【摘要】 目的探讨妊娠期肝内胆汁淤积症(ICP)患者血清总胆汁酸(TBA)与新生儿肺损伤程度及预后的相关性。方法回顾性分析2013年1月至2017年1月于浙江省金华市中心医院分娩的ICP孕妇52例(观察组)的临床资料,选取同期正常妊娠孕妇50例作为对照,比较两组孕妇血清TBA水平和围产结局,对比两组新生儿肺损伤发生率、Apgar评分及肺主动脉血流指数,并分析孕妇血清TBA水平与新生儿肺损伤程度相关性。结果观察组孕妇血清TBA、AST及ALT水平显著高于对照组(t值分别为28.352、25.552、24.067,均P<0.05)。观察组新生儿肺损伤发生率为40.38%,对照组新生儿肺损伤发生率为12.00%,观察组显著高于对照组(χ~2=10.552,P<0.05)。观察组孕妇剖宫产19例(36.54%),对照组孕妇剖宫产5例(10.00%),观察组剖宫产率显著高于对照组(χ~2=9.977,P<0.05)。观察组孕妇分娩孕周显著短于对照组(t=2.069,P<0.05)。观察组孕妇不良围产结局发生率为69.23%,对照组孕妇不良围产结局发生率为8.00%,观察组显著高于对照组(χ~2=30.690,P<0.05)。观察组新生儿Apgar评分显著低于对照组新生儿(t=6.262,P<0.05),观察组胎儿肺主动脉血流指数S/D、RI及PI均显著高于对照组(t值分别为9.185、5.502、7.733,均P<0.05)。孕妇血清TBA水平与新生儿肺损伤程度呈正相关(r=0.653,P=0.000)。结论 ICP孕妇血清TBA水平会显著升高,ICP孕妇所生新生儿肺损伤发生率及孕妇不良围产结局发生率也明显升高,ICP会对胎儿肺血循环造成影响,孕妇血清TBA水平与新生儿肺损伤呈正相关。更多还原

【Abstract】 Objective To investigate the correlation of serum total bile acid(TBA)with the degree of neonatal lung injury and prognosis in patients with intrahepatic cholestasis of pregnancy(ICP).Methods Retrospective analysis was conducted on the clinical data of 52 pregnant women with ICP(observation group)who delivered in Central Hospital of Jinhua City in Zhejiang Province during the period of January 2013 to January 2017.Fifty normal pregnant women were selected as controls at the same time.The serum TBA level,perinatal outcomes,incidence of neonatal lung injury,Apgar score and pulmonary aortic blood flow index were compared between two groups,and the correlation between maternal serum TBA level and neonatal lung injury was analyzed.Results The serum TBA,AST and ALT levels of pregnant women in the observation group were significantly higher than those in the control group(t value was 28.352,25.552 and 24.067,respectively,all P<0.05).The incidence of neonatal lung injury in the observation group was 40.38%,which was significantly higher than that in the control group(12.00%)(χ~2=10.552,P<0.05).There were 19 cases of cesarean section in the observation group(36.54%),and 5 cases in the control group(10.00%).The rate of cesarean section in the observation group was significantly higher than that in the control group(χ~2=9.977,P<0.05).The gestational weeks of pregnant women in the observation group were significantly shorter than those in the control group(t=2.069,P<0.05).The incidence of adverse perinatal outcomes was 69.23%in the observation group,which was 8.00%in the control group,and it was significantly higher in the observation group than in the control group(χ~2=30.690,P<0.05).The Apgar scores of neonates in the observation group were significantly lower than those in the control group(t=6.262,P<0.05),and blood flow index of S/D,RI and PI of fetal pulmonary aorta in the observation group were significantly higher(t value was 9.185,5.502 and 7.733,respectively,all P<0.05).There was a positive correlation between maternal serum TBA level and neonatal lung injury(r=0.653,P=0.000).Conclusion The serum TBA level,incidence of neonatal lung injury and adverse perinatal outcomes are significantly higher in pregnant women with ICP.ICP can affect the pulmonary blood circulation of fetus,and the maternal serum TBA level is positively correlated with neonatal lung injury.更多还原