早发型妊娠期肝内胆汁淤积症患者妊娠结局临床研究

Clinical studies of pregnant outcome of early-onset intrahepatic cholestasis of pregnancy

目的:探讨早发型妊娠期肝内胆汁淤积症(ICP)患者的临床生化指标特点及其围生结局。方法:收集2010年1月至2013年12月于温州市人民医院妇产科住院分娩的符合ICP诊断的226例患者的临床资料进行回顾性分析。按照ICP发病孕周不同,分为早发型ICP组(妊娠<28周,37例)及晚发型ICP组(妊娠≥28周,189例),并随机抽取同期正常分娩的产妇200例作为对照组。分析ICP组患者治疗前血清总胆汁酸(TBA)、总胆红素(TBIL)、丙氨酸转氨酶(ALT)水平及治疗后血清总胆汁酸(TBA)变化;分析3组间围生结局的差异。结果:1早发型ICP组患者治疗前后血清TBA水平均显著高于晚发型ICP组,2组比较差异有统计学意义(P<0.05)。2早发型ICP组在新生儿转入新生儿监护病房(NICU)的发生率上明显高于晚发型ICP组,差异有统计学意义(P<0.05);早发型ICP组与晚发型ICP组间在早产、胎儿生长受限、胎儿窘迫、新生儿窒息、剖宫产发生率及新生儿出生体质量方面,差异均无统计学意义(P>0.05)。3ICP组早产、胎儿窘迫、剖宫产及新生儿NICU的转诊发生率均显著高于对照组,新生儿出生体质量明显低于对照组。结论:ICP患者早产、胎儿窘迫、剖宫产及新生儿转入NICU的发生率较高,围生结局不良;早发型ICP患者血清TBA水平显著升高,新生儿转入NICU的发生率较高,不能忽视对早发型ICP患者的长期管理。

Objective：To analyze the clinical characteristics and perinatal outcome of early-onset intrahepatic cholestasis of pregnancy（ICP）.Methods：A total of 226 ICP cases were collected in the Third Clinical College of Wenzhou Medical University between Jan 2010 and Dec 2013.According to the onset time of ICP,patients were divided into early-onset ICP group（onset time28 gestational weeks） and late-onset ICP group（onset time≥28 gestational weeks）,200 normal pregnant women were randomly enrolled as controls.The levels of maternal serum total bile acid（TBA）,total bilirubin（TBIL）,alanine aminotransferase（ALT） and serum total bile acid（TBA） were evaluated.The perinatal outcome were assessed.Results：1The maternal serum concentrations of TBA in early-onset ICP group were higher than that in late-onset ICP group before and after treatment,and the difference between the two groups was statistically significant（P〈0.05）.2The early-onset ICP group had significant higher（P〈0.05） incidence of admission to the neonatal unit compared to the late-onset ICP group and the control group.There was no significant difference（P〈0.05） in incidence of premature delivery,fetal distress,fetal growth retardation,newborn asphyxia,cesarean section and average birth weight between the early-onset ICP group and the late-onset ICP group.3The ICP group had significant higher（P〈0.05） incidence of premature delivery,fetal distress,cesarean section and admission to the neonatal unit when compared to the control group.The average birth weight in the ICP group was lower than that in the control group.Conclusion：The ICP patients presents worse clinical manifestations than the controls.And ICP is much more likely to lead to fetal distress.The level of serum TBA is markedly elevated in the early-onset ICT patients.The incidence of admission to the neonatal unit is significantly higher compared to the controls.We can＇t ignore the long-term management of patients with early-onset ICP.