LS)、红细胞压积(HCT)变化。结果 ICP缺氧组的TBA水平明显高于ICP正常组及正常妊娠组(P<0.05或P<0.01);ICP正常组与正常妊娠组的TBA水平差异亦显著(P<0.01);ICP缺氧组各血液流变学指标值均明显高于正常妊娠组(P<0.05或P<0.01),且RV、LS及HCT显著高于ICP正常组(P<0.05或P<0.01)。ICP正常组与正常妊娠组的RV、PV、LS、HCT有明显统计学差异(P<0.01)。结论 ICP患者TBA水平升高及血流变学的指标变化可以作为临床预测胎儿窘迫的重要指标。

Objective To investigate the clinical significance of serum total bile acid （TBA） and hemorheology indexes in inttrahepatic cholestasis of pregnancy （ICP）.Methods A total of 30 singleton pregnant women with ICP and 18 normal singleton pregnant women were recruited for ICP and normal group,respectively.Patients in ICP group were subdivided into hypoxia group （n =14） and Non-hypoxia group （n =16） according to the occurrence of fetal distress.Levels of TBA in umbilical cord blood and related hemorheology indexes,including reduced viscosity （RV）,plasma viscosity （PV）,high-sheard reduced viscosity （HS）,low-sheard reduced viscosity （L S） and hematokrit （HCT）,were observed.Results TBA levels in hypoxia group were significant higher than those in Non-hypoxia group and normal group （P〈0.05; P〈0.01）,and there was also significant difference between Non-hypoxia group and normal group （P 〈 0.01）.patients in hypoxia group reported higher levels in All hemorheology indexes compared to normal group （P 〈 0.05; P〈0.01）,and higher RV,LS and HCT compared to Non-hypoxia group （P〈0.05; P 〈0.01）.RV,PV,LS and HCT were significantly different between Non-hypoxia group and normal group （P 〈 0.01）.Conclusion Increased TBA and changes in hemorheology indexes could be important marker for prediction of fetal distress.