妊娠肝内胆汁淤积症分度诊断和处理的临床意义

Grading of intrahepatic cholestasis of pregnancy

目的 探讨妊娠肝内胆汁淤积症 (ICP)分度诊断和处理的临床意义。方法 将 1999年1月至 2 0 0 3年 5月 ,在我院产前检查并诊为ICP的 2 78例患者 ,应用我院 1999年自订的ICP分度标准 ,根据ICP患者的血清胆红素、肝转氨酶和甘胆酸水平分为轻度与重度ICP。并进行分度诊断和分度处理 ,观察其妊娠结局与分度诊断前后的围产儿死亡率。结果 (1)轻度ICP患者为 192例 (轻度组 ) ,重度ICP患者为 86例 (重度组 )。 (2 )重度组和轻度组ICP患者终止妊娠的平均孕周分别为(35 8± 1 6 )周和 (37 7± 1 9)周 ,两组比较 ,差异有极显著性 (P <0 0 1)。 (3)重度组和轻度组ICP分度诊断后 ,期待治疗的时间为 (10± 5 )d和 (19± 6 )d ,两组比较 ,差异有极显著性 (P <0 0 0 1)。 (4)重度组ICP患者羊水粪染、新生儿窒息和新生儿转入重症监护室的发生率分别为 38 4 % (33/ 86 )、12 8% (11/ 86 )、30 2 % (2 6 / 86 ) ,明显高于轻度组的 9 4 % (18/ 192 )、4 2 % (8/ 192 )、9 4 % (18/ 192 )。(5 )采用分度诊断前围产儿死亡率为 3 9%～ 6 0 % ,分度诊断后围产儿死亡率为 0 7%～ 1 2 % ,两者比较 ,差异有极显著性 (P <0 0 1)。结论 对ICP患者进行分度诊断和处理 ,有助于改善围产儿预后。

Objective This study was to evaluate the grading of intrahepatic cholestasis of pregnancy (ICP) Methods All 278 ICP cases were collected in the First Affiliated Hospital of Chongqing Medical University between Jan 1999 and May 2003 They were graded into mild ICP and severe ICP based on liver function test Outcome of pregnancy and perinatal mortality were assessed Results One hundred and ninety two cases were diagnosed as mild ICP while 86 cases were as severe ICP There was significant difference in the average time of expectant therapy (10 3±4 8 vs 19 1±6 4 days) and gestational weeks (35 8±1 6 vs 37 7±1 9) between severe ICP and mild ICP groups ( P <0 01 and P <0 001) The incidences of meconium passage, newborn asphyxia and admissions to neonatal intensive care unit in severe ICP were significantly higher than that in mild ICP These were 38 4% vs 9 4%, 12 8% vs 4 2%, and 30 2% vs 9 4%, respectively The difference of perinatal mortality between the patients with ICP diagnosed by using and not using the grading system (0 7%～1 2% vs 3 9%～6 0%) was statistically significant ( P <0 01) Conclusion Grading of ICP based on liver function test may improve perinatal prognosis