ICP患者肝酶和新生儿预后的相关性分析

目的 探讨妊娠期肝内胆汁淤积症(ICP)患者的肝酶指标、胆汁酸水平与新生儿预后的相关性.方法 选取2014年1月至2015年12月在广东省东莞市妇幼保健院产检并分娩的ICP孕妇236例为ICP组,另选取同时期进行产检的正常孕妇120例为对照组,检测两组孕妇血清总胆汁酸、肝酶相关指标天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及碱性磷酸酶(ALP)水平,对比两组孕妇分娩方式、分娩孕周、新生儿体重、Apgar评分及新生儿结局.结果 ICP组孕妇AST、ALT、ALP、总胆汁酸水平均显著高于对照组孕妇(t值分别为7.312、10.647、11.518、9.199,均P<0.05).ICP组孕妇剖宫产率显著高于对照组(χ2=12.331,P<0.05),分娩孕周显著低于对照组(t=4.159,P<0.05).三组新生儿体重、Apgar评分均有显著性差异(F值分别为8.913、10.532,均P<0.05),进一步每两组间比较发现,重度ICP组新生儿体重、Apgar评分均显著低于轻度ICP组和对照组(t值分别为2.769、2.963、2.543、2.447,均P<0.05),而轻度ICP组和对照组比较无显著性差异(t值分别为0.638、1.012,均P>0.05).三组胎儿宫内窘迫、早产、羊水污染、新生儿窒息发生率均有显著性差异(Z值分别为7.159、10.468、8.486、5.197,均P<0.05),以重度ICP组发生率均最高,对照组发生率均最低.结论 妊娠期肝内胆汁淤积症患者肝酶指标、胆汁酸水平明显升高,与新生儿预后存在密切的联系,应加强对肝酶指标及总胆汁酸的监测,以改善新生儿结局.

Relationship between levels of liver enzymes and bile acid in women with intrahepatic cholestasis of pregnancy and neonatal prognosis

Objective To investigate the relationship between the levels of liver enzymes and bile acid in women with intrahepatic cholestasis of pregnancy (ICP) and neonatal prognosis.Methods Totally 236 ICP women who took antenatal examination and gave birth in Dongguan Maternal and Child Health Care Hospital from January 2014 to December 2015 were assigned to ICP group, and 120 normal pregnant women at the same period were assigned to control group.Serum total bile acid and the relevant indicators of liver enzymes including aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were detected in two groups.Two groups were compared in delivery mode, gestational age, birth weight, Apgar score and neonatal outcomes.Results AST, ALT, ALP and total bile acid level in ICP group were significantly higher than those in control group (t value was 7.312, 10.647, 11.518 and 9.199, respectively, all P<0.05).The cesarean section rate in ICP group was significantly higher than that in control group (χ2=12.331,P<0.05), and gestational week was significantly lower than the control group (t=4.159,P<0.05).There was significant difference in neonatal weight and Apgar score among three groups (F value was 8.913 and 10.532, respectively, both P<0.05).Group comparison showed neonatal weight and Apgar score in severe ICP group were significantly lower than those in mild ICP group and control group (t value was 2.769, 2.963, 2.543 and 2.447, respectively, all P<0.05), but there was no significant difference in them between mild ICP group and control group (t value was 0.638 and 1.012, respectively, both P>0.05).Moreover, there was significant difference in fetal distress, premature delivery, amniotic fluid contamination and neonatal asphyxia incidence among three groups (Z value was 7.159, 10.468, 8.486 and 5.197, respectively, all P<0.05), with highest incidence in severe ICP group and lowest incidence in control group.Conclusion In patients with ICP, the levels of liver enzymes and bile acid are significantly increased, which is closely related to the prognosis of neonates.The monitoring of liver enzymes and total bile acid should be strengthened to improve neonatal outcomes.