ICP与妊娠期CHB伴胆汁酸升高的围产结局比较26

目的:比较妊娠期肝内胆汁淤积症(ICP)和妊娠合并慢乙肝孕妇胆汁酸升高病例的生化指标及围产结局,以期为临床提供参考.方法:回顾分析2013年12月到2015年11月在上海市公共卫生临床中心妇产科产检并分娩的262例孕妇的病例资料,ICP组116例,妊娠合并CHB孕妇合并胆汁酸升高组146例,比较两组的生化指标和围产结局.结果:单纯性ICP组与妊娠合并CHB组在总胆汁酸最高状态下指标无明显差异,经治疗后生化指标均明显好转,但ICP组的转氨酶水平仍明显高于CHB组.两组的胎儿胎窘发生率分别为23.28%和14.38%,羊水胎粪污染发生率分别为34.48%和16.44%,发生早产比例分别为43.1%和19.86%,LGA发生率分别为9.84%和2.1%,差别均有统计学意义(P<0.05).结论:单纯性ICP与妊娠合并CHB经积极治疗均得到明显改善.单纯性ICP的病情监测中,除胆汁酸外,还应重视转氨酶变化.合并胆汁酸升高的CHB孕妇如治疗效果良好,可在密切监测下适当延长孕周.

Comparison of perinatal outcome between ICP and chronic hepatitis B with elevated ser-um total bile acid during pregnancy

Objective:To explore the differences of biochemical indicators and preg-nancy outcomes between ICP and chronic hepatitis B with elevated serum total bile acid during pregnancy . Methods:A retrospective analysis of patients was performed on the data of 262 preg-nant women who had their prenatal examinations and delivered in Shanghai Public Health Clini-cal Center from Dec. 2013 to Nov. 2015. They were divided into two groups:intrahepatic chole-stasis of pregnancy group ( ICP) (116 cases) ,and chronic hepatitis B group ( CHB) with ele-vated serum total bile acid( TBA) (146 cases) . Results:No significant difference was found in the liver function indicators between the two groups when the TBA was in the peak level. After treatment,TBA and transaminase significantly decreased in both groups. The level of transami-nase in ICP group was still higher than that of CHB group(P<0. 05). The rate of fetal distress, meconium stained amniotic fluid( MSAF) ,incidence of premature delivery,asphyxia of newborn ( Apgar score in 1 and 5 minute) had statistically significant difference between the two groups (P<0. 05). In ICP group,the rate of LGA was significantly higher than that of CHB group ( 9 . 84% vs 2 . 1%) . Conclusions:ICP and pregnancy with CHB will be significantly improved after active treatment. In the disease observation of simple ICP,both bile acid and transaminases levels should be paid high attention. In CHB pregnant women, if there is a good treatment effect,the gestational age can be extended under closely monitoring.