妊娠期肝内胆汁淤积症患者血清总胆汁酸的水平及终止妊娠的时间与其围产儿结局的相关性

Correlation between serum total bile acid levels,time of pregnancy termi nation and perinatal outcomes in patients with intrahepatic cholestasis during pregnancy

目的:探讨妊娠期肝内胆汁淤积症患者血清总胆汁酸的水平、终止妊娠的时间与其围产儿结局的相关性。方法:选取在绵阳市人民医院接受产检并完成分娩的妊娠期肝内胆汁淤积症患者183例,按照血清总胆汁酸水平的不同将其分为低水平组、中水平组与高水平组。根据终止妊娠时间的不同将低水平组患者分为低水平A组、低水平B组与低水平C组,将中水平组患者分为中水平A组、中水平B组与中水平C组。然后比较低水平A组、低水平B组、低水平C组、中水平A组、中水平B组与中水平C组患者的围产儿结局,观察高水平组患者的围产儿结局。结果:1)与低水平B组患者和低水平C组患者相比,低水平A组患者分娩低体重儿、羊水污染、新生儿入住NICU、新生儿心肌炎、新生儿肺炎、新生儿高胆红素血症、新生儿呼吸窘迫综合征、新生儿代谢性酸中毒的发生率均较高,P<0.05。与低水平C组患者相比,低水平B组患者分娩低体重儿的发生率较高,P<0.05。低水平C组患者与低水平B组患者羊水污染、新生儿入住NICU、新生儿心肌炎、新生儿肺炎、新生儿高胆红素血症、新生儿呼吸窘迫综合征、新生儿代谢性酸中毒的发生率相比,P>0.05。2)与中水平B组患者和中水平C组患者相比,中水平A组患者分娩低体重儿、羊水污染、新生儿入住NICU、新生儿心肌炎、新生儿肺炎、新生儿高胆红素血症、新生儿呼吸窘迫综合征、新生儿代谢性酸中毒的发生率均较高,P<0.05。中水平C组患者与中水平B组患者分娩低体重儿、羊水污染、新生儿入住NICU、新生儿心肌炎、新生儿肺炎、新生儿高胆红素血症、新生儿呼吸窘迫综合征、新生儿代谢性酸中毒的发生率相比,P>0.05。3)高水平组患者中发病孕周较小的1号患者和2号患者其终止妊娠孕周也较小。该组患者发生羊水污染的情况与其他不良围产儿结局的发生情况密切相关。结论:对于血清总胆汁酸的水平≥10μmol/L且<40μmol/L的妊娠期肝内胆汁淤积症患者,应尽量在其孕周达37周后再为其终止妊娠。对于血清总胆汁酸的水平≥40μmol/L且<100μmol/L的此病患者,应尽量在其孕周达36周后再为其终止妊娠。血清总胆汁酸的水平≥100μmol/L的此病患者其发生羊水污染的情况与其他不良围产儿结局的发生情况密切相关,其发病孕周与其终止妊娠孕周密切相关。

Objective:To investigate the correlation between serum total bile acid levels,time of pregnancy termination and perinatal outcomes in patients with intrahepatic cholestasis during pregnancy.Methods:A total of 183 patients with intrahepatic cholestasis during pregnancy were selected in Mianyang People’s Hospital,and were divided into groups according to the serum total bile acid level and the time of termination of pregnancy.Then the perinatal outcomes of each group were observed and compared.Results:1)and A low level and low level of group C group B patients compared to patients with low levels of group A childbirth,amniotic fluid contamination,low birth weight newborn in NICU,newborn myocarditis,high neonatal pneumonia,neonatal bilirubin hematic disease,the incidence of neonatal respiratory distress syndrome,neonatal metabolic acidosis were higher,P<0.05).Compared with low level GROUP C,low level group B had a higher incidence of low birth weight infants(P<0.05).The incidence of amniotic fluid pollution,neonatal admission to NICU,neonatal myocarditis,neonatal pneumonia,neonatal hyperbilirubinemia,neonatal respiratory distress syndrome and neonatal metabolic acidosis in low level GROUP C was compared with that in low level group B,P>0.05.2)with the level and the level of group C in group B patients compared to levels in the patients of group A childbirth,amniotic fluid contamination,low birth weight newborn in NICU,newborn myocarditis,high neonatal pneumonia,neonatal bilirubin hematic disease,the incidence of neonatal respiratory distress syndrome,neonatal metabolic acidosis were higher,P<0.05).The incidence of low birth weight,amniotic fluid pollution,neonatal admission to NICU,neonatal myocarditis,neonatal pneumonia,neonatal hyperbilirubinemia,neonatal respiratory distress syndrome and neonatal metabolic acidosis in group C was compared with group B,P>0.05.3)Among patients in the high level group,patients no.1 and No.2 with lower onset gestation age also had lower termination gestation age.Amniotic fluid contamination was closely related to other adverse perinatal outcomes.Conclusion:For patients with intrahepatic cholestasis during pregnancy whose serum total bile acid levels are≥10μmol/L and<40μmol/L,pregnancy termination should be performed after the gestational age of 37 weeks.For patients with this disease whose serum total bile acid levels are≥40μmol/L and<100μmol/L,pregnancy should be terminated after 36 weeks of gestation as far as possible.The incidence of amniotic fluid pollution in patients with serum total bile acid level≥100μmol/L was closely related to the occurrence of other adverse perinatal outcomes,and the onset of pregnancy was closely related to the termination of pregnancy.