妊娠期肝内胆汁淤积症产前监测指标与围产儿预后关系的研究

摘要

目的 探讨妊娠期肝内胆汁淤积症产前监测指标与围产儿预后相关性.方法 采用病例对照方法回顾性分析2011年1月至2014年1月同济医学院附属普爱医院收治的88例妊娠期肝内胆汁淤积症患者及其围产儿(研究组)的临床资料,选取同期收治的正常妊娠妇女100例及其围产儿为对照组,分析妊娠期肝内胆汁淤积症产前监测指标与围产儿预后的关系及其围产儿流行病学特点.结果 研究组围产儿羊水粪源性感染、新生儿窒息、早产儿和胎儿宫内窘迫发生率均明显高于对照组,差异有统计学意义(P＜0.05).研究组中围产儿不良组孕妇甘胆酸(CG)、ALT、AST、总胆红素(TBIL)、直接胆红素(DBIL)和总胆汁酸(TBA)水平均明显比良好组孕妇高,差异有统计学意义(P＜0.05).多因素回归分析显示,CG、ALT、AST、TBIL和TBA与围产儿预后不良有明显关系.围产儿疾病中以羊水粪源性感染为最多(33.3％),其次为早产儿(28.6％)、胎儿宫内窘迫(20.6％)、新生儿窒息(15.9％)和死胎(1.6％).结论 妊娠期肝内胆汁淤积症孕妇围产儿预后不良发生率较高,其中以羊水粪源性感染为最多,产前CG、ALT、AST、TBIL和TBA水平监测可作为预测围产儿预后的指标.%Objective To investigate the association between prenatal monitoring index in intrahepatic cholestasis of pregnancy and the perinatal prognosis,as well as the characteristics of perinatal situations.Methods A retrospective study on the clinical data of 88 cases intrahepatic cholestasis of pregnancy and prognosis that were treated in our hospital from Jan.2011 to Jan.2014 was carried out.Relationship between prenatal monitoring index in intrahepatic cholestasis of pregnancy and perinatal prognosis,together with the epidemiological features of infants were analyzed.Results The incidence rates of perinatal meconium stained amniotic fluid,asphyxia neonatorum,premature and fetal distress were significantly higher in the study group than those in the controls,with differences statistically significant (P＜0.05).The levels of CG,ALT,AST,TBIL,DBIL and TBA in puerperant with bad perinatal situation were significantly higher than puerperant with good perinatal situation,with the difference statistically significant (P＜0.05).Results from the multiple regression analysis indicated that close relations did exist between CG,ALT,AST,TBIL,TBA and adverse perinatal prognosis.The main perinatal risks were related to meconium stained amniotic fluid (33.3％),prematurity (28.6％),fetal distress (20.6％),asphyxia neonatorum (15.9％) and stillbirth (1.6％).Conclusion The rate of adverse perinatal prognosis was low in intrahepatic cholestasis of pregnancy,with most frequently seen as meconium stained amniotic fluid.It was necessary to monitor the level of prenatal CG,ALT,AST,TBIL and TBA in puerperant in predicting the perinatal prognosis.