妊娠期肝内胆汁郁积症合并妊娠期糖尿病诊治分析

Diagnosis and Treatment of Intrahepatic Cholestasis of Pregnancy and Gestation Diabetes Mellitus

目的探讨妊娠期肝内胆汁淤积症(ICP)合并妊娠期糖尿病(GDM)的围生期母儿结局。方法选取2010年1月—2015年1月中国人民解放军第451医院住院分娩ICP合并GDM者16例(研究组),单纯ICP 105例(对照组),分别观察两组并发症及分娩情况、围生儿结局。结果研究组妊娠期高血压疾病(PHI)、重度ICP发生率分别为12.5%(2/16)和25.0%(4/16),高于对照组的1.0%(1/105)和4.8%(5/105),差异有统计学意义(P=0.046和0.018)。研究组平均分娩时孕周为36.6周,对照组为36.7周,差异无统计学意义(P=0.545)。研究组早产发生率为25.0%(4/16),高于对照组的3.8%(4/105),差异有统计学意义(P=0.001)。两组剖宫产率分别为87.5%(14/16)和85.7%(90/105),差异无统计学意义(P=0.848)。两组羊水粪染、胎膜早破、胎儿窘迫、胎儿畸形、新生儿窒息、围生儿死亡、巨大儿、低出生体质量儿发生率比较,差异无统计学意义(P>0.05);研究组新生儿低血糖发生率高于对照组,差异有统计学意义(P<0.05)。研究组新生儿1 min Apgar评分为8.25分,低于对照组的8.87分,差异有统计学意义(P=0.02)。结论 ICP合并GDM使围生期母儿患病率增加,临床应严密监护、个体化治疗,适时终止妊娠,可降低围生期母儿患病率。

Objective To investigate the perinatal outcome of intrahepatic cholestasis of pregnancy（ ICP） and gestational diabetes mellitus（ GDM）. Methods 16 patients with ICP and GDM in 451 th Military Hospital from January 2010 to January 2015 as study group,105 patients with ICP as control group. The complications,delivery and perinatal outcomes were observed in the two groups. Results The incidence of PHI and severe ICP in the study group was 12. 5%（ 2/16） and 25. 0%（ 4/16）,respectively,higher than that in the control group 1. 0%（ 1/105） and 4. 8%（ 5/105）,the difference was statistically significant（ P = 0. 046 and 0. 018）. The average gestational age in the study group was 36. 6 weeks,and the control group was 36. 7 weeks,the difference was not statistically significant（ P = 0. 545）. The incidence of premature delivery in the study group was 25. 0%（ 4/16）,higher than that in the control group 3. 8%（ 4/105）,and the difference was statistically significant（ P = 0. 001）. The cesarean section rate of the two groups was 87. 5%（ 14/16） and 85. 7%（ 90/105）,respectively,the difference was not statistically significant（ P = 0. 848）. There were no significant differences in the incidence of meconium stained amniotic fluid, premature rupture of membranes, fetal distress, fetal malformation, neonatal asphyxia,perinatal death,macrosomia,and low birth weight infants between the two groups（ P 〉 0. 05）. The incidence of hypoglycemia in the study group was higher than that in the control group,the difference was statistically significant（ P 〈 0. 05）. The 1 min Apgar score of the study group was 8. 25 points,which was lower than that of the control group（ 8. 87）,the difference was statistically significant（ P = 0. 02）. Conclusion The incidence of perinatal maternal and neonatal morbidity increased with the ICP and GDM,and the clinical treatment should be closely monitored.