肝内胆汁淤积症患者发病孕周及临床分度对围产期结局影响的临床研究

发布时间：2018-09-17 07:42

【摘要】：目的：探讨在妊娠期肝内胆汁淤积症患者的早期诊断、发病时间和临床分度对围产期妊娠结局的影响。 方法：对2012年5月-2014年3月期间在扬州大学临床医学院产科分娩的100例正常孕妇和150例妊娠期肝内胆汁淤积症患者进行回顾性分析,并进行统计学分析。分析多种因素与妊娠结局的关系。 结果： 1.妊娠期肝内胆汁淤积症患者大多发生于妊娠28-37周之间,少数发生在28周之前及37周之后,伴有不同的临床症状、体征和实检室检查等特征。 2.在正常孕妇血清甘胆酸升高发生率为10%(10/100),在ICP孕妇升高发生率为100%(150/150),在正常孕妇血清总胆汁酸升高发生率为0,在ICP孕妇升高发生率是58.33%(87/150)。 3.孕周≤28周,围产儿死亡率16.67%(3/18),新生儿窒息率11.11%(2/18);孕周28周+1-36周+6,发病围产儿死亡率2.85%(1/35),新生儿窒息率5.71%(2/35)：孕周≥37周新生儿窒息率14.29%(1/7)。孕周越早三组合并产后出血、胎膜早破、血小板减少的发生率越大。 4.重度ICP组的围生儿死亡、羊水粪染、新生儿窒息、低体重儿、转NICU发生率早产率、剖宫产率、合并血小板减少均高于轻度ICP组,有显著性差异(P0.05)；两组产后出血、胎膜早破统计学数据表明无明显差距,无统计学意义(P0.05)。 结论： 1.通过对患者早期诊断、及时治疗,可以改善母婴结局。 2.在诊断ICP方面CG较TBA更为敏感,但在特异性特别在与ICP的严重程度方面,TBA比CG更有优势。联合血清TBA及CG检测可以作为评估疾病严重程度及围产儿结局的诊断指标。 3.妊娠期肝内胆汁淤积症的妊娠结局与发病孕周有关系,ICP发病时间越早,其对母婴结局不良影响愈大。 4.ICP的妊娠结局与ICP轻重度有密切关系。重度ICP患者对于母婴结局的不良影响大于轻度ICP患者对于母婴结局的影响。故应加强对ICP患者的监测,预防和减少不良妊娠结局和不良新生儿结局的发生。
[Abstract]:Objective: to investigate the early diagnosis of intrahepatic cholestasis of pregnancy, the influence of onset time and clinical grading on perinatal pregnancy outcome. Methods: from May 2012 to March 2014, 100 normal pregnant women and 150 patients with intrahepatic cholestasis of pregnancy were analyzed retrospectively and statistically. The relationship between multiple factors and pregnancy outcome was analyzed. Results: 1. Most of the patients with intrahepatic cholestasis of pregnancy occurred between 28-37 weeks of pregnancy, and a few occurred before 28 weeks and after 37 weeks, with different clinical symptoms, signs and laboratory findings. 2. The incidence of serum cholic acid elevation was 10% (10 / 100) in normal pregnant women, 100% (150 / 150) in ICP, 0 in normal pregnant women and 58.33% (87 / 150) in ICP. The perinatal mortality rate was 16.67% (3 / 18), the neonatal asphyxia rate was 11.11% (2 / 18), the perinatal mortality rate was 2.85% (1 / 35), the neonatal asphyxia rate was 5.71% (2 / 35) and the neonatal asphyxia rate was 14.29% (1 / 7) at gestational age 鈮，

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