妊娠期肝内胆汁淤积症总胆汁酸水平及终止妊娠时间与围产儿结局的关系
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摘要
目的:探究妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)总胆汁酸(total bile acid,TBA)水平及终止妊娠的不同时间对围产儿结局产生的影响。方法:选取本院2017年1月-2018年6月住院分娩的妊娠期肝内胆汁淤积症孕妇60例作为研究对象,根据其体内总胆汁酸水平进行分组,将总胆汁酸水平<40 mol/L的30例作为低水平组(A组),包括终止妊娠孕周<36周的10例为AC组和≥36周的20例为AD组;将总胆汁酸水平≥40 mol/L的30例作为高水平组(B组),包括终止妊娠孕周<36周的9例为BC组和≥36周的21例为BD组。分析比较孕妇不同总胆汁酸水平与不同终止妊娠时间对围产儿不良结局的影响,以及A、B组间的肝功能指标水平。结果:B组的总胆红素(TBIL)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、血清TBA指标水平均明显高于A组,差异均有统计学意义(P<0.05)。AC组围产儿各项不良结局发生率均明显高于AD组,BC组均明显高于BD组,差异均有统计学意义(P<0.05)。结论:当孕妇总胆汁酸水平<40 mol/L且孕周≥36周时,终止孕妇妊娠有利于降低围产儿不良结局的发生率;当孕妇总胆汁酸水平>40 mol/L且孕周<36周时,终止产妇妊娠可以降低围产儿发生不良结局的发生率,控制总胆汁酸水平相关指标的平衡,采取积极治疗的方式可治疗妊娠期肝内胆汁淤积症孕妇。
Objective:To explore the effect of total bile acid(TBA) level and different termination time of pregnancy in intrahepatic cholestasis of pregnancy(ICP) and its influence on perinatal outcome.Method:A total of 60 pregnant women with intrahepatic cholestasis of pregnancy who were hospitalized and delivered in our hospital from January 2017 to June 2018 were selected as the study objects.According to their total bile acid levels, 30 cases pregnant women with total bile acid levels<40 mol/L were divided into low level group(group A),including 10 cases pregnant women with termination of gestational weeks<36 weeks as AC group and 20 cases pregnant women with termination of gestational weeks≥36 weeks as AD group;30 cases pregnant women with total bile acid levels≥40 mol/L were divided into high level group(group B),including 9 cases pregnant women with termination of gestational weeks<36 weeks as BC group and 21 cases pregnantwomen with termination of gestational weeks≥36 weeks as BD group.The influence of different levels of total bile acid and different termination time of pregnancy on perinatal adverse outcomes,as well as the level of liver function indicators between A and B groups were analyzed and compared.Result:The levels of total bilirubin( TBIL),aspartate aminotransferase( AST),alanine aminotransferase( ALT) and serum TBA in group B were significantly higher than those in group A,the differences were statistically significant( P<0.05).The incidence of perinatal adverse outcomes in AC group were significantly higher than those in AD group,BC group were significantly higher than those in BD group,the differences were statistically significant( P<0.05).Conclusion:When the total bile acid level of pregnant women is less than 40 mol/L and gestational weeks are more than 36 weeks,termination of pregnancy is beneficial to reduce the incidence of perinatal adverse outcomes.When the total bile acid level of pregnant women is more than 40 mol/L and gestational weeks are less than 36 weeks,termination of pregnancy can reduce the incidence of perinatal adverse outcomes,control the balance of related indicators of total bile acid level and adopt active treatment method in the treatment of pregnant women with intrahepatic cholestasis of pregnancy were treated.
Objective:To explore the effect of total bile acid(TBA) level and different termination time of pregnancy in intrahepatic cholestasis of pregnancy(ICP) and its influence on perinatal outcome.Method:A total of 60 pregnant women with intrahepatic cholestasis of pregnancy who were hospitalized and delivered in our hospital from January 2017 to June 2018 were selected as the study objects.According to their total bile acid levels, 30 cases pregnant women with total bile acid levels<40 mol/L were divided into low level group(group A),including 10 cases pregnant women with termination of gestational weeks<36 weeks as AC group and 20 cases pregnant women with termination of gestational weeks≥36 weeks as AD group;30 cases pregnant women with total bile acid levels≥40 mol/L were divided into high level group(group B),including 9 cases pregnant women with termination of gestational weeks<36 weeks as BC group and 21 cases pregnantwomen with termination of gestational weeks≥36 weeks as BD group.The influence of different levels of total bile acid and different termination time of pregnancy on perinatal adverse outcomes,as well as the level of liver function indicators between A and B groups were analyzed and compared.Result:The levels of total bilirubin( TBIL),aspartate aminotransferase( AST),alanine aminotransferase( ALT) and serum TBA in group B were significantly higher than those in group A,the differences were statistically significant( P<0.05).The incidence of perinatal adverse outcomes in AC group were significantly higher than those in AD group,BC group were significantly higher than those in BD group,the differences were statistically significant( P<0.05).Conclusion:When the total bile acid level of pregnant women is less than 40 mol/L and gestational weeks are more than 36 weeks,termination of pregnancy is beneficial to reduce the incidence of perinatal adverse outcomes.When the total bile acid level of pregnant women is more than 40 mol/L and gestational weeks are less than 36 weeks,termination of pregnancy can reduce the incidence of perinatal adverse outcomes,control the balance of related indicators of total bile acid level and adopt active treatment method in the treatment of pregnant women with intrahepatic cholestasis of pregnancy were treated.
引文
[1]王玲敏.妊娠期肝内胆汁淤积症患者血清碱性磷酸酶、甘胆酸、总胆汁酸预测胎儿宫内窘迫的价值[J].浙江实用医学,2016,21(5):351-352.
[2]柯盈月,崔盈盈,李权伦,等.妊娠期肝内胆汁淤积症患者血生化指标及其对围产儿预后的影响[J].实用肝脏病杂志,2017,20(2):187-190.
[3]余丽辉,李名花.111例妊娠期肝内胆汁淤积症合并妊娠期糖尿病终止妊娠时机与围生结局分析[J].中国医师杂志,2015,17(3):448-450.
[4]镇澜,潘勉,陈宏.影响妊娠期肝内胆汁淤积症终止妊娠时机相关因素的分析[J].中国医药指南,2016,14(31):163-165.
[5]聂敦利,徐雁飞,温磊.妊娠期肝内胆汁淤积合并糖尿病孕妇终止妊娠的时机及围产儿结局[J].西部医学,2016,28(5):698-701.
[6]朱文芳,韩双,邹爱民,等.血清TBA和CG检测在妊娠期肝内胆汁淤积症早期诊断及围产儿不良结局影响的临床意义[J].现代检验医学杂志,2017,32(6):112-114.
[7]张小峰,黄庆慧,缪韵仪.重度妊娠期肝内胆汁淤积症对凝血功能的影响及诊治分析[J].中国卫生标准管理,2017,8(14):36-38.
[8]肖静,叶德华.妊娠肝内胆汁淤积症患者血清总胆汁酸和转氨酶水平与妊娠结局的相关性研究[J].中国医药,2016,11(7):1066-1071.
[9]黄玲飞,柯冬香,赖筱琍,等.妊娠期肝内胆汁淤积症孕妇总胆汁酸水平与妊娠结局的相关性[J].中国妇幼保健,2018,8(14):34-35.
[10]郑维群.围产儿结局和早发型妊娠期肝内胆汁淤积症血清总胆汁酸水平的关系[J].医药前沿,2017,7(8):24-26.
[11]蔡朝霞.妊娠期肝内胆汁淤积症患者总胆汁酸水平对母婴结局的影响[J].白求恩医学杂志,2015,13(6):658-659.
[12]于清梅,孙彬彬.妊娠期肝内胆汁淤积症孕妇胎儿肺损伤与血清总胆汁酸水平的相关性研究[J].肝脏,2017,22(5):451-453.
[13]陈清智.血清总胆汁酸检测在孕妇肝内胆汁淤积症诊断中的应用价值[J].中国卫生标准管理,2016,7(24):143-145.
[14]肖凤莲,郑英如.妊娠期肝内胆汁淤积症总胆汁酸水平及终止妊娠时间与围产儿结局的关系[J].第三军医大学学报,2018,40(11):1028-1032.
[15]Demir B?,Güne?E?,Atalay M A.Intrahepatic cholestasis of pregnancy:relationship between bile acid levels and maternal and fetal complications[J].Journal of Turkish Society of Obstetrics&Gynecology,2014,11(3):148-152.
[16]Ataalla W M,Ziada D H,Gaber R,et al.The impact of total bile acid levels on fetal cardiac function in intrahepatic cholestasis of pregnancy using fetal echocardiography:a tissue Doppler imaging study[J].J Matern Fetal Neonatal Med,2016,29(9):1445-1450.
[17]Kowalska-kańka A,Maciejewski T,Niemiec K T.The concentrations of bile acids and erythropoietin in pregnant women with intrahepatic cholestasis and the state of the fetus and newborn[J].Medycyna Wieku Rozwojowego,2013,17(3):232-245.
[18]Kowalski A,Janoszga?dy?I,Olejek A,et al.Correlation between serum levels of bile acids in pregnant women with intrahepatic cholestasis of pregnancy and condition of their newborns[J].Ginekologia Polska,2014,85(2):101-104.
[19]Brouwers L,Koster M P,Page-Christiaens G C,et al.Intrahepatic cholestasis of pregnancy:maternal and fetal outcomes associated with elevated bile acid levels[J].American Journal of Obstetrics and Gynecology,2015,212(1):100.e1-7.
[20]Cui D,Zhong Y,Zhang L,et al.Bile acid levels and risk of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy:a meta-analysis[J].J Obstet Gynaecol Res,2017,43(9):1411-1420.
[2]柯盈月,崔盈盈,李权伦,等.妊娠期肝内胆汁淤积症患者血生化指标及其对围产儿预后的影响[J].实用肝脏病杂志,2017,20(2):187-190.
[3]余丽辉,李名花.111例妊娠期肝内胆汁淤积症合并妊娠期糖尿病终止妊娠时机与围生结局分析[J].中国医师杂志,2015,17(3):448-450.
[4]镇澜,潘勉,陈宏.影响妊娠期肝内胆汁淤积症终止妊娠时机相关因素的分析[J].中国医药指南,2016,14(31):163-165.
[5]聂敦利,徐雁飞,温磊.妊娠期肝内胆汁淤积合并糖尿病孕妇终止妊娠的时机及围产儿结局[J].西部医学,2016,28(5):698-701.
[6]朱文芳,韩双,邹爱民,等.血清TBA和CG检测在妊娠期肝内胆汁淤积症早期诊断及围产儿不良结局影响的临床意义[J].现代检验医学杂志,2017,32(6):112-114.
[7]张小峰,黄庆慧,缪韵仪.重度妊娠期肝内胆汁淤积症对凝血功能的影响及诊治分析[J].中国卫生标准管理,2017,8(14):36-38.
[8]肖静,叶德华.妊娠肝内胆汁淤积症患者血清总胆汁酸和转氨酶水平与妊娠结局的相关性研究[J].中国医药,2016,11(7):1066-1071.
[9]黄玲飞,柯冬香,赖筱琍,等.妊娠期肝内胆汁淤积症孕妇总胆汁酸水平与妊娠结局的相关性[J].中国妇幼保健,2018,8(14):34-35.
[10]郑维群.围产儿结局和早发型妊娠期肝内胆汁淤积症血清总胆汁酸水平的关系[J].医药前沿,2017,7(8):24-26.
[11]蔡朝霞.妊娠期肝内胆汁淤积症患者总胆汁酸水平对母婴结局的影响[J].白求恩医学杂志,2015,13(6):658-659.
[12]于清梅,孙彬彬.妊娠期肝内胆汁淤积症孕妇胎儿肺损伤与血清总胆汁酸水平的相关性研究[J].肝脏,2017,22(5):451-453.
[13]陈清智.血清总胆汁酸检测在孕妇肝内胆汁淤积症诊断中的应用价值[J].中国卫生标准管理,2016,7(24):143-145.
[14]肖凤莲,郑英如.妊娠期肝内胆汁淤积症总胆汁酸水平及终止妊娠时间与围产儿结局的关系[J].第三军医大学学报,2018,40(11):1028-1032.
[15]Demir B?,Güne?E?,Atalay M A.Intrahepatic cholestasis of pregnancy:relationship between bile acid levels and maternal and fetal complications[J].Journal of Turkish Society of Obstetrics&Gynecology,2014,11(3):148-152.
[16]Ataalla W M,Ziada D H,Gaber R,et al.The impact of total bile acid levels on fetal cardiac function in intrahepatic cholestasis of pregnancy using fetal echocardiography:a tissue Doppler imaging study[J].J Matern Fetal Neonatal Med,2016,29(9):1445-1450.
[17]Kowalska-kańka A,Maciejewski T,Niemiec K T.The concentrations of bile acids and erythropoietin in pregnant women with intrahepatic cholestasis and the state of the fetus and newborn[J].Medycyna Wieku Rozwojowego,2013,17(3):232-245.
[18]Kowalski A,Janoszga?dy?I,Olejek A,et al.Correlation between serum levels of bile acids in pregnant women with intrahepatic cholestasis of pregnancy and condition of their newborns[J].Ginekologia Polska,2014,85(2):101-104.
[19]Brouwers L,Koster M P,Page-Christiaens G C,et al.Intrahepatic cholestasis of pregnancy:maternal and fetal outcomes associated with elevated bile acid levels[J].American Journal of Obstetrics and Gynecology,2015,212(1):100.e1-7.
[20]Cui D,Zhong Y,Zhang L,et al.Bile acid levels and risk of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy:a meta-analysis[J].J Obstet Gynaecol Res,2017,43(9):1411-1420.