妊娠期肝内胆汁淤积症与早期新生儿高胆红素血症发病率的相关性研究

发布时间：2018-06-01 21:25

本文选题：妊娠期肝内胆汁淤积症 + 新生儿高胆红素血症　；参考：《遵义医学院》2014年硕士论文

【摘要】：目的：了解妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy,ICP)的发病情况及其围产儿结局，探讨母亲患有ICP与其新生儿发生早期新生儿高胆红素血症发病率的相关性。方法：选取2012年10月至2013年10月于遵义医学院附属医院住院分娩的ICP患者及其分娩的新生儿各57例为观察组，正常孕产妇及其分娩新生儿各161例为对照组，记录所有孕产妇的年龄、孕周、孕产次、分娩方式，及新生儿体重、喂养方式、早产、胎膜早破、窒息或宫内窘迫、羊水粪染及羊水量情况，经皮黄疸仪动态监测出生7日内新生儿胆红素情况，并予末梢血微量测定法进行间断复核。结果：（1）ICP组与对照组妇女在年龄、分娩孕周、孕次及产次比较无差异（P＞0.05）；（2）ICP妇女血清总胆汁酸（total bile acid，TBA）、总胆红素（total Bilirubin，TBIL）、直接胆红素（direct bilirubin，DBIL）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、门冬氨酸氨基转移酶（aspartate aminotransferase，AST）水平明显高于对照组,差异具有显著性（P＜0.05）；（3）ICP组剖宫产、羊水粪染、新生儿窒息、早产及围产儿死亡发生率分别为78.59%、22.81%、17.54%、26.32%、8.78%，对照组分别为56.62%、8.07%、5.64%、4.35%、0.62%，两组比较均具有显著性差异（P＜0.05），出生体重、发病时间及胎膜早破发生率比较均无明显差异（P＞0.05）；（4）ICP组早期新生儿高胆红素血症发病率35.10%，对照组10.56%，ICP组较对照组明显高（P＜0.05）；ICP组早产儿较足月儿高胆红素血症发病率高（P＜0.05）；（5）ICP组剖宫产分娩新生儿发生早期高胆红素血症发病率40.00%，，自然分娩新生儿高胆发病率16.67%，ICP时自然分娩新生儿高胆发病率较剖宫产儿发病率低，具有显著性差异（P＜0.05）；（6）ICP组新生儿高胆红素血症发病率与母亲血清TBA、TBIL、DBIL水平呈正相关（P＜0.05），相关系数分别为0.384、0.301、0.308。结论： 1、ICP患者分娩的新生儿早期新生儿高胆红素血症发病率高。 2、高浓度胆汁酸、胆红素水平及其所致早产、剖宫产及胎儿宫内缺氧等，可能与ICP的新生儿发生早期高胆红素血症有关。
[Abstract]:Objective: To investigate the incidence and perinatal outcome of intrahepatic cholestasis of precancerous cholestasis of pregnancy, and to explore the relationship between maternal ICP and the incidence of early neonatal hyperbilirubinemia. Methods: From October 2012 to October 2013, 57 ICP patients and 57 newborns delivered in the affiliated Hospital of Zunyi Medical College were selected as observation group and 161 normal pregnant women and their newborn babies as control group. The age of all pregnant women was recorded. Gestational week, time of delivery, mode of delivery, weight of newborn, feeding mode, preterm delivery, premature rupture of membranes, asphyxia or intrauterine distress, feces staining of amniotic fluid and amniotic fluid volume, dynamic monitoring of neonatal bilirubin within 7 days of birth by percutaneous jaundice instrument. The method of microdetermination of peripheral blood was used for intermittent reexamination. Results: There was no significant difference between ICP group and control group in age, gestational age, pregnancy and delivery (P > 0.05). The serum total bile acid (TBA), total bilirubin (TBI), direct bilirubin (DBIL), alanine aminotransferase (Ala), aspartate aminotransferase (AST) in the ICP group were significantly higher than those in the control group (P < 0.05). The incidence of neonatal asphyxia, premature delivery and perinatal death were 78.59, 22.81 and 17.54, 26.32 and 8.78, respectively, and those in the control group were 56.62 and 8.07, respectively. There was significant difference between the two groups (P < 0.05, birth weight). There was no significant difference in the incidence of premature rupture of membranes and the incidence of premature rupture of membranes (P > 0.05). The incidence of early neonatal hyperbilirubinemia was 35.1010 in the ICP group, and significantly higher in the ICP group than that in the control group (P < 0.05); the incidence of hyperbilirubinemia in the ICP group was significantly higher than that in the term group (P < 0.05); the incidence of hyperbilirubinemia in the ICP group was significantly higher than that in the control group (P < 0.05). The incidence of early hyperbilirubinemia in newborns born by cesarean section was 40.00.The incidence of hyperbilirubinemia in newborns with spontaneous delivery was 16.67. The incidence of hyperbilirubinemia in newborns born naturally during ICP was lower than that in infants born by cesarean section. The incidence of neonatal hyperbilirubinemia was positively correlated with the maternal serum TBABILL DBIL level (P < 0.05), and the correlation coefficients were 0.3840.301 and 0.308, respectively. Conclusion: 1the incidence of early neonatal hyperbilirubinemia in ICP patients was high. 2, high concentration of bile acid, bilirubin and preterm labor, cesarean section and fetal intrauterine hypoxia may be associated with early hyperbilirubinemia in neonates with ICP.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.7

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