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

摘要

目的 探讨血清总胆汁酸(TBA)、甘胆酸(CG)检测在妊娠期肝内胆汁淤积症(ICP)的早期诊断及围产儿不良结局的临床意义.方法 选取长安医院产科2015年6月~2017年6月诊治的 ICP孕妇67例作为观察组,根据2015年《妊娠期肝内胆汁淤积症诊疗指南》的诊断标准分为轻度 ICP组和重度 ICP组,同时选择健康妊娠孕妇60例作为对照组.采用第五代循环酶法检测血清总胆汁酸(TBA)浓度,胶乳增强免疫比浊法检测血清甘胆酸(CG)浓度.比较各组血清 TBA和CG检测结果以及结果异常率,同时比较各组间围产儿不良结局的发生率,评价血清TBA,CG检测对ICP的早期诊断及围产儿不良结局的临床价值.结果 血清TBA,CG检测结果在对照组、轻度 ICP组、重度 ICP组三组之间,差异均有统计学意义(F=267.13,201.09,均P<0.01),轻度 ICP组血清TBA和CG检测结果高于对照组,差异有统计学意义(t=22.27, 39.68,P<0.05),重度 ICP组血清 TBA,CG检测结果高于轻度 ICP 患者组,差异有统计学意义(t=10.24,70.87,P<0.05),且对照组、轻度 ICP组、重度 ICP组孕妇血清TBA,CG检测结果随着病情的加重而升高;血清 TBA,CG异常结果在60例对照组中均未检出,在67例 ICP组(轻度 ICP组和重度 ICP组)分别为63例和61例,两组结果异常率比较,差异有统计学意义(χ2=29.35,31.27,P<0.01);围产儿发生早产、胎儿窘迫、围产儿死亡及死胎的不良围产儿结局发生率在对照组、轻度 ICP组、重度 ICP组三组之间有明显差异(χ2=39.17,56.31,13.02,6.92,均P<0.01).结论 ICP 时,血清TBA和CG升高明显,可作为 ICP诊断的敏感指标,提高 ICP的检出率,并能有效预测围产儿结局,对 ICP的早发现、早诊断具有重要的临床意义.%Objective To investigate the clinical significance of serum total bile acid(TBA)and cholyglycine(CG)detection in the early diagnosis of intrahepatic cholestasis of pregnancy(ICP)and perinatal adverse outcomes.Methods Chose 67 ca-ses of ICP pregnant women diagnosed and treated in Chang'an Hospital from June 2015 to June 2017 and they were selected as observation group.According to the 2015 edition of the diagnostic guidelines for the diagnosis and treatment of intrahe-patic cholestasis of pregnancy.The patients were divided into mild ICP group and severe ICP group,and 60 healthy pregnant women were selected as the control group.The serum TBA concentration was measured by fifth generation cyclic enzyme method and the concentration of serum CG was detected by latex enhanced turbidimetric immunoassay.The serum TBA,CG test results and the rate of abnormal test results,the incidence rate of perinatal adverse outcomes were compared between groups.Evaluation of serum TBA and CG detection of pregnancy early diagnosis of intrahepatic cholestasis and clinical value of perinatal adverse outcomes.Results The detection results of serum TBA and CG in the control group,mild ICP group and severe ICP group,there were significant differences between the three groups,the difference was statistically significant (P<0.01),the detection results in the CG group,serum TBA,ICP slightly higher than the control group,the difference was statistically significant(t=22.27,39.68,P<0.05).Weight of serum TBA and ICP group,the results of CG was higher than that of patients with mild ICP group,the difference was statistically significant(t=10.24,70.87,P<0.05).And in the con-trol group,mild ICP group,severe ICP group pregnant women serum TBA,CG test results increased with the aggravation of the disease.Serum TBA and CG abnormal results in 60 cases of the control group were not detected.In 67 cases of group ICP(mild ICP group and severe ICP group)were 63 cases and 61 cases,two groups of abnormal results rate comparison,and the difference was statistically significant(χ2=29.35,31.27,P<0.01).Perinatal premature labor,fetal distress,perinatal death and stillbirth incidence of adverse perinatal outcomes in the control group,mild ICP group and severe ICP group were significantly different between the three groups(χ2=39.17,56.31,13.02,6.92,P<0.01).Conclusion Intrahepatic chole-stasis of pregnancy,serum TBA and CG increased significantly,can be used as a sensitive indicator of ICP diagnosis,improve the detection rate of ICP,and effectively predict perinatal outcome.For intrahepatic cholestasis of pregnancy early detection and early diagnosis,it has important clinical significance.