【摘要】：目的：探討在妊娠期肝內膽汁淤積癥患者的早期診斷、發(fā)病時間和臨床分度對圍產(chǎn)期妊娠結局的影響。 方法：對2012年5月-2014年3月期間在揚州大學臨床醫(yī)學院產(chǎn)科分娩的100例正常孕婦和150例妊娠期肝內膽汁淤積癥患者進行回顧性分析,并進行統(tǒng)計學分析。分析多種因素與妊娠結局的關系。 結果： 1.妊娠期肝內膽汁淤積癥患者大多發(fā)生于妊娠28-37周之間,少數(shù)發(fā)生在28周之前及37周之后,伴有不同的臨床癥狀、體征和實檢室檢查等特征。 2.在正常孕婦血清甘膽酸升高發(fā)生率為10%(10/100),在ICP孕婦升高發(fā)生率為100%(150/150),在正常孕婦血清總膽汁酸升高發(fā)生率為0,在ICP孕婦升高發(fā)生率是58.33%(87/150)。 3.孕周≤28周,圍產(chǎn)兒死亡率16.67%(3/18),新生兒窒息率11.11%(2/18);孕周28周+1-36周+6,發(fā)病圍產(chǎn)兒死亡率2.85%(1/35),新生兒窒息率5.71%(2/35)：孕周≥37周新生兒窒息率14.29%(1/7)。孕周越早三組合并產(chǎn)后出血、胎膜早破、血小板減少的發(fā)生率越大。 4.重度ICP組的圍生兒死亡、羊水糞染、新生兒窒息、低體重兒、轉NICU發(fā)生率早產(chǎn)率、剖宮產(chǎn)率、合并血小板減少均高于輕度ICP組,有顯著性差異(P0.05)；兩組產(chǎn)后出血、胎膜早破統(tǒng)計學數(shù)據(jù)表明無明顯差距,無統(tǒng)計學意義(P0.05)。 結論： 1.通過對患者早期診斷、及時治療,可以改善母嬰結局。 2.在診斷ICP方面CG較TBA更為敏感,但在特異性特別在與ICP的嚴重程度方面,TBA比CG更有優(yōu)勢。聯(lián)合血清TBA及CG檢測可以作為評估疾病嚴重程度及圍產(chǎn)兒結局的診斷指標。 3.妊娠期肝內膽汁淤積癥的妊娠結局與發(fā)病孕周有關系,ICP發(fā)病時間越早,其對母嬰結局不良影響愈大。 4.ICP的妊娠結局與ICP輕重度有密切關系。重度ICP患者對于母嬰結局的不良影響大于輕度ICP患者對于母嬰結局的影響。故應加強對ICP患者的監(jiān)測,預防和減少不良妊娠結局和不良新生兒結局的發(fā)生。
[Abstract]:Objective: to investigate the early diagnosis of intrahepatic cholestasis of pregnancy, the influence of onset time and clinical grading on perinatal pregnancy outcome. Methods: from May 2012 to March 2014, 100 normal pregnant women and 150 patients with intrahepatic cholestasis of pregnancy were analyzed retrospectively and statistically. The relationship between multiple factors and pregnancy outcome was analyzed. Results: 1. Most of the patients with intrahepatic cholestasis of pregnancy occurred between 28-37 weeks of pregnancy, and a few occurred before 28 weeks and after 37 weeks, with different clinical symptoms, signs and laboratory findings. 2. The incidence of serum cholic acid elevation was 10% (10 / 100) in normal pregnant women, 100% (150 / 150) in ICP, 0 in normal pregnant women and 58.33% (87 / 150) in ICP. The perinatal mortality rate was 16.67% (3 / 18), the neonatal asphyxia rate was 11.11% (2 / 18), the perinatal mortality rate was 2.85% (1 / 35), the neonatal asphyxia rate was 5.71% (2 / 35) and the neonatal asphyxia rate was 14.29% (1 / 7) at gestational age 鈮，

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