不同严重程度妊娠期肝内胆汁淤积症患者胆汁酸、肝功能指标检测及其妊娠结局分析

Detection of Bile Acid and Liver Function in Patients with Intrahepatic Cholestasis of Pregnancy of Different Severity and Analysis of Pregnancy Outcome

目的:分析不同严重程度妊娠期肝内胆汁淤积症患者胆汁酸、肝功能指标检测变化及其妊娠结局,为临床预防及治疗提供参考依据。方法:选择2017年2月-2019年1月在本院进行治疗的妊娠期肝内胆汁淤积症患者106例为研究对象。应用酶循环法对所有患者进行胆汁酸(TBA)检测,使用乙肝荧光定量PCR检测法检测白蛋白(ALB)、球蛋白(GLB)、谷丙转氨酶(GPT)、总胆红素(TBil)、碱性磷酸酶(ALP)、丙氨酸转氨酶(ALT)等肝功能指标。根据检测结果将患者分为轻度、中度、重度组,比较各组患者检测结果及妊娠结局。结果:中度组与重度组的TBA水平分别为(26.41±4.38)、(51.35±6.49)μmol/L,TBil水平分别为(208.91±10.52)、(373.5±21.85)μmol/L,ALP水平分别为(223.54±15.52)、(335.72±21.84)U/L,GPT水平分别为(134.45±6.71)、(214.32±12.34)U/L,均显著高于轻度组的(14.71±2.02)μmol/L、(174.45±4.57)μmol/L、(112.58±12.53)U/L、(53.83±5.57)U/L,差异均有统计学意义(P<0.05)。中度组与重度组的ALB水平分别为(29.26±3.43)、(20.67±2.61)g/L,GLB水平分别为(39.99±4.97)、(52.58±5.75)g/L,均显著低于轻度组(34.32±4.82)、(35.57±3.24)g/L,差异均有统计学意义(P<0.05)。中度组与重度组的剖宫产率分别为60.00%、75.00%,均显著高于轻度组的28.21%,差异均有统计学意义(P<0.05)。中度组与重度组的新生儿体重分别为(2.95±0.71)、(2.57±0.46)kg,新生儿Apgar评分分别为(2.95±0.71)、(2.57±0.46)分,均显著低于轻度组(3.02±1.13)kg、(9.05±1.07)分,差异均有统计学意义(P<0.05)。中度组与重度组羊水污染、新生儿黄疸、新生儿窒息、早产、胎儿窘迫、新生儿死亡等情况的发生率均显著高于轻度组,差异均有统计学意义(P<0.05)。结论:妊娠期肝内胆汁淤积症患者胆汁酸、肝功能指标的检测指标越高,其不良妊娠现象发生率也随之增长,加强患者胆汁酸、肝功能指标检测能够有效预判妊娠结局。

Objective:To analyze the changes of bile acid,liver function and pregnancy outcome in patients with intrahepatic cholestasis of pregnancy of different severity,and to provide reference for clinical prevention and treatment.Method:A total of 106 patients with intrahepatic cholestasis during pregnancy who were treated in our hospital from February 2017 to January 2019 were selected as subjects.Bile acid(TBA)was detected by enzyme circulation method in all patients.Albumin(ALB),globulin(GLB),alanine aminotransferase(GPT),total bilirubin(TBil),and alkaline phosphatase(ALP)were detected by fluorescence quantitative PCR.According to the results,patients were divided into mild,moderate and severe groups,and the results and pregnancy outcomes of each group were compared.Result:The levels of TBA were(26.41±4.38),(51.35±6.49)μmol/L,TBil levels were(208.91±10.52)and(373.5±21.85)μmol/L,ALP levels were(223.54±15.52)and(335.72±21.84)U/L,GPT levels were(134.45±6.71)and(214.32±12.34)U/L in moderate group and severe group,which were significantly higher than(14.71±2.02),(174.45±4.57)μmol/L,(112.58±12.53),(53.83±5.57)U/L in the mild group,the differences were statistically significant(P<0.05).The levels of ALB were(29.26±3.43)and(20.67±2.61)g/L,GLB levels were(39.99±4.97)and(52.58±5.75)g/L in moderate group and severe group,which were significantly lower than(34.32±4.82)and(35.57±3.24)g/L of mild group,the differences were statistically significant(P<0.05).The cesarean section rates in moderate group and severe group were 60.00%and 75.00%,respectively,which were significantly higher than 28.21%in mild group,the differences were statistically significant(P<0.05).The weight of newborns in moderate group and severe group were(2.95±0.71)and(2.57±0.46)kg,respectively,the Apgar scores of newborns were(2.95±0.71)and(2.57±0.46)scores respectively,which were significantly lower than(3.02±1.13)kg and(9.05±1.07)scores in mild group,the differences were statistically significant(P<0.05).The incidence of amniotic fluid pollution,neonatal jaundice,neonatal asphyxia,premature delivery,fetal distress and neonatal death in moderate and severe groups were significantly higher than those in mild group,the differences were statistically significant(P<0.05).Conclusion:The higher the detection indexes of bile acid and liver function in patients with intrahepatic cholestasis of pregnancy,the higher the incidence of adverse pregnancy,strengthening the detection of bile acid and liver function can effectively predict pregnancy outcome.