妊娠期肝内胆汁淤积症患者血清生化指标的变化及临床意义

Changes and clinical significance of the serum biochemical indicators in patients with intrahepatic cholestasis of pregnancy

目的探讨妊娠期肝内胆汁淤积症（ICP）患者血清生化指标的变化及临床意义。方法选择2012年1月～2013年12月在乌鲁木齐市第一人民医院（以下简称“我院”）产科就诊的62例妊娠期ICP患者作为观察组．选择同期在我院就诊的62例正常妊娠者作为对照组。使用日立7600全自动生化分析仪分别检测两组孕妇的血清总胆汁酸（TBA）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转肽酶（GGT）的水平；采用放射免疫法检测甘胆酸（CG）的水平；比较不同TBA、CG水平ICP患者其新生儿宫内窘迫和羊水污染发生情况。结果与对照组比较，观察组TBA值及CG值明显升高，差异均有高度统计学意义（P〈0．01）；观察组ALT、AST、GGT与对照组比较差异有高度统计学意义（P〈0．01）。观察组各项生化指标的异常情况依次为：TBA62例（100．0％）、CG61例（98．4％）、ALT55例（88．7％）、AST52例（83．9％）、GGT40例（64．5％）。观察组患者血清TBA或CG水平升高时．胎儿宫内窘迫及羊水污染的发生率均升高（P〈0．05），且当TBA和CG水平同时升高时，胎儿宫内窘迫及羊水污染发生率均明显升高（JP〈0．01）。结论围生期妇女进行血清TBA、CG及肝功能的常规检测是非常有必要的．可以作为中晚期妊娠的常规检验项目，用于ICP的筛查，而且TBA、CG水平的联合测定能更好地反映ICP对胎儿的影响程度。

Objective To investigate the changes and clinical significance of serum biochemical parameters in patients with intrahepatic eholestasis of pregnancy （ICP）. Methods All 62 patients with ICP admitted in the First People＇s Hospital in Urumqi City （＂our hospital＂ for short） from January 2012 to December 2013 were selected as the observation group, 62 cases of healthy pregnant women in our hospital at the same period were chosen as the control group. Levels of serum total bile acid （TBA）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, γ-glutamyl endopeptidase （GGT） in two groups were detected by Hitachi 7600 automatic biochemical analyzer; CG （CG） levels were detected by radioimmunoassay and the occurrence of fetal distress and amniotie fluid pollution in ICP patients with different levels of TBA, CG were compared. Results Compared with the control group, TBA, CG of the observation group were significantly increased, the differences were statistically significant （P 〈 0.01）; ALT, AST, GGT of the two groups had statistically significant differences （P 〈 0.01）. The abnormal condition of biochemical indicators in the observation group were： 62 cases of TBA （100.0%）, 61 cases of CG （98.4%）, 55 cases of ALT （88.7%）, 52 cases of AST （83.9%）, and 40 cases of GGT （64.5%）. With the raise of serum CG or TBA, the incidence rate of fetal distress and amniotic fluid pol- lution were significantly increased, the differences were statistically significant （P 〈 0.05）, and with the raise of serum TBA and CG, incidence rate of fetal distress and amniotic fluid pollution in the observation group were increased obviously （P 〈 0.01）. Conclusion Routine detection of serum TBA, CG and liver function for perinatal women is very nee-essary, it can be used as conventional test items in late pregnancy, screening for the ICP, and combined determination of TBA and CG can better reflect the impact of ICP on the fetus.