妊娠肝内胆汁淤积症胎儿宫内缺氧的初步研究

目的　探讨妊娠肝内胆汁淤积症胎儿宫内缺氧与促红细胞生成素 (EPO)之间的关系以及胆酸对胎儿的影响。方法　分别测定于临产前行剖宫产术的正常对照组胎儿 2 5例及ICP组胎儿 32例脐静脉血EPO水平 ;放射免疫法分别测定二组孕妇血清、脐血、羊水胆酸水平 ;胎儿娩出时抽取脐动脉血进行血气分析。结果　ICP组妇女EPO水平同正常对照组相比无差异 ,ICP胎儿脐血EPO及羊水EPO水平均明显低于正常对照组胎儿 ,ICP组缺氧胎儿脐血EPO水平显著低于未发生缺氧的胎儿水平 ,ICP母血、脐血及羊水胆酸与脐血、羊水EPO分别成负相关。结论　ICP胎儿EPO水平低下可能是其宫内缺氧的原因之一 ;ICP妇女血清高胆酸水平可能对胎儿体内合成EPO有一定影响 ;检测羊水EPO或许可以作为产前监测ICP胎儿宫内缺氧的一项指标。

Preliminary study on the fetal hypoxiain with intrahepatic cholestasis of pregnancy

Objective To explore the relationship between the level of cord plasma EPO and fetal hypoxia in patients with intrahepatic cholestasis of pregnancy Methods The concentration of cord plasma erythropoietin(EPO) concentration was measured in 32 infants with ICP and 25 infants in control group after elective cesarean section.Furthermore,the bile acid of maternal serum,cord plasma and anmiotic fluid were measured.According to NST and the degree of meconium-stained anmiotic fluid,fetal intrauterine hypoxia was dignosed. Results There was no significant statistical difference in the maternal serum EPO levels of the two groups, however, cord plasma and anmiod fluid EPO were lower in infants of ICP group than that of control infants;The mean cord plasma EPO level of fetal hypoxia in ICP group was lower than that of non-hypoxia fetals,Whereas it was higher in infants of control group.The bile acid of the matemal serum,anmiotic fluid and cord plasma were all negatively correlated with EPO of infants in ICP group.Conclusion The lower EPO level of cord plasma may be a cause of the fetal hypoxia of ICP.The high bile acid level may affect the EPO productive ability of fetal liver in patients with ICP.