妊娠肝内胆汁淤积症脐动脉血流异常与胎儿宫内缺氧的关系

Relationship of abnormal umbilical artery flow velocity waveforms and fetal anoxia in intrahepatic cholestasis of pregnancy.

目的:探讨妊娠肝内胆汁淤积症(Intrahepatic cholestatis of pregnancy,ICP)患者胎儿脐动脉血流异常与胎儿宫内缺氧的关系。方法:ICP患者30例,正常足月妊娠32例,剖宫产当天测定脐动脉血流,剖宫产时检测脐动脉血pH值、有核红细胞及胆汁酸水平。结果:ICP缺氧组脐动脉血流异常高于ICP组胎儿不缺氧组,高于正常妊娠组(81.8％,15.8％,6.3％,P<0.05),ICP缺氧组脐动脉胆汁酸水平高于ICP不缺氧组,高于正常妊娠组(24.33±8.93,15.24±4.48,8.61±4.52,P<0.05),3组脐动脉有核红细胞比较,差异无统计学意义(5.09±3.24,3.84±1.46,3.81±1.71,P>0.05),ICP组脐动脉血流异常者的脐动脉胆汁酸水平高于ICP脐动脉血流正常者,高于正常妊娠组(24.83±9.49,15.50±4.66,8.61±4.37,P<0.05),而ICP组脐动脉血流异常者的pH值低于脐动脉血流正常者及正常妊娠组(7.17±0.06,7.29±0.04,7.30±0.03,P<0.05)。结论:ICP患者脐动脉血流异常与ICP胎儿宫内缺氧明显有关。ICP时高浓度的胆汁酸水平可致脐血管及胎盘绒毛表面血管收缩,胎盘血流灌注不足和胎儿缺氧。

Objective : To investigate the relationship of abnormal umbilical artery ( UmA) flow velocity waveform (FVWS) and fetal anoxia in intrahepafic cholestasis of pregnancy (ICP). Methods ; Color Doppler ultrasound was used to detect blood FVWS of UmA in 30 caces with ICP and 32 caces normal pregnancy before cesarean section. Results: The abnormal UmA FVWS rate in the group of ICP with fetal anoxia was higher than that without fetal anoxia,and higher than that in normal pregnancy group (81. 8% ,15. 8% ,6. 3% ,P < 0. 05) ;The mean bile acid consentration in ICP with fetal anoxia was higher than those without fetal anoxia, and higher than those in normal pregnancy group (24. 33±8.93,15.24±4.48,8.61±4. 52,P <0. 05). There was no significant difference of the mean cord nucleated red blood cells value among the three groups (5.09 ± 3.24,3. 84 ±1.46,3. 81±1. 71, P > 0. 05). The mean bile acid consentration of fetuses in abnormal UmA with ICP was higher than that among others of ICP group(24. 83 ±9.49,15.50 ±4.66,8.61 ±4. 37, P < 0. 05). But the mean UmA blood pH was lower than that among others of ICP group and normal pregnancy group (7. 17±0.06,7. 29 ±0.04,7. 30 ±0.03,P<0. 05). Conclusions;Abnormal UmA FVWS is related with fetal anoxia in ICP. The reduction of blood flow associated with the vesoconstrictive effect of bile acid especially at the level of placental plate and umbilical vessels in ICP leads to insufficient fetal infusion and oxygenation.