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目的探讨妊娠期肝内胆汁淤积症(ICP)患者的胆汁酸和肝酶指标对围产结局的影响。方法回顾性分析265例ICP患者的临床资料,分析ICP患者总胆汁酸(TBA)、ALT、AST与围产结局的关系。结果 265例ICP患者中,TBA≥40μmol/L者早产率、胎儿生长受限率、羊水污染率、剖宫产率高于10μmol/L≤TBA<40μmol/L者(P<0.05);甘胆酸(GCA)≥43μmol/L者早产率、胎儿生长受限率高于10.75μmol/L≤GCA<43μmol/L者(P<0.05);TBil≥21μmol/L者早产率、胎儿生长受限率、羊水污染率、剖宫产率高于TBil<21μmol/L者(P<0.05);ALT≥200U/L或AST≥200U/L者与ALT<200U/L且AST<200U/L者的早产率、胎儿生长受限率、羊水污染率、新生儿窒息率差异均无统计学意义。结论对ICP患者检测胆汁酸和肝酶指标有助于判断患者的疾病严重程度;产前TBA、TBil水平监测可作为ICP分型的依据,能可靠预测围产不良结局。
Objective To investigate the effect of bile acid and liver enzymes on perinatal outcome in patients with intrahepatic cholestasis of pregnancy (ICP). Methods The clinical data of 265 patients with ICP were retrospectively analyzed. The relationship between total bile acid (TBA), ALT, AST and perinatal outcome was analyzed. Results Among 265 patients with ICP, the preterm birth rate, fetal growth restriction rate, amniotic fluid contamination rate and cesarean section rate were higher than those with 10μmol / L≤TBA <40μmol / L (P <0.05) (GCA) ≥43μmol / L, fetal growth restriction rate was higher than 10.75μmol / L≤GCA <43μmol / L (P <0.05) .The preterm birth rate of fetus with TBil≥21μmol / L, fetal growth restriction rate , Amniotic fluid contamination rate and cesarean section rate were higher than those with TBil <21μmol / L (P <0.05); those with ALT≥200U / L or AST≥200U / L and those with ALT <200U / L and AST <200U / L Rates, fetal growth restriction rate, amniotic fluid contamination rate, neonatal asphyxia rate differences were not statistically significant. Conclusion The detection of bile acid and liver enzymes in ICP patients can help determine the severity of the disease. Prenatal monitoring of TBA and TBil levels can be used as a basis for ICP typing to reliably predict perinatal adverse outcomes.