早发及晚发型妊娠期肝内胆汁淤积症患者围生儿结局观察

肝脏 ›› 2019, Vol. 24 ›› Issue (6): 635-637.

早发及晚发型妊娠期肝内胆汁淤积症患者围生儿结局观察

李亚男, 韦娟冰

100083 北京中医药大学附属中西医结合医院妇产科(李亚男);福建医科大学附属第一医院妇产科(韦娟冰)

收稿日期:2019-02-20 发布日期:2020-03-30

Perinatal outcomes of early- and late-onset intrahepatic cholestasis of pregnancy

LI Ya-nan, WEI Juan-bing

Department of Obstetrics and Gynecology, Integrated Chinese and Western Medicine Hospital Affiliated to Beijing University of Traditional Chinese Medicine,Beijing 100083,China

Received:2019-02-20 Published:2020-03-30

摘要/Abstract

摘要： 目的比较早发及晚发型妊娠期肝内胆汁淤积症患者围生儿结局。方法纳入2016年12月至2018年12月妊娠期肝内胆汁淤积症患者170例,按发病孕周分为早发型组(＜28孕周)68例和晚发型组(≥28孕周)102例。统计两组患者轻、重度妊娠期肝内胆汁淤积症发生情况,以及血清总胆汁酸、甘胆酸、丙氨酸氨基转移酶、天冬氨酸转移酶、碱性磷酸酶、总胆固醇、三酰甘油、空腹血糖、糖化血红蛋白变化,并比较两组患者分娩孕周、新生儿体质量、Apgar评分、产后出血量及围产儿结局。结果早发型组重度妊娠期肝内胆汁淤积症发生率显著高于晚发型组(P<0.05),血清总胆汁酸、甘胆酸、总胆固醇、三酰甘油、空腹血糖显著高于晚发型组(P<0.05),丙氨酸氨基转移酶、天冬氨酸转移酶、碱性磷酸酶显著低于晚发型组(P<0.05)。早发型组分娩孕周显著短于晚发型组(P<0.05),新生儿体质量显著低于晚发型组(P<0.05),Apgar评分显著高于晚发型组(P<0.05)。早发型组剖宫产、新生儿窒息、羊水Ⅱ度以上污染、早产发生率均显著高于晚发型组(P<0.05)。结论与晚发型妊娠期肝内胆汁淤积症患者相比,早发型患者围生儿结局更差,临床应引起足够重视。

关键词: 妊娠期肝内胆汁淤积症, 早发型, 晚发型, 围生儿结局

Abstract: Objective To study the perinatal outcomes of early- and late-onset intrahepatic cholestasis of pregnancy.Methods A total of 170 patients with intrahepatic cholestasis of pregnancy admitted to our hospital from December 2016 to December 2018 were divided into observation group (early-onset type, < 28 gestational weeks, 68 cases) and control group (late-onset type, ≥ 28 gestational weeks, 102 cases). The occurrences of mild and severe intrahepatic cholestasis of pregnancy in 2 groups were counted. The biochemical indexes including serum total bile acid, glycocholic acid, alanine aminotransferase, aspartate transaminase, alkaline phosphatase, total cholesterol, triglycerides, fasting blood glucose, glycosylated hemoglobin were tested. Labor gestational age, birth weight, Apgar score, postpartum blood loss and perinatal outcome were recorded. Results In the observation group, the incidence of severe intrahepatic cholestasis of pregnancy and the serum total bile acid, glycocholic acid, total cholesterol, triglyceride and fasting blood sugar were significantly higher than that in the control group (P<0.05), inversely, the alanine aminotransferase, aspartate transferase and alkaline phosphatase were significantly lower than those in the control group (P<0.05). In the observation group, the gestational weeks of delivery were significantly shorter than those in the control group (P<0.05), the neonatal weight was significantly lower than that in the control group (P<0.05), and the Apgar score was significantly higher than that in the control group (P<0.05). Moreover, the incidences of cesarean section, neonatal asphyxia, grade II to III amniotic fluid pollution and premature delivery in the observation group were significantly higher than those in the control group (P<0.05).Conclusion Compared with late-onset intrahepatic cholestasis of pregnancy patients, early-onset patients have worse perinatal outcomes. Therefore, they should be paid more attention to clinically.

Key words: Intrahepatic cholestasis of pregnancy, Early onset, Late onset, Perinatal outcome

李亚男, 韦娟冰. 早发及晚发型妊娠期肝内胆汁淤积症患者围生儿结局观察[J]. 肝脏, 2019, 24(6): 635-637.

LI Ya-nan, WEI Juan-bing. Perinatal outcomes of early- and late-onset intrahepatic cholestasis of pregnancy[J]. Chinese Hepatolgy, 2019, 24(6): 635-637.