60例肝内胆汁淤积症妊娠母婴结局临床分析(1)
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[摘要] 目的：探讨妊娠期肝内胆汁淤积症妊娠结局对母婴的影响。方法：60例肝内胆汁淤积症(ICP)患者为ICP组，取同期60例正常孕妇为对照组，对妊娠结局进行回顾性分析。结果：妊娠期肝内胆汁淤积综合征组并发症，如肝功能受损、血小板减少、早产等与对照组相比明显增加，胎儿窘迫发生例数、剖宫产率、早产儿及新生儿窒息等发生均高于对照组(P<0.05)。结论：妊娠期肝内胆汁淤积症对母婴危害大，早产、胎儿窘迫及围生儿并发症，死亡率明显高于正常孕妇组，加强对ICP组的产前监护及管理，尽量改善母婴结局。
[关键词] 妊娠期；肝内胆汁淤积综合征；并发症；母婴
[中图分类号] R714 [文献标识码]A[文章编号]1674-4721(2011)03(c)-034-02
Clinical analysis of maternal and neonatal outcomes about sixty cases of intrahepatic cholestasis of pregnancy
LAN Xiaoling
Maternal and Child Health Hospital of Nanhai District, Foshan City, Guangdong Province, Foshan 528200, China
[Abstract] Objective: To investigate the intrahepatic cholestasis of pregnancy on maternal outcome of pregnancy. Methods: 60 patients with intrahepatic cholestasis (ICP) ICP group of patients, 60 normal pregnant women to take over the same period as the control group, on pregnancy outcome were analyzed retrospectively. Results: The intrahepatic cholestasis syndrome group complications such as impaired liver function, thrombocytopenia, premature delivery compared with the control group significantly increased the number of cases of fetal distress, cesarean section rate and neonatal asphyxia in preterm children such as occurred were higher (P<0.05). Conclusion: Intrahepatic cholestasis of pregnancy on maternal and child against a large, premature delivery, fetal distress and perinatal complications in children, mortality is significantly higher than normal pregnant women group, strengthening the monitoring of ICP and management of the prenatal group, try to improve maternal and child outcome.
[Key words] Pregnancy; Intrahepatic cholestasis syndrome; Complications; Maternal and child
妊娠期肝内胆汁淤积综合征(intrahepatic cholestasis of pregnancy，ICP)发生于妊娠中晚期，以皮肤瘙痒和黄疸为特征的妊娠特有的疾病[1]。其发病率为0.8%～12.0%，有明显的地域和种族差异，以智利和瑞典发病率最高。其主要危害胎儿，围生儿发病率及死亡率增高，对胎儿影响程度与病情程度相关，已受到人们的重视，现将本院60例妊娠合并胆汁淤积症孕妇的临床资料进行回顾性分析。
1 资料与方法
1.1 一般资料
资料来源于2009年7月～2010年8月在本院住院分娩产妇，经系统产前检查确诊为妊娠期肝内胆汁淤积症患者60例，作为ICP组，其中初产妇44例，经产妇16例。取同期正常孕妇60例作为对照组，其中初产妇48例，经产妇12例。两组均为单胎，B超排除胎儿畸形，合并羊水过少等妊娠并发症者，两组孕妇的年龄、孕产次等差异无统计学意义(P>0.05)，具有可比性。
1.2 诊断标准
ICP诊断标准参见第6版《妇产科学》[1]：瘙痒；血清胆酸升高；血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶升高：甲、乙、丙型肝炎的病毒标志物均为阴性；排除其他能引起瘙痒、黄疸和肝功能异常的疾病。早产定义为妊娠满28周至不满37周间分娩者。肝功能受损指谷丙转氨酶及谷草转氨酶均大于80 U/L。血小板减少症指血小板计数<100×109/L。产后出血指胎儿娩出后24 h内出血超过500 ml。
1.3 胆汁酸的测定
应用日本日立7180生化分析仪，采用北京利德曼公司生产的TBA试剂盒测定总胆汁酸，正常值是0～10 μmol/L ......
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