激活素A对妊娠期肝内胆汁淤积症患者胎儿窘迫的预测价值

摘要

目的 探讨妊娠期肝内胆汁淤积症(ICP)孕妇血清激活素A(ACTA)的水平与急性胎儿窘迫发病的关系.方法 选择2012年4月至2013年12月在甘肃省妇幼保健院产科病房行剖宫产手术的118名孕妇,采用双抗体夹心(ABC-ELISA)法测定50例ICP孕妇(研究组)和68例正常孕妇(对照组)术前、术后血清ACTA水平及新生儿脐动脉血气pH值水平,分析ACTA与急性胎儿窘迫之间的相关性.结果 研究组术前、术后ACTA水平明显高于对照组(t值分别为8.23、12.43,均P<0.05),两组新生儿脐动脉pH值无显著性差异(t=-2.72,P>0.05).研究组中胎儿窘迫孕妇术前、术后血清ACTA均显著高于对照组中胎儿窘迫孕妇(t值分别为5.10、9.42,均P<0.05),而两组新生儿脐动脉pH值无显著性差异(t=-1.76,P>0.05).两组中未发生胎儿窘迫孕妇术前、术后血清ACTA、新生儿脐动脉pH值均无显著性差异(t值分别为1.84、1.23、-1.04,均P>0.05).ICP孕妇术前血清ACTA与血清总胆汁酸、谷丙转氨酶、谷草转氨酶均存在显著正相关(r值分别为0.85、0.78、0.80,均P<0.05),与胎儿窘迫(脐动脉血气pH值)存在显著负相关(r=-0.75,均P<0.05).结论 ICP孕妇胎儿窘迫时血清ACTA水平明显高于正常孕妇,提示ICP孕妇血清ACTA的水平变化在产前急性胎儿窘迫的监测中具有重要的临床意义和价值.%objective To discuss the relationship between the level of serum activin A (ACTA) in patients with intrahepatic cholestasis of pregnancy (ICP) and pathogenesis of acute fetal distress.Methods From April 2012 to December 2013 totally 118 cases undergoing cesarean section in obstetrics department in Gansu Province Maternal and Children-care Hospital were selected in study.Double antibody sandwich ABC-ELISA assay was used to measure serum levels of ACTA before and after surgery as well as umbilical arterial blood gas PH value of 50 cases of ICP in study group and 68 normal cases in control group.The correlation between ACTA and acute fetal distress was analyzed.Results In the study group ACTA levels before and after surgery were significantly higher than those in the control group (t value was 8.23 and 12.43, respectively, both P<0.05), but no significant difference was found in newborn umbilical artery PH value (t=-2.72, P>0.05).Compared to the control group, the levels of serum ACTA before and after surgery in cases with fetal distress in the study group were significantly higher (t value was 5.10 and 9.42, respectively, both P<0.05), but the difference in umbilical artery PH value was not statistically significant between two groups (t =-1.76, P>0.05).There were no obvious differences in serum ACTA before and after surgery as well as umbilical artery PH value between cases without fetal distress in both groups (t value was 1.84, 1.23 and -1.04, respectively, all P>0.05) .Serum ACTA of cases of ICP before surgery was positively correlated with serum total bile acid, alanine aminotransferase and aspartate aminotransferase (r value was 0.85, 0.78 and 0.80, respectively, all P<0.05), and negatively correlated with fetal distress (umbilical arterial blood gas PH value) (r=-0.75, P<0.05).Conclusion When fetal distress occurs in cases of ICP, serum ACTA level is significantly higher than in normal pregnant women, which suggests that the change of serum ACTA level in ICP cases has important clinical significance or value in prenatal monitoring of acute fetal distress.