ICP患者相关生化指标改变与母儿结局的关联研究

Study on the Relationship Between the Biochemical Changes and the Pregnancy Outcome in the Women with Intrahepatic Cholestasis of Pregnancy

目的探讨妊娠期肝内胆汁淤积症(ICP)孕妇的相关生化指标改变及与母儿结局的关系.方法回顾分析2013年6月—2017年12月在南京医科大学附属苏州医院确诊的ICP患者110例的临床资料,根据总胆汁酸(TBA)是否大于40μmol/L分为重度组和轻度组,其中重度组40例,轻度组70例,选择同时期的健康孕妇50例为对照组.测定三组孕妇血清TBA、碱性磷酸酶(ALP)及其胎盘型同工酶(PALP)、乳酸脱氢酶(LDH)及其5型同工酶(LDH1、LDH2、LDH3、LDH4、LDH5)、γ-谷氨酰酶(γ-GGT)、α-羟丁酸脱氢酶(α-HBDH)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)的水平,并同时记录各组母儿结局.结果重度组的TBA、ALP、LDH、ALT、AST分别为(45.3±4.6)μmol/L、(253.4±57.3)U/L、(242.1±66.1)U/L、(182.4±65.3)U/L、(153.4±47.6)U/L,高于轻度组及对照组,轻度组略高于对照组,LDH同工酶LDH5在ICP患者中呈上升趋势,PALP、γ-GGT、α-HBDH在三组间差异无统计学意义(P>0.05).重度组与轻度组在胎儿窘迫、早产、新生儿窒息、低体重儿及剖宫产发生率均显著高于对照组,差异有统计学意义(P<0.05).重度组与轻度组在胎儿窘迫、新生儿窒息及剖宫产发生率方面差异有统计学意义(P<0.05).在早产和低体重儿发生率方面,重度组与轻度组差异无统计学意义(P>0.05).ALP与TBA、AST、ALT呈正相关,相关系数分别是0.325、0.307、0.229;LDH与TBA、AST、ALT呈正相关,相关系数分别是0.331、0.374及0.381.而γ-GGT、α-HBDH与TBA、ALT、AST无相关性.结论ALP、LDH及其同工酶是预测ICP患者母儿结局的良好指标,具有较高的敏感性.

Objective To investigate the changes of biochemical indexes in the women of intrahepatic cholestasis of pregnancy(ICP)and its relationship with maternal and infant outcomes.Methods Clinical data of 110 ICP patients diagnosed in Suzhou Hospital Affiliated to Nanjing Medical University from June 2013 to December 2017 were retrospectively analyzed.They were divided into severe group and mild group according to whether TBA was greater than 40μmol/L,including 40 cases in severe group and 70 cases in mild group.50 healthy pregnant women of the same period were selected as normal control group.The serum levels of TBA,ALP and its placental isoenzyme(PALP),LDH and its isoenzymes(LDH,,LDH2,LDH3,LDH4,LDH5),7-GGT,a-HBDH,ALT,AST were measured in the three groups.The maternal and fetal outcomes of the three groups were recorded.Results TBA,ALP,LDH,ALT and AST in the severe group were(45.3±4.6)μmol/L,(253.4±57.3)U/L,(242.1±66.1)U/L,(182.4±65.3)U/L,(153.4±47.6)U/L,respectively,higher than that of mild group and the control group.Mild group slightly higher than the control group(P<0.05).LDH isozyme LDH5 in patients with ICP is on the rise.There was no significant difference in PALP,γ-GGT and α-HBDH among three groups(P>0.05).The incidence of fetal distress,premature delivery,neonatal asphyxia,low birth weight and cesarean section in severe and mild groups were significantly higher than those in control group,with statistical significance(P<0.05).There were significant differences in the incidence of fetal distress,neonatal asphyxia and cesarean section between the severe group and the mild group(P<0.05).There was no significant difference in the incidence of premature delivery and low birth weight between the severe and mild groups(P>0.05).ALP was positively correlated with TBA,AST and ALT,and the correlation coefficients were 0.325,0.307 and 0.229 respectively.LDH was positively correlated with TBA,AST and ALT,and the correlation coefficients were 0.331,0.374 and 0.381 respectively.However,there was no correlation between γ-GGT,α-HBDH and TBA,ALT,AST.Conclusion ALP,LDH and their isozymes are good indicators for predicting maternal and infant outcomes of ICP patients with high sensitivity.