妊娠期肝内胆汁瘀积症母儿胆酸和肝功能的变化

目的:通过检测妊娠期肝内胆汁瘀积症(ICP)母儿胆汁酸和肝功能变化,探讨ICP对围产儿胆汁酸和肝功能的影响。方法:选择2004年3月~2004年12月在四川大学华西第二医院产科住院的ICP患者38例,于能量合剂治疗前后分别抽取孕妇空腹肘静脉血,分娩时(均系剖宫产)抽取脐静脉血和新生儿血查血清TBA和肝功能。结果:(1)孕妇治疗后(即手术前)TBA、肝功能(主要是ALT、AST)均较治疗前显著下降(P<0.01),治疗前后母血TBA与ALT、AST分别呈正相关(均为P<0.05);(2)孕妇术前血清TBA、ALT、AST显著高于脐静脉血(均为P<0.01);(3)新生儿血TBA显著高于脐静脉血TBA(P<0.01),而ALT、AST无显著变化(P>0.05);(4)新生儿血TBA与术前母血TBA呈正相关(P<0.05),新生儿血TBA、ALT、AST显著低于术前母血(均为P<0.01)。结论:(1)升高的母血TBA能造成孕妇肝细胞不同程度受损,且TBA值愈高,ALT、AST亦升高愈明显;(2)能量合剂治疗ICP是有益的,能降低TBA,改善肝脏功能;(3)ICP患者因胎盘胆汁酸代谢发生障碍而导致围产儿TBA明显受到影响,但肝功能未见明显变化。

Maternal and perinatal bile acid metabolism and liver functional condition in intrahepatic cholestasis of pregnancy

Objective:By detecting maternal and perinatal total bile acid(TBA) metabolism and liver functional condition in intrahepatic cholestasis of pregnancy(ICP) to explore its effect.Methods:38 cases with ICP were selected in the obstetric department of West China Second Hospital,Sichuan University from March 2004 to December 2004.TBA and liver function tests were detected by ENZABILE and fully-automatic biochemical analysis instrument.The maternal blood before treatment and preoperation,as well as the umbilical cord blood,and neonatal blood after birth were collected.Results:(1)Women with ICP presented TBA,ALT and AST levels greatly dropped preoperation when compared to those before treatment(P<0.01).Women with ICP revealed significant correlations among level of TBA with ALT(P<0.01,P<0.01,respectively) and AST(P<0.05,P<0.05,respectively) before treatment and preoperation.(2) The levels of TBA,ALT and AST in maternal preoperation blood were significantly higher than those of umbilical cord blood(P<0.01,P<0.01,P<0.01,respectively).(3)There was notable increase in the level of TBA in neonatal blood as compared with umbilical cord blood(P<0.01),while the levels of ALT and AST were no significant difference between neonatal blood and umbilical cord blood(P>0.05).(4) The levels of TBA between maternal preoperation blood and neonatal blood showed significant correlations(P<0.05),the levels of TBA,ALT and AST in neonatal blood were remarkably lower than those of maternal anteoperation blood(P<0.01,P<0.01,P<0.01,respectively).Conclusion:(1) The elevation of TBA can lead to the injury of the hepaticyte,and the higher TBA,the higher ALT and AST.(2) Reasonable treatment is beneficial to ICP,it can reduce the level of TBA and improve liver function.(3)The unbalance of bile acid metabolism in ICP women had marked effect on neonatal TBA,however,it had no effect on fetal liver function.