妊娠期肝内胆汁淤积症孕妇脐血胆酸变化及其临床意义

Clinical value of measuring umbilical blood cholyglycine in Intrahepatic Cholestasis of Pregnancy

目的 探讨妊娠期肝内胆汁淤积症 (ICP)患者脐血胆酸变化及其临床意义。方法 对22例孕龄为33～37周和57例孕龄为37～42周ICP患者用放免法 (RIA)和酶联免疫吸附试验 (ELISA)测定孕妇血胆酸和娩出胎儿脐血胆酸及胆固醇水平 ,另选取34例正常足月单胎待产妇作正常对照。结果 ICP者娩出胎儿脐血胆酸值(4.66±2.05)mg/L明显高于正常对照者 (1.98±0.87)mg/L(t=8.65 ,P<0.05)。脐血胆固醇分别为 (1.95±0.71)mmol/L和 (1.75±0.47)mmol/L ,两组差别无显著性意义 (t=1.58 ,P>0.05)。ICP组孕龄为33～37- 周时 ,脐血胆酸升高发生率为73%[母血胆酸与脐血胆酸存在正相关 (r=0.45 ,P<0.05)] ,孕龄37～42- 周时脐血胆酸升高发生率为49 % ,两者差别有显著性意义 ( χ2 =3.95,P<0.05)。ICP组孕龄为33～37- 周时脐血胆酸升高时重度妊高征、羊水污染和胎儿宫内窘迫发生率均显著升高。结论 ICP患者发病时间越早 ,脐血胆酸升高发生率越高 。

Objective To investigate the change of umbilical blood cholyglycine in intrahepatic cholestasis of pregnancy (ICP) and to explore its clinical value.Methods The concentrations of maternal serum cholyglycine(CG) ,umbilical blood cholyglycine and total cholesterol were measured in 79 cases of ICP and 34 normal pregnancies.The group of ICP was composed of 22 cases with 33～37-weeks' gestation and 57 cases with 37～42- weeks' gestation.Results The concentrations of CG in umbilical blood were higher in ICP group than that in the normal group( 4.66±2.05mg/L Vs 1.98±0.87mg/L,P<0.05),however there was no significant difference in umbilical cholesterol between two groups (1.95±0.71mmol/L Vs 1.75±0.47mmol/L, P>0.05).There was a positive correlation between maternal serum CG and umbilical CG in 33～37- weeks' gestation group(r=0.45, P<0.05).The rate of increasing levels of umbilical blood CG is higher in 33～37- weeks' gestation group than that in 37～42- weeks' gestation of ICP patients (73% vs 49%, P<0.05).The incidence rates of severe pregnancy- induced hypertension, meconium stained amniotic fluid and fetal distress were also higher in 33～37- weeks' gestation group a increased levels of umbilical blood CG.Conclusions This study confirms that the earlier onset of ICP,the higher levels of the elevated CG in umbilical blood, which may increase the rate of pregnancy complication.