妊娠肝内胆汁淤积症孕妇肝胆B超特点及临床意义

目的探讨妊娠肝内胆汁淤积症(ICP)孕妇肝胆B超特点,评价肝胆系B超检查产前预测ICP孕妇病情轻重和围生儿预后的临床意义.方法根据B超有无肝内胆管扩张表现将ICP孕妇分为观察组(12例)和对照组(20例),用SPSS13.0统计软件回顾性分析两组孕妇症状的轻重和转氨酶、胆红素、胆汁酸等生化指标以及围生儿预后情况.结果观察组孕妇重症者比例显著高于对照组(P＜0.05),且瘙瘁出现的时间显著早于对照组(t=2.06,P＜0.05);观察组生化指标ALT、AST、TBA、TBIL显著高于对照组(P＜0.01),DBIL观察组虽有高于对照组趋势但无显著性差异(P＞0.05);观察组胎儿窘迫、新生儿窒息发生率显著高于对照组(P＜0.05),分娩孕周和新生儿体重明显低于对照组(t=3.52,P＜0.01;t=2.11,P＜0.05).结论ICP孕妇若肝胆B超有肝内胆管扩张表现提示病情严重、围生儿预后差,应积极保肝利胆治疗,有条件者还可进行血浆置换并适时剖宫产终止妊娠.

B ultrasonography on the liver and cholecystis of ICP and it's clinical value

Objective:To investigate the characteristics of B ultrasonography on the liver and cholecystis and to assess it's cjinical value of predicting the severity degree and perinatal outcomes of patients with ICP. Methods: 32 pregnant women of ICP were divided into two groups according to the B ultrasonic imaging with or without intrahepatic cholangiectasis: the test group (12 cases) and the control group (20 cases). The symptoms, biochemical examinations and perinatal outcomes of the two groups were analyzed retrospectively by SPSS13.0. Results: The severe cases proportion of the test group was significantly higher than that of the control group( P<0.05)and the skin pruritus in the test group appeared significantly earlier than the control group(t=2.06,P<0.05); serum transaminase, total bile acid and total bilirubin all have significant difference between the two groups(P<0.01) while no significant difference was found in the direct bilirubin(P>0.05); the incidence of fetal distress and asphyxia of newborn(P<0.05) , the gestational age of delivery and the birth weight (t=3.52, P<0.01;t=2.11,P<0. 05)all have significant difference between the two groups. Conclusion: B ultrasonic imaging with intrahepatic cholangiectasis of ICP pregnant women indicates the severe state and the poor perinatal outcomes, we should take initiative measures to treat ICP with choleretic, if possible, plasma therapy can be applied.Moreover,cesarean deliveries ought to be taken at the appropriate time.