妊娠肝内胆汁淤积症患者总胆汁酸水平与胎儿窘迫的相关性分析  

Correlation between total bile acid level and fetal distress in patients with intrahepatic cholestasis of pregnancy

作　　者：周丽琴[1] 陈洁[2] 吴惠[1] 王智慧[1] ZHOU Liqin;CHEN Jie;WU Hui;WANG Zhihui(Department of Obstetrics and Gynecology,Xiangcheng People’s Hospital of Suzhou City,Jiangsu Province,Suzhou215131,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Soochow University,Jiangsu Province,Suzhou215006,China)

机构地区：[1]苏州市相城人民医院妇产科,江苏苏州215131 [2]苏州大学附属第一医院妇产科,江苏苏州215006

出　　处：《中国医药导报》2020年第33期110-113,125,共5页China Medical Herald

基　　金：江苏省卫生科研资助项目(H201011)。

摘　　要：目的探讨妊娠肝内胆汁淤积症(ICP)孕妇血清总胆汁酸(TBA)水平与胎儿窘迫的相关性。方法选取2014年7月—2019年6月于苏州市相城人民医院妇产科收治的87例ICP孕妇为研究对象,根据血清TBA水平将其分为轻度ICP组(57例,血清TBA 10.00~<40.00μmol/L)和重度ICP组(30例,TBA≥40.00μmol/L);另选择同期入院体检的38例健康孕妇为正常对照组。比较三组血清TBA、γ-谷氨酰转肽酶(GGT)、门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)和甘胆酸(CG)水平及胎儿窘迫发生情况,观察ICP孕妇血清TBA水平与肝功能指标的相关性,并分析TBA与ICP孕妇胎儿窘迫的相关性。结果轻度ICP组、重度ICP组血清TBA、AST、ALT、GGT和CG水平均高于正常对照组(P<0.05),且轻度ICP组上述指标均低于重度ICP组(P<0.05)。ICP孕妇血清TBA与AST、ALT、GGT、GC均无相关性(P>0.05)。三组胎儿窘迫发生率比较,差异有统计学意义(P<0.05)。ICP孕妇血清TBA预测胎儿窘迫的临界值为38.600μmol/L,ROC曲线下面积为0.792,渐进P值为0.002,血清TBA预测胎儿窘迫差异有统计学意义(P<0.05)。结论血清TBA损害孕妇肝功能,TBA水平与ICP孕妇胎儿窘迫风险密切相关,为临床治疗及病情判断提供参考。Objective To explore the correlation between the serum total bile acid(TBA)level and fetal distress in intrahepatic cholestasis of pregnancy(ICP).Methods Eighty-seven cases of ICP pregnant women admitted to Department of Obstetrics and Gynecology of Xiangcheng People’s Hospital of Suzhou from July 2014 to June 2019 were selected as research objects.According to the serum TBA level,they were divided into mild ICP group(57 cases,serum TBA 10.00-<40.00μmol/L)and severe ICP group(30 cases,TBA≥40.00μmol/L).Another 38 healthy pregnant women were selected as control group.The levels of serum TBA,gamma-glutamyl transpeptidase(GGT),aspartate aminotransferase(AST),alanine aminotransferase(ALT)and cholyglycine(CG)and the occurrence of fetal distress were compared among three groups.The correlation between serum TBA level and liver function indexes of ICP pregnant women was observed,and the correlation between TBA and fetal distress in ICP pregnant women was analyzed.Results The levels of TBA,AST,ALT,GGT and CG in mild ICP group and severe ICP group were higher than those in normal control group(P<0.05),and the above indexes in mild ICP group were lower than those in severe ICP group(P<0.05).There was no correlation between serum TBA and AST,ALT,GGT,GC(P>0.05).There was significant difference in the incidence of fetal distress among three groups(P<0.05).The critical value of serum TBA in predicting fetal distress was 38.600μmol/L,the area under ROC curve was 0.792,and the progressive P value was 0.002.The difference of serum TBA in predicting fetal distress was statistically significant(P<0.05).Conclusion Serum TBA can damage the liver function of pregnant women.The level of TBA is closely related to the risk of fetal distress in ICP pregnant women,which provides reference for clinical treatment and disease judgment.

关 键 词：妊娠肝内胆汁淤积症 总胆汁酸 胎儿窘迫 肝功能 

分 类 号：R714.25[医药卫生—妇产科学]