妊娠肝内胆汁淤积症1241例发病特点分析

Clinical characteristics of 1241 cases of intrahepatic cholestasis of pregnancy

目的 探讨妊娠肝内胆汁淤积症 (ICP)的发病特点。方法 采用回顾性分析的方法 ,对我院 1991年 1月至 2 0 0 0年 12月收治的 12 4 1例ICP患者的临床资料进行回顾性系统分析。结果 12 4 1例ICP患者中 ,多胎妊娠 4 4例 ( 3 5 % ) ,合并妊娠高血压综合征 (妊高征 ) 10 1例 ( 8 1% ) ;12 6例经产妇中 ,38例 ( 30 2 % )为ICP复发 ;有发病时间记录的 12 30例患者的平均发病孕周为 32 6周 ,孕晚期发病有 110 0例 ( 88 6 % ) ;12 0 1例 ( 96 8% )以皮肤瘙痒为首发症状 ,也有以黄疸 ( 8例 ,占0 6 % )、肝功能异常 ( 2 8例 ,占 2 3% )等为起始表现者 ;生化指标中主要以血清总胆汁酸 (TBA)、丙氨酸氨基转移酶 (ALT)、天冬氨酸氨基转移酶 (AST)升高为主 ,但大多为轻、中度升高 ;也有患者TBA、ALT或AST正常 (分别占 17 7%、15 6 %、17 1% ) ,少数患者 ( 35例 ,3 2 % )白蛋白 /球蛋白比值倒置。结论 ( 1)ICP具有复发性 ,多胎妊娠孕妇更易发病 ,瘙痒常是ICP显著而且首发的症状 ,TBA和肝脏转氨酶升高有助于该病的诊断。 ( 2 )少数患者发病时临床表现及实验室检查结果均不典型 。

Objective To investigate the clinical characteristics of intrahepatic cholestasis of pregnancy(ICP) Methods Totally 1241 cases of ICP during the 10 years from Jan 1991 to Dec 2000 in our hospital were retrospectively reviewed Results Forty four (3 5%) patients were multiple gestation One hundred and one (8 1%) patients had pregnancy induced hypertension ICP recurred in 30 2% multipara (38/126) On average, it occurred at gestational week of 32 6 Pruritus was the first symptom in 1201(96 8%)patients while 8 (0 6%) patients had jaundice and 28 (2 3%) patients had abnormal liver function at the onset Serum total bile acid (TBA), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were usually mild or moderately elevated, while some patients had normal TBA(17 7%), ALT(15 6%), or AST(17 1%) level The albumin/globulin ratio was reversed in 35 (3 2%) patients Conclusion ICP tends to recur in subsequent pregnancy It is more likely to develop in multiple gestation Pruritus is the most common and prominent manifestation Elevated TBA and ALT or AST level is helpful for diagnosis It should be noted that the above manifestations might not be typical in some patients