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目的分析妊娠期肝内胆汁淤积症(ICP)患者雌激素水平、肝功能变化和血脂水平变化的特点,为临床治疗提供参考。方法随机选取2013年6月至2015年6月我院住院分娩并确诊为ICP的72例患者,轻度ICP组49例,重度ICP组23例;对照组选同期剖宫产正常孕妇72例。所有研究对象空腹状态下均抽取静脉血5 m L,采用ELISA方法测定血清总胆汁酸,行ICP诊断及分组,放射免疫分析法测定其雌激素水平,酶法测定肝功能及血脂水平,分析比较三组间各项指标的差异性,ICP胎儿窘迫的相关因素作Logistic回归分析。结果轻度ICP组与对照组比较,总胆红素、ALT、AST水平差异有统计学意义(P<0.05),总胆汁酸水平差异无统计学意义(P>0.05);重度ICP组与轻度ICP组、对照组比较,总胆红素、总胆汁酸水平、AST、ALT差异有统计学意义(P<0.05);ICP两组比较,甘油三酯、总胆固醇、LDLC水平差异有统计学意义(P<0.05),HDLC水平差异无统计学意义(P>0.05);甘油三酯、总胆固醇、LDLC回归方程偏回归系数t检验结果显示总胆红素差异有统计学意义(P<0.05),甘油三酯、总胆固醇、LDLC水平增高与总胆红素关系密切;随着雌二醇、总胆汁酸和ALT水平升高,胎儿窘迫的发病率也会增加。结论胆汁淤积直接导致血脂水平变化,雌二醇、总胆汁酸能有效预测胎儿窘迫。
Objective To analyze the changes of estrogen level, hepatic function and blood lipid levels in patients with intrahepatic cholestasis of pregnancy (ICP) and provide reference for clinical treatment. Methods 72 patients with hospitalized delivery and diagnosed with ICP were randomly selected from June 2013 to June 2015 in our hospital, 49 patients in mild ICP group and 23 patients in severe ICP group. The control group selected 72 pregnant women with normal cesarean section in the control group. All subjects were drawn venous blood 5 m L, serum total bile acids were measured by ELISA, ICP diagnosis and grouping, radioimmunoassay determination of estrogen levels, enzymatic determination of liver function and blood lipid levels, analysis and comparison Logistic regression analysis was used to analyze the differences among the three groups and the related factors of ICP fetal distress. Results Compared with the control group, the levels of total bilirubin, ALT and AST in mild ICP group were significantly different (P <0.05), and there was no significant difference in total bile acid level between mild ICP group and control group (P> 0.05) There were significant differences in total bilirubin, total bile acid level, AST and ALT between the ICP group and the control group (P <0.05). There was significant difference in triglyceride, total cholesterol and LDLC between the two groups (P <0.05). There was no significant difference in HDLC levels between the two groups (P> 0.05). The partial regression coefficient t-test of triglyceride, total cholesterol and LDLC showed that the total bilirubin had statistical significance ), Triglyceride, total cholesterol and LDLC levels are closely related to total bilirubin. With the increase of estradiol, total bile acid and ALT levels, the incidence of fetal distress will also increase. Conclusions Cholestasis can directly lead to changes in blood lipid levels. Estradiol and total bile acids can effectively predict fetal distress.