【摘要】 目的分析妊娠期肝内胆汁瘀积症(ICP)孕妇的血液指标检查结果,探讨ICP对孕妇及围生儿结局的影响。方法选取2013年8月至2018年8月在该院分娩的120例ICP孕妇作为研究对象,以10μmol/L<总胆汁酸(TBA)<40μmol/L者为轻度ICP组(70例),TBA≥40μmol/L者为重度ICP组(50例);另选取同期在该院正常分娩的100例无ICP孕妇作为对照组。分别检测3组孕妇的肝功能、凝血功能及血常规,记录3组孕妇的妊娠结局和围生儿结局。结果轻度ICP组和重度ICP组孕妇TBA、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平均明显高于对照组,以重度ICP组更明显,且较轻度ICP组高,差异均有统计学意义(P<0.05);重度ICP组孕妇总胆红素(TBIL)和直接胆红素(DBIL)水平均明显高于轻度ICP组和对照组,差异均有统计学意义(P<0.05);对照组孕妇纤维蛋白原(FIB)、血小板计数(PLT)均高于轻度ICP组和重度ICP组,轻度ICP组和重度ICP组孕妇活化部分凝血活酶时间(APTT)较对照组长,差异均有统计学意义(P<0.05);轻度ICP组和重度ICP组胎儿窘迫、羊水污染(羊水Ⅱ～Ⅲ度浑浊)、早产率、Apgar评分≤7分、围生儿死亡、新生儿需要转新生儿重症监护室治疗、剖宫产率及产后出血量均明显高于对照组,除胎儿窘迫外,重度ICP组孕妇高于轻度ICP组;轻度ICP组和重度ICP组新生儿平均体质量及终止妊娠平均孕周均较对照组明显降低。结论 ICP孕妇相关生化指标升高及凝血功能指标异常均对母儿预后产生不良影响,尤其是重度ICP。做好孕期ICP诊断及监测,可能对改善围生儿结局有重要意义。更多还原

【Abstract】 Objective To investigate the blood test results of pregnant women with intrahepatic cholestasis of pregnancy(ICP)and analyze the effect of ICP on the outcome of pregnant women and perinatal infants.Methods A total of 120 patients with ICP who were delivered in the hospital from August 2013 to August2018 were selected as the objects of study.The patients with 10μmol/L<Total bile acid(TBA)<40μmol/L were classified as mild ICP group(70 cases),while the patients of whose TBA was≥40μmol/L were clarified as severe ICP group(50 cases).Another 100 pregnant women without ICP who normal delivered in the hospital during the same period were selected as the control group.The liver function,coagulation function and blood routine of the three groups of pregnant women were tested,and the pregnancy outcomes and perinatal outcomes of the three groups of pregnant women were recorded.Results The levels of TBA,alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in the mild ICP group and severe ICP group were significantly higher than those in the control group,especially in the severe ICP group,and those in the severe ICP group were higher than those in the mild ICP group.The total bilirubin(TBIL)and direct bilirubin(DBIL)in the severe ICP group were significantly higher than those in the mild group and control group.The levels of fibrinogen(FIB)and platelet count(PLT)in the control group were higher than those in the mild group and the severe group.The activated partial thromboplastin time(APTT)in the mild ICP group and the severe ICP group were significantly longer than that in the control group.The fetal distress,amniotic fluid pollution(amniotic fluid with Ⅱ-Ⅲ degree turbidity),premature birth rate,Apgar soore≤7,perinatal death,newborns transferred to Department of neonatal intensive care unit to treat,cesarean delivery rate and postpartum hemorrhage in the mild ICP Group and severe ICP group were significantly higher than those in the control group,except the fetal distress,the above indicators in the severe ICP group were also higher than those in the mild ICP group.The neonatal average weight and the average weeks of termination of gestation of mild ICP group and severe ICP group were significantly lower than those in the control group.Conclusion The increase of biochemical indicators and abnormal blood coagulation function indicators in pregnant women with ICP have adverse effects on the prognosis of mother and infant,especially for those severe ICP patients.ICP diagnosis and monitoring during pregnancy may play an important role in improving perinatal outcomes.更多还原