妊娠肝内胆汁淤积症孕妇胎儿总胆酸水平对胎儿胰腺内分泌功能及胎儿生长发育的影响  

Relationship of fetal total bile acid and the change of fetal pancreas endocrine secretion and its impact on fetal growth and development in intrahepatic cholestasis of pregnancy

作　　者：程贤鹦[1] 张丽娟[1] 林莉[1] 刘佳[1] 丁依玲[1] 

机构地区：[1]中南大学湘雅二医院妇产科,长沙410011

出　　处：《中华妇产科杂志》2009年第1期23-26,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：湖南省自然科学基金（07JJ5097）

摘　　要：目的探讨妊娠肝内胆汁淤积症（ICP）孕妇的胎儿总胆酸水平与胎儿胰腺内分泌功能变化的关系及其对胎儿生长发育的影响。方法选择2007年3月至2008年2月在中南大学湘雅二医院妇产科行剖宫产分娩的30例单胎ICP孕妇为ICP组，同期行剖宫产分娩的30例正常单胎孕妇为对照组。采用放射免疫法测定两组新生儿脐动脉血中胰岛素、胰高糖素水平；循环酶法测定总胆酸水平；氧化酶一过氧化物法测定血糖水平。并测量两组新生儿出生体重、身长，计算肥胖指数（PI）。结果（1）ICP组新生儿脐动脉血中胰岛素水平为（9．0±3．3）mU／L、胰岛素／胰高糖素比值为0．048±0．028，分别低于对照组的（10．1±3．7）mU／L及0．050±0．020，差异有统计学意义（P〈0．05）；ICP组新生儿脐动脉血中总胆酸水平为（10．3±3．8）μmol／L、胰高糖素水平为（235±57）ng／L，分别高于对照组的（4．1±1．3）μmol／L及（205±34）ng／L，差异有统计学意义（P〈0．05）；ICP组新生儿脐动脉血中血糖水平为（3．4±1．1）mmol／L，对照组为（3．6±1．2）mmol／L，两组比较，差异无统计学意义（P〉0．05）。（2）ICP组新生儿出生体重及身长分别为（3163±478）g及（46．5±2．3）cm，对照组分别为（3498±393）g及（49．3±1．9）cm，两组分别比较，差异均有统计学意义（P〈0．01）；ICP组新生儿PI（3．13±0．23）明显高于对照组（2．92±0．29），差异有统计学意义（P〈0．01）。（3）ICP组新生儿总胆酸水平分别与胰岛素、胰高糖素水平及胰岛素／胰高糖素比值呈直线关系，且随着总胆酸水平的升高，胰岛素水平及胰岛素／胰高糖素比值均降低，胰高糖素水平升高（P〈0．01）；ICP组新生儿脐动脉血中胰岛素水平及胰岛素／胰高糖素比值分别与出生体重、身长呈正相关，与PI呈负相关（P均〈0．01）�Objective To investigate the relationship of fetal total bile acid （TBA） concentration with the change of fetal pancreas endocrine secretion and its impact on fetal growth and development in intrahepatic cholestasis of pregnancy（ICP）. Methods The concentrations of TBA, insulin, glucagon and glucose in the cord blood were measured in 30 fetuses with maternal ICP （case group ） and 30 fetuses of nonnogravidas（ control group） after elective cesarean section during the same period in the Department of Obstetrics of Xiangya Second Hospital of Central South University from March 2007 to February 2008. The cord blood TBA concentration was investigated by enzyme method and the concentrations of insulin and glucagon were investigated by radioimmunoassay. The glucose was measured by oxidase-superoxide method. The neonatal weight, length and the ponderal index （PI） were measured after parturition. Results （ 1 ） The cord blood insulin concentration （9.0 ± 3.3 ） mU/L and the ratio of insulin over glucagon 0. 048 ±0. 028 in the case group was significantly lower than that of controls（ 10. 1 ± 3. ：7 ） mU/L, 0. 050 ± 0. 020 （ P 〈 0. 05 ）. The concentrations of TBA （ 10. 3 ± 3.8 ） μmol/L and glucagon （235±57 ） ng/L in case group were obviously higher than that in controls （4. 1 ± 1.3） μmol/L, （205 ±34） ng/L（P 〈0. 05）. But no difference was shown in the glucose concentration in cord blood between the case and control groups [ （ 3.4 ± 1.1 ） mmol/L vs （ 3.6 ± 1.2） mmol/L, P 〉 0. 05 ]. （2）The neonatal weight and length in case group were significantly lower than that of control [ （3163±478） g vs （3498±393）g, （46.5 ±2.3） cm vs （49.3 ± 1.9）cm, P〈0.01]; while the Ponderal index in case group was significantly higher than that of control group （3.13 ± 0. 23 vs 2. 92 ±0. 29,P 〈0.01 ）. （3） The cord blood TBA concentration respectively showed a linear relationship with the cord blood insulin concentration, the cord blood

关 键 词：妊娠并发症 胆汁淤积 肝内 胆汁酸类和盐类 胰岛素 胰高血糖素 人体质量指数 

分 类 号：R686[医药卫生—骨科学]