妊娠期肝内胆汁淤积症患者血脂、肝功能和雌激素水平的变化及临床意义

Changes of serum lipids,liver function tests and estrogen levels in patients with intrahepatic cholestasis of pregnancy and its clinical significance

目的探讨妊娠期肝内胆汁淤积症(ICP)患者血脂、肝功能和雌激素水平的变化及意义。方法2014年3月~2018年9月本院就诊的120例ICP患者,其中轻度组81例,重度组39例,另选择同期健康孕妇50例作为对照组。采用放射免疫法测定血清雌二醇和雌三醇及总胆汁酸(TBA)水平。结果重度ICP患者血甘油三酯(TG)、总胆固醇(CHOL)和低密度脂蛋白(LDL)水平分别为(4.9±0.8)mmol/L、(7.9±1.0)mmol/L和(4.1±1.3)mmol/L,显著高于轻度组的(3.3±0.7)mmol/L、(5.7±0.8)mmol/L和(3.2±0.7)mmol/L或对照组的[(2.3±0.5)mmol/L、(4.5±0.6)mmol/L和(2.1±0.5)mmol/L,P<0.05],重度组患者血TG、CHOL和LDL水平显著高于轻度组,差异具有统计学意义(P<0.05);重度ICP患者血清AST、ALT和TBA水平分别为(93.2±43.5)U/L、(87.7±52.3)U/L和(65.3±37.5)μmol/L,显著高于对照组的(38.3±7.4)U/L、(41.4±6.5)U/L和(8.9±5.2)μmol/L或者轻度ICP组的[(43.4±11.6)U/L、(39.3±11.5)U/L和(15.2±6.5)μmol/L,P<0.05];重度ICP患者血清雌二醇和雌三醇水平分别为(83.6±13.5)ng/L和(47.82±20.19)ng/L,显著高于轻度组的(67.2±11.4)ng/L和(39.2±15.4)ng/L或对照组的[(43.2±7.5)ng/L和(23.3±12.6)ng/L,P<0.05];重度组患者早产、新生儿窒息和宫内窘迫发生率分别为18.0%、12.8%和12.8%,显著高于轻度组的11.1%、8.6%和9.9%,也显著高于对照组的2.0%、0.0%和2.0%(P<0.05)。结论ICP患者血脂、肝功能和雌激素水平发生了显著的变化,对诊断和治疗具有重要的意义。

Objective The aim of this stud was to investigate the changes and its clinical significance of serum lipids,liver function index and estrogen levels in patients with intrahepatic cholestasis of pregnancy(ICP).Methods The clinical data of 120 patients with ICP who were admitted in our hospital between March 2014 and September 2018 were analyzed.According to the severity of ICP,there were 81 patients with mild and 39 patients with severe ICP.Another 50 healthy pregnant women in the same period were selected as the control group.Serum estradiol,estratriol and total bile acid(TBA)levels were detected by RIA.Results Blood triglyceride(TG),total cholesterol(CHOL)and low density lipoprotein(LDL)levels in patients with severe ICP were(4.9±0.8)mmol/L,(7.9±1.0)mmol/L and(4.1±1.3)mmol/L,significantly higher than(3.3±0.7)mmol/L,(5.7±0.8)mmol/L and(3.2±0.7)mmol/L in patients with mild ICP or[(2.3±0.5)mmol/L,(4.5±0.6)mmol/L and(2.1±0.5)mmol/L,P<0.05]in healthy women(P<0.05);serum aspartate aminotransferase(AST),alanine aminotransferase and TBA levels in patients with severe ICP were(93.2±43.5)U/L,(87.7±52.3)U/L and(65.3±37.5)μmol/L,significantly higher than(38.3±7.4)U/L,(41.4±6.5)U/L and(8.9±5.2)μmol/L in healthy individuals or[(43.4±11.6)U/L,(39.3±11.5)U/L and(15.2±6.5)μmol/L,respectively,P<0.05]in patients with mild ICP;serum estradiol and estratriol levels in patients with severe ICP were(83.6±13.5)ng/L and(47.82±20.19)ng/L,significantly higher than(67.2±11.4)ng/L and(39.2±15.4)ng/L in patients with mild ICP or[(43.2±7.5)ng/L and(23.3±12.6)ng/L,P<0.05]in the control;the incidences of preterm delivery,neonatal asphyxia and intrauterine distress in patients with severe ICP were 18.0%,12.8%and 12.8%,much higher than 11.1%,8.6%and 9.9%in patients with mild ICP or 2.0%,0.0%and 2.0%in the control(P<0.05).Conclusion The blood lipids,liver function tests and estrogen levels in patients with ICP changes greatly,which might help evaluate the severity of ICP and guide clinical managements.