妊娠肝内胆汁淤积症孕妇围生期母婴结局与TBil和DBil水平及其比值变化的研究

目的 探究血清总胆红素（TBil）和直接胆红素（DBil）比值变化与妊娠肝内胆汁淤积孕妇围生期母婴结局的关系。方法 选取2012年1月—2017年8月在中国医科大学附属盛京医院进行治疗的妊娠合并肝内胆汁淤积的孕妇100例作为研究对象。根据孕妇体内DBil和TBil的比值，分为观察Ⅰ组（0.50～0.75）和观察Ⅱ组（>0.75），每组50例。以同期50例健康孕妇作为对照组，观察各组患者体内TBil、DBil和胆汁酸（TBA）水平及各组母婴并发症及结局情况。结果 观察Ⅱ组血清TBA、TBil和DBil水平高于观察Ⅰ组和对照组（P?<0.05），观察I组的血清TBA、TBil和DBil水平高于对照组（P?<0.05）；两组孕妇的结局，观察I组的剖宫产分娩发生率、产后出血发生率均低于观察Ⅱ组，产后出血量少于观察Ⅱ组（P?<0.05）；新生儿结局（早产、胎儿窘迫、羊水污染、新生儿窒息和出生体重），观察Ⅰ组均优于观察Ⅱ组（P?<0.05）。结论 血清TBil和DBil可反映妊娠妇女早期肝内胆汁淤积情况，通过血清DBil和TBil的比值可以及早判断病情，及时干预，在改善围生期母婴结局上具有一定意义。

Study on relationship of maternal and child outcomes with TBIL, DBIL levels and their ratios in pregnant women with intrahepatic cholestasis

Objective To investigate the relationship between changes in the ratio of total bilirubin (TBIL), direct bilirubin (DBIL) and perinatal maternal, infant outcomes in pregnant women with intrahepatic cholestasis. Methods From January 2012 to August 2017, 100 pregnant women with intrahepatic cholestasis treated in Shengjing Hospital affiliated to China Medical University were selected as the research objects. According to the ratio of DBIL and TBIL in pregnant women, they were divided into observation group I (DBIL/TBIL: 0.50 to 0.75) and observation group II (DBIL/TBIL: > 0.75), 50 cases in each group; 50 healthy mothers during the same period were used as the control group. TBil, DBil, bile acid (TBA) levels and outcomes of maternal and child were recorded. Results The serum levels of TBIL and DBIL in group II were higher than those in observation group I and the control group, and the differences were statistically significant (P?