妊娠肝内胆汁淤积症孕妇及其新生儿血清总胆酸水平变化对胎儿心脏功能的影响

目的 探讨妊娠肝内胆汁淤积症(ICP)孕妇及其新生儿脐动脉血(脐血)血清总胆酸(TBA)水平变化对胎儿心脏功能的影响.方法 应用循环酶法测定30例ICP孕妇(ICP组)及30例正常妊娠妇女(对照组)外周静脉血及其新生儿脐血TBA水平,单克隆夹心酶联免疫法测定新生儿脐血心肌肌钙蛋白I(cTnI)水平,用彩色多普勒超声诊断仪测定胎儿左心室Tei指数.结果 (1)TBA:ICP组孕妇血清TBA水平为(36.0±9.6)μmol/L,新生儿脐血TBA水平为(10.1±2.0)μmol/L;分别高于对照组的(3.8±0.9)、(5.5±0.4)μmol/L,差异均有统计学意义(P<0.01),且ICP组孕妇血清TBA水平明显高于其分娩的新生儿脐血TBA水平,两者比较,差异有统计学意义(P<0.01),对照组孕妇血清TBA水平明显低于其分娩的新生儿脐血TBA水平,两者比较,差异也有统计学意义(P<0.01).(2)Tei指数:ICP组胎儿左心室Tei指数为0.58±0.04,明显高于对照组的0.43±0.03,差异有统计学意义(P<0.01).(3)cTnI:ICP组新生儿脐血cTnI水平为(0.92±0.23)μg/L,明显高于对照组的(0.52±0.10)μg/L,差异也有统计学意义(P<0.01).(4)ICP组脐血TBA水平与孕妇血清TBA、脐血cTnI水平及胎儿左心室Tei指数均呈正相关关系(r=0.769、0.635、0.758,P<0.01);脐血cTnI水平与胎儿左心室Tei指数呈正相关关系(r=0.637,P<0.01).结论ICP胎儿存在左心室功能异常及心肌损伤,这种损伤可能与孕妇血TBA水平升高有密切关系;胎儿左心室Tei指数可作为监测ICP胎儿心脏功能及心肌损伤程度的指标.

Influence of total bile acid in maternal serum and cord blood on neonatal cardiac function from intrahepatic cholestasis of pregnancy

Objective To study the influence of total bile acid (TBA) of maternal serum and cord blood on neonatal cardiac function in women with intrahepatic cholestasis of pregnancy (ICP). Methods The concentration of TBA in the maternal peripheral blood and neonatal cord blood were measured by enzyme in 30 women with ICP as patients group matched with 30 normogravidas as control group. The concentration of cardiac troponin Ⅰ (cTnI) in cord blood was detected by monoclonal enzymelinked immunosorbent assay.Fetal left ventricle Tei index was evaluated by color Doppler uhrasonoscope. Results (1) TBA concentration of maternal serum and cord blood at ICP group were significantly higher than that of control group [ (36.0±9.6) μmol/L vs. (3.8±0.9) μmol/L, (10.1±2.0) p, mol/L vs. (5.5±0.4 )μmol/L,P <0.01 ]. TBA concentration of maternal serum at ICP group was significantly higher than that of neonatal cord blood(P<0.01 ). Meanwhile, TBA concentration of maternal serum at control group was significantly lower than that of neonatal cord blood (P<0.01 ). (2) The Tel index of neonatal left ventricle at ICP group were significantly higher than that of control (0.58±0.04 vs. 0.43±0.03, P<0.01 ). (3) The concentration of cTnI from cord blood(0.92±0.23)μg/L at ICP group were obviously higher than that of control group [ (0.52±0.10)μg/L, P<0.01]. (4) The TBA concentration of cord blood at ICP group showed positive correlation with maternal blood TBA, cord blood cTnI and fetal left ventricle Tei index respectively( r=0.769, 0.635, 0.758,P<0.01). In the mean time, the positive correlation between the concentration of cTnI from cord blood and fetal left ventricle Tel index was also observed (r=0.637.P<0.01). Conclusions Left ventricular dysfunction and myocardial injury were shown in the neonates with ICP, which might be associated with with the elevated TBA level of maternal blood. The Tel index of fetal left ventricle could be used as a reliable parameter to monitor cardiac function and the degree of injured myocardial muscles.