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目的探讨妊娠期肝内胆汁淤积症(ICP)患者胆汁酸、肝酶指标对围生儿预后的影响。方法对1997年1月至2006年12月在浙江中医药大学附属广兴医院的240例ICP患者,根据分娩前总胆汁酸(TBA)、天冬氨酸转氨酶(AST)及丙氨酸转氨酶(ALT)水平将ICP患者分为3组:轻度组、中度组和重度组,同时抽取同期分娩的正常孕妇70例作为正常组,并统计四组年龄、产后出血量、剖宫产率、羊水性状及新生儿胎龄、出生体重、1minApgar评分。结果随着胆汁酸、肝酶指标的上升,四组孕妇产后出血百分率呈上升趋势。ICP轻、中、重度三组剖宫产率(69.57%、78.67%、95.89%)高于正常组(31.43%),差异有统计学意义(χ2=21.71、30.88、61.94,P均<0.05);ICP重度组剖宫产率高于轻度、中度组,差异有统计学意义(χ2=16.80、8.33,P均<0.05)。ICP重度组低体重儿发生率(17.81%)高于正常组(2.86%)、轻度组(6.51%),差异有统计学意义(χ2=6.99、4.04,P均<0.05)。ICP重度组新生儿窒息率(20.55%)高于正常组(4.28%)及ICP轻度组(6.51%),差异有统计学意义(χ2=7.17、6.00,P均<0.05);ICP中度组(16.00%)亦高于正常组,差异有统计学意义(χ2=4.17,P<0.05)。ICP重度组羊水Ⅱ度以上污染率(31.51%)与正常组(7.14%)、ICP轻度组(13.04%)比较均有明显升高,差异有统计学意义(χ2=11.97、7.23;P均<0.01);ICP中度组(20.00%)比正常组间差异亦有明显升高,差异有统计学意义(χ2=4.01,P<0.05)。结论ICP孕妇胆汁酸、肝酶指标越高,围生儿结局越差。
Objective To investigate the effect of bile acid and liver enzymes on the prognosis of perinatal infants during intrahepatic cholestasis of pregnancy (ICP). Methods From January 1997 to December 2006, 240 patients with ICP in Guangxing Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine were enrolled in this study. Their total bile acid (TBA), aspartate aminotransferase (AST) and alanine aminotransferase ALT) were divided into three groups: mild group, moderate group and severe group. At the same time, 70 normal pregnant women who delivered at the same period were selected as normal group. The age, postpartum hemorrhage, cesarean section rate, Amniotic fluid traits and neonatal gestational age, birth weight, 1minApgar score. Results With the increase of bile acid and liver enzymes, the percentage of postpartum hemorrhage in four groups of pregnant women showed an upward trend. The incidence of cesarean section in the mild, moderate and severe ICP patients was 69.57%, 78.67% and 95.89%, respectively, which was significantly higher than that in the normal group (χ2 = 21.71, 30.88, 61.94, P <0.05) . The rate of cesarean section in ICP severe group was higher than that in mild and moderate group (χ2 = 16.80, 8.33, P <0.05). The incidence of severe weight and weight was 17.81% in ICP severe group (2.86%) and mild group (6.51%), the difference was statistically significant (χ2 = 6.99,4.04, P <0.05). The rate of neonatal asphyxia (20.55%) in ICP severe group was significantly higher than that in normal group (4.28%) and mild ICP group (6.51%) (χ2 = 7.17, (16.00%) was also higher than the normal group, the difference was statistically significant (χ2 = 4.17, P <0.05). In the ICP severe group, the second-degree amniotic fluid contamination rate (31.51%) was significantly higher than that in the normal group (7.14%) and ICP mild group (13.04%), the difference was statistically significant (χ2 = 11.97, <0.01). There was also a significant difference between the moderate ICP group (20.00%) and the normal group (χ2 = 4.01, P <0.05). Conclusion ICP bile acid, liver enzymes, the higher the index, the worse the outcome of perinatal children.