肝内胆汁淤积症对妊娠期患者肝生化指标、炎性细胞因子变化及胎儿结局的影响

肝脏 ›› 2020, Vol. 25 ›› Issue (9): 982-985.

肝内胆汁淤积症对妊娠期患者肝生化指标、炎性细胞因子变化及胎儿结局的影响

张艳伟, 杨锐, 岳欣, 韩国荣, 王根菊

210003 江苏南京中医药大学附属南京医院妇产科(张艳伟,岳欣,韩国荣,王根菊);内蒙古赤峰市医院妇科(杨锐)

出版日期:2020-09-30 发布日期:2020-10-22
通讯作者: 岳欣,Email: njeyfck@163.com
基金资助:
南京市一般项目基金资助(YKK09045)

Effects of intrahepatic cholestasis of pregnancy on liver function, inflammatory cytokines and fetal outcome

ZHANG Yan-wei, YANG Rui, YUE Xin, HAN Guo-rong, WANG Gen-ju

Department of Obstetrics and Gynecology, Nanjing Hospital Affiliated to Nanjing University of traditional Chinese Medicine, Nanjing, Jiangsu 210003, China

Online:2020-09-30 Published:2020-10-22
Contact: YUE Xin,Email: njeyfck@163.com

摘要/Abstract

摘要： 目的探讨妊娠期肝内胆汁淤积症(ICP)对患者肝生化指标、炎症细胞因子水平变化与胎儿结局的影响。方法 2014年8月—2019年8月ICP患者96例(ICP组),平均(29.5±1.3)岁。ICP符合“妇产科ICP诊断标准(第7版)”。另选取同期收治正常妊娠患者100例(对照组)。两组患者年龄、孕次、剖宫产等无明显差异(P>0.05)。计量资料t检验比较;计数资料χ²检验比较。结果 ICP组患者血清胆汁酸(TBA)、ALT及AST为(35.9±5.8)μmol/L、(70.7±6.1)U/L及(86.0±7.9)U/L,与对照组[分别为(4.7±1.1)μmol/L、(16.0±4.1)U/L及(14.6±4.2)U/L]比,具有显著差异(P<0.05)。ICP组患者hs-CRP、IL-6及TNF-α为(13.5±0.6)mg/L、(0.7±0.1)ng/L及(142.0±7.9)ng/L,与对照组[分别为(8.4±0.4)mg/L、(0.4±0.1)ng/L及(82.6±5.2)ng/L]比,具有显著差异(P<0.05)。ICP组新生儿体质量、孕周、出生1 min Apgar评分、羊水浑浊、宫内窘迫及新生儿黄疸为(2860.4±30.5)g、(36.2±1.2)周、(8.2±0.3)分、33例(34.4%)、12例(12.5%)及28例(29.2%),与对照组[分别为(3205.8±40.2)g、(38.6±1.2)周、(9.4±0.4)分、7例(7.0%)、4例(4.0%)及8例(8.0%)]比,具有显著差异(P<0.05)。结论 ICP患者肝生化指标显著异常,同时炎性细胞因子明显高于正常患者,ICP患者相较于正常患者胎儿不良结局发生率高,临床中需要加以重视。

关键词: 妊娠期肝内胆汁淤积症, Apgar评分

Abstract: Objective To investigate the effects of intrahepatic cholestasis of pregnancy (ICP) on liver function, inflammatory cytokines and fetal outcomes. Methods Between August 2014 and August 2019, there were 96 patients with ICP (ICP group), with an average of (29.5±1.3) years old. ICP accorded with the Diagnostic criteria of ICP in Obstetrics and Gynecology (7th edition). Another 100 patients with normal pregnancy were selected in the same period (control group). There was no significant difference in age, pregnancy and cesarean section between the two groups (P>0.05). T-test comparison of measurement data and χ² test comparison of counting data. Results Serum bile acid (TBA), ALT and AST in ICP group were (35.9±5.8) μmol/l, (70.7±6.1) u/l and (86.0±7.9) u/l, which were significantly different from those in control group (4.7±1.1) μmol/l, (16.0±4.1) u/l and (14.6±4.2) u/l, respectively) (P<0.05). Hs-CRP, IL-6 and TNF-α in ICP group were (13.5±0.6)mg/L/l, (0.7±0.1) ng/l and (142.0±7.9)ng/L/l, which were significantly different from those in control group (8.4±0.4) mg/l, (0.4±0.1) ng/l and (82.6±5.2) ng/l, respectively) (P<0.05). The neonatal weight, gestational week, Apgar score at 1 minute of birth, amniotic fluid turbidity, intrauterine distress and neonatal jaundice in ICP group were (2860.4±30.5) g, (36.2±1.2) weeks, (8.2±0.3) minutes, 33 cases (34.4%), 12 cases (12.5%) and 28 cases (29.2%), Compared with the control group [3205.8±40.2)g, (38.6±1.2) weeks, (9.4±0.4) minutes, 7 cases (7.0%), 4 cases (4.0%) and 8 cases (8.0%)] there was significant difference (P<0.05). Conclusion ICP patients have abnormal liver function and higher inflammatory cytokines than normal patients. compared with normal patients, ICP patients have a higher incidence of fetal adverse outcome, which should be paid more attention to in clinic.

Key words: Intrahepatic cholestasis of pregnancy, Apgar score

张艳伟, 杨锐, 岳欣, 韩国荣, 王根菊. 肝内胆汁淤积症对妊娠期患者肝生化指标、炎性细胞因子变化及胎儿结局的影响[J]. 肝脏, 2020, 25(9): 982-985.

ZHANG Yan-wei, YANG Rui, YUE Xin, HAN Guo-rong, WANG Gen-ju. Effects of intrahepatic cholestasis of pregnancy on liver function, inflammatory cytokines and fetal outcome[J]. Chinese Hepatolgy, 2020, 25(9): 982-985.

参考文献

[1] Estiú MC, Frailuna MA, Otero C, et al. Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid. PLoS One, 2017, 12: e0176504.
[2] Günaydin B, Bayram M, Altu? M, et al. Retrospective analysis of maternal, fetal, and neonatal outcomesof intrahepatic cholestasis of pregnancy at Gazi University. Turk J Med Sci, 2017, 47: 583-586.
[3] Kong X, Kong Y, Zhang F, et al. Expression and significance of dendritic cells and Th17/Treg in serum and placental tissues of patients with intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med, 2018, 31: 901-906.
[4] Tayyar AT, Kozalι S, Yetkin Yildirim G, et al. Role of ischemia-modified albumin in the evaluation of oxidative stress in intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med, 2018, 11: 1-5.
[5] Sharifzadehgan S, Hermann M, Nedellec S, et al. Intrahepatic cholestasis of pregnancy: shorter duration of labor? Eur J Obstet Gynecol Reprod Biol, 2018, 225: 258-259.
[6] Feng C, Li WJ, He RH, et al. Impacts of different methods of conception on the perinatal outcome of intrahepatic cholestasis of pregnancy in twin pregnancies. Sci Rep, 2018, 8: 3985.
[7] Wood AM, Livingston EG, Hughes BL, et al. Intrahepatic cholestasis of pregnancy: a review of diagnosis and management. Obstet Gynecol Surv, 2018, 73: 103-109.
[8] Mei Y, Gao L, Lin Y, et al. Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy with dichorionic diamniotic twin pregnancies. J Matern Fetal Neonatal Med, 2019, 32: 472-476.
[9] Adeyemi O, Alvarez-Laviada A, Schultz F, et al. Ursodeoxycholic acid prevents ventricular conduction slowing and arrhythmia by restoring T-type calcium current in fetuses during cholestasis. PLoS One, 2017, 12: e0183167.
[10] Li L, Chen YH, Yang YY, et al. Effect of intrahepatic cholestasis of pregnancy on neonatal birth weight: a meta-analysis. J Clin Res Pediatr Endocrinol, 2018, 10: 38-43.
[11] Dadhwal V, Sharma A, Khoiwal K, et al. Pregnancy outcomes in HIV-infected women: experience from a tertiary care center in India. Int J MCH AIDS, 2017, 6: 75-81.
[12] Herrera CA, Manuck TA, Stoddard GJ, et al. Perinatal outcomes associated with intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med, 2018, 31: 1913-1920.
[13] Mattila M, Kemppainen H, Isoniemi H, et al. Pregnancy outcomes after liver transplantation in Finland. Acta Obstet Gynecol Scand, 2017, 96: 1106-1111.
[14] Tayyar A, Temel Yuksel I, et al. Maternal copeptin levels in intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med, 2018, 31: 2066-2070.
[15] Sanhal CY, Daglar K, Kara O, et al. An alternative method for measuring oxidative stress in intrahepatic cholestasis of pregnancy: Thiol/disulphide homeostasis. J Matern Fetal Neonatal Med, 2018, 31: 14771482.
[16] Türkmen GG, Timur H, Yilmaz Z, et al. Effect of intrahepatic cholestasis of pregnancy on maternal serum screening tests. J Neonatal Perinatal Med, 2016, 9: 411-415.