不同发病孕周与妊娠期肝内胆汁淤积症围生儿结局的关系

目的:探讨不同发病孕周与妊娠期肝内胆汁淤积症(ICP)胎儿预后的关系。方法:采用回顾性方法,对我院2004年1月～2010年1月收治的无其它合并症的506例ICP患者的临床资料进行回顾性系统分析。按照发病时间不同分为:≤28孕周组(104例),28+1-32孕周组(124例),32+1-36+6孕周组(203例),≥37孕周组(75例);根据是否治疗,各组又被分为治疗组和未治疗组。结果:死胎(3例,0.59%),胎儿生长受限(14例,2.76%),胎儿窘迫(85例,16.79%),早产(80例,13.83%),发生胎儿窘迫和/或发生早产的ICP患者甘胆酸(CG)、总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(BIL)水平明显增高,与围产结局好的ICP患者相比,差异有统计学意义(P<0.05);≤28孕周和28+1-32孕周发病并且接受治疗的患者CG、TBA、ALT、AST、BIL、直接胆红素(CB)、间接胆红素(UCB)、碱性磷酸酶(ALP)水平低于未治疗者,差异有统计学意义(P<0.05);早产主要集中在≤28孕周和28+1-32孕周发病并且未治疗的患者,分娩孕周分别为(35.50±2.19)周和(36.37±1.96)周,并且与对应的治疗组相比,早产发生率差异有统计学意义(P<0.05);各组胎儿窘迫发生率比较均无统计学意义(P>0.05);结论:病程长是胎儿不良预后的重要影响因素,孕期监测甘胆酸和肝功能变化是评估胎儿宫内情况的有效指标,早期诊断早期治疗可以通过改善肝脏功能,降低胆酸浓度,从而延长胎龄,减少早产的发生,但是,及时剖宫产终止妊娠仍然是减少死胎和胎儿窘迫最重要的手段。

The Relationship Between the Course of Disease and Prognosis of Perinatal Outcome in Intrahepatic Cholestasis of Pregnancy

Objective:To investigate the relationship between the course of disease with prognosis of neonates in intrahepatic cholestasis of pregnancy(ICP).Methods:A retrospective analysis was conducted on 506 cases of ICP without complication admitted to our hospital from January 2004 to January 2010.All subjects were divided into 4 groups according to the onset of ICP,≤28 gestational week group(n=104),28+1-32 gestational week group(n=124),32+1-36+6 gestational week group(n=203),≥37 gestational week group(n=75),each group were divided into two groups according to whether they received the treatment or not.Results The incidence rates of perinatal outcomes of ICP were as foll-ows:0.59%(3/506)for still birth,2.76%(1 /506) for fetal growth restriction,16.79%(85 /506) for fetal distress,13.83%(80/506) for premature labor.The concentration of CG,TBA,ALT,AST,BIL in the patients who with fetal distress and premature labor are higher,the significant difference were found(P<0.05).The concentration of serum CG,TBA,ALT,AST,BIL,CB,UCB,ALP were lower for ≤28 and 28+1-32 gestational week groups,the significant difference was found between the cases who with and without treatment(P<0.05).The patient who’s onset of ICP was ≤28 and 28+1-32 and without treatment were predispose to premature labor,the delivery time are(35.50±2.19) and(36.37±1.96) gestational week,comparing with the patient who after treatment,the significant difference of premature labor rate were found(P<0.05).No significant difference of fetal distress were found between all groups(P>0.05).Conclusion:The longer course of disease was the high risk of poor perinatal outcome of in ICP,monitoring of CG and Liver function so that the ICP can be diagnosed and treated earlier,thus the gestational age prolonged and the incidence of premature labor decreased,but the most important measure to decrease the perinatal mortality and fetal distress is terminating the pregnancy in time by cesarean section.