妊娠期肝内胆汁瘀积症对胎儿预后的影响及处理  

Influence of Intrahepatic Cholestasis during Pregnancy on Fetal Pregnanies and Its Treatment

作　　者：刘玉梅[1] 曾蔚越[1] 

机构地区：[1]四川大学华西第二医院,四川成都610041

出　　处：《华西医学》2004年第4期581-583,共3页West China Medical Journal

摘　　要：目的 :探讨妊娠期肝内胆汁瘀积症 (ICP)患者血清肝酸水平 (TBA)、谷丙转氨酶 (ALT)、谷草转氨酶 (AST)对胎儿预后的影响 ,并分析ICP的治疗效果。方法 :6 6 0例ICP孕妇 ,将上述指标分为不同程度的两组 ,TBA :T12 0～ 4 0 μmol/L ,T2 >4 0 μmol/L ;ALT、AST :A15 0～ 15 0 μmol/L ,A2 >15 0 μmol/L。分析其与羊水污染、Apgar评分 (<7分 )、早产及低体重发生率之间的关系。结果 :T1、T2 两组相比 ,差异有显著性 ,P <0 0 1,说明胆酸水平高于 4 0 μmol/L组羊水污染、新生儿窒息、早产及低体重儿发生率明显高于胆酸水平低于 4 0 μmol/L ,ALT、AST >15 0 μ/L时围产儿预后差。地塞米松与熊去氧胆酸治疗前后孕妇血清胆酸水平差异有显著性 ,P <0 0 2 ,两组相比差异无显著性 ,P >0 0 5。结论 :血清胆酸水平、谷丙转氨酶及谷草转氨酶可反映ICP的严重程度 ,预测不良妊娠结局 ;地塞米松与熊去氧胆酸能有效改善ICP症状及肝功能。Objective:To investigate the influence of serum cholic acids,glutamic-pyruvic transaminase enzyme(ALT)and glutamic-oxaloacetic aminotransferase(AST) in intrahepatic cholestasis during pregnancy on fetal prognosis and to analyze the effect of treatment.Methods:To divide the above-mentioned makers into two groups,TBA:T 20～40μmol/L,T 2>40μmol/L,and ALT、AST:A 150～150μmol/L,A 2>150μmol/L.The relationships of different degreef of TBA、ALT and AST with meconium、Apgar score(<7),preterm labor and low weight birth in 660 ICP patients were analyzed.Results:there was significance T 1 compared with T 2,P<0.01,and the incidence of which was higher in T 2>μmol/L them in 20～40μmol/L.The same outcome was acquired in A 1compared with A 2,P<0.01.There would be poor perinatal prognosis in T 2>μmol/L,ALT、AST>150μ/L.Dexamethasone(Dex)and ursodeoxycholic acid (DUCA)had the same treatment effects,and the mean serum cholic acid was significantly lower after treatment ,P<0.02.But there was no significance between Dexamethasone and DUCA,P>0.05.conclusion:The serum cholic acids、glutamic-pyruvic transaminase enzyme and glutamic-oxaloacetic aminotransferase might predict poor perinatal outcome and severity degree of ICP patients.Dexamethasone and DUCA could improve the symptoms and liver functions effectively.

关 键 词：妊娠期肝内胆汁瘀积症 胎儿预后 ALT AST ICP TBA 谷草转氨酶 显著性 水平 目的 

分 类 号：R714.2[医药卫生—妇产科学]