肝内胆汁淤积症对妊娠期患者肝生化指标、炎性细胞因子变化及胎儿结局的影响

Effects of intrahepatic cholestasis of pregnancy on liver function,inflammatory cytokines and fetal outcome

目的探讨妊娠期肝内胆汁淤积症(ICP)对患者肝生化指标、炎症细胞因子水平变化与胎儿结局的影响。方法2014年8月—2019年8月ICP患者96例(ICP组),平均(29.5±1.3)岁。ICP符合"妇产科ICP诊断标准(第7版)"。另选取同期收治正常妊娠患者100例(对照组)。两组患者年龄、孕次、剖宫产等无明显差异(P>0.05)。计量资料t检验比较;计数资料χ2检验比较。结果 ICP组患者血清胆汁酸(TBA)、ALT及AST为(35.9±5.8)μmol/L、(70.7±6.1)U/L及(86.0±7.9)U/L,与对照组[分别为(4.7±1.1)μmol/L、(16.0±4.1)U/L及(14.6±4.2)U/L]比,具有显著差异(P<0.05)。ICP组患者hs-CRP、IL-6及TNF-α为(13.5±0.6)mg/L、(0.7±0.1)ng/L及(142.0±7.9)ng/L,与对照组[分别为(8.4±0.4)mg/L、(0.4±0.1)ng/L及(82.6±5.2)ng/L]比,具有显著差异(P<0.05)。ICP组新生儿体质量、孕周、出生1 min Apgar评分、羊水浑浊、宫内窘迫及新生儿黄疸为(2860.4±30.5)g、(36.2±1.2)周、(8.2±0.3)分、33例(34.4%)、12例(12.5%)及28例(29.2%),与对照组[分别为(3205.8±40.2)g、(38.6±1.2)周、(9.4±0.4)分、7例(7.0%)、4例(4.0%)及8例(8.0%)]比,具有显著差异(P<0.05)。结论 ICP患者肝生化指标显著异常,同时炎性细胞因子明显高于正常患者,ICP患者相较于正常患者胎儿不良结局发生率高,临床中需要加以重视。

Objective To investigate the effects of intrahepatic cholestasis of pregnancy(ICP)on liver function,inflammatory cytokines and fetal outcomes.Methods Between August 2014 and August 2019,there were 96 patients with ICP(ICP group),with an average of(29.5±1.3)years old.ICP accorded with the Diagnostic criteria of ICP in Obstetrics and Gynecology(7 th edition).Another 100 patients with normal pregnancy were selected in the same period(control group).There was no significant difference in age,pregnancy and cesarean section between the two groups(P>0.05).Ttest comparison of measurement data andχ2 test comparison of counting data.Results Serum bile acid(TBA),ALT and AST in ICP group were(35.9±5.8)μmol/l,(70.7±6.1)u/l and(86.0±7.9)u/l,which were significantly different from those in control group(4.7±1.1)μmol/l,(16.0±4.1)u/l and(14.6±4.2)u/l,respectively)(P<0.05).HsCRP,IL-6 and TNF-αin ICP group were(13.5±0.6)mg/L/l,(0.7±0.1)ng/l and(142.0±7.9)ng/L/l,which were significantly different from those in control group(8.4±0.4)mg/l,(0.4±0.1)ng/l and(82.6±5.2)ng/l,respectively)(P<0.05).The neonatal weight,gestational week,Apgar score at 1 minute of birth,amniotic fluid turbidity,intrauterine distress and neonatal jaundice in ICP group were(2860.4±30.5)g,(36.2±1.2)weeks,(8.2±0.3)minutes,33 cases(34.4%),12 cases(12.5%)and 28 cases(29.2%),Compared with the control group[3205.8±40.2)g,(38.6±1.2)weeks,(9.4±0.4)minutes,7 cases(7.0%),4 cases(4.0%)and 8 cases(8.0%)]there was significant difference(P<0.05).Conclusion ICP patients have abnormal liver function and higher inflammatory cytokines than normal patients.compared with normal patients,ICP patients have a higher incidence of fetal adverse outcome,which should be paid more attention to in clinic.