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目的 探讨妊娠肝内胆汁淤积症(ICP)胎儿总胆汁酸浓度与胎儿肾上腺皮质功能变化的关系。 方法 采用放射免疫法测定正常孕妇22例(对照组)及ICP孕妇20例(ICP组)胎儿脐血皮质醇及硫酸脱氢表雄酮(DHEA S)浓度;循环酶法测定两组母血及脐血总胆汁酸浓度。 结果 ICP组胎儿脐血总胆汁酸浓度(8.93±3.16) mmol/L高于对照组(4.33±1.51) mmol/L,两组比较有显著性差异(P<0. 05),且与母血胆汁酸浓度呈正相关。ICP 组脐血皮质醇浓度(99. 83±41. 34)ng/ml与对照组(74.93±29.58)ng/ml相比无明显差别(P>0.05)。ICP组脐血DHEA S浓度(24.62±8.89)μg/dl明显低于对照组(69.18±39.37)μg/dl,两组比较有显著性差异(P<0.05)。ICP组脐血DHEA S与皮质醇比值(0.29±0.09)亦明显低于对照组(0.87±0.31),两组比较有显著性差异(P<0.05)。ICP组脐血皮质醇、DHEA S浓度及DHEA S与皮质醇比值均与脐血胆汁酸浓度相关(相关系数分别为:r1= 0.87,r2=-0.88,r3=-0.84;P<0.05)。 结论 ICP孕妇的胎儿总胆汁酸浓度增高,与母血总胆汁酸浓度呈正相关;ICP孕妇的胎儿肾上腺皮质功能受损,其受损程度与脐血总胆汁酸浓度呈正相关。
Objective To investigate the relationship between fetal total bile acid concentration and fetal adrenocortical function in intrahepatic cholestasis of pregnancy (ICP). Methods Cord blood cortisol and DHEA S concentrations were determined by radioimmunoassay in 22 pregnant women (control group) and 20 pregnant women (ICP group) Cord blood total bile acid concentration. Results The concentration of total bile acid in fetal umbilical cord blood in ICP group (8.93 ± 3.16 mmol / L) was significantly higher than that in control group (4.33 ± 1.51 mmol / L), there was significant difference between the two groups (P <0.05) Bile acid concentration was positively correlated. The cortisol concentration of cord blood in ICP group (99. 83 ± 41. 34) ng / ml was not significantly different from that in control group (74.93 ± 29.58) ng / ml (P> 0.05). The concentration of DHEA S in umbilical cord blood in ICP group (24.62 ± 8.89) μg / dl was significantly lower than that in control group (69.18 ± 39.37) μg / dl, with significant difference between the two groups (P <0.05). The ratio of DHEA S to cortisol in cord blood of ICP group was also significantly lower than that of control group (0.29 ± 0.09 vs 0.87 ± 0.31, P <0.05). The cord blood cortisol, DHEA S concentration and the ratio of DHEA S to cortisol in cord blood were correlated with cord blood bile acid concentrations (r1 = 0.87, r2 = -0.88, r3 = -0.84, P <0.05, respectively). CONCLUSION: Fetal total bile acid concentration in ICP pregnant women is increased, which is positively correlated with total bile acid concentration in pregnant women. ICP fetus has impaired fetal adrenocortical function and its degree of impairment is positively correlated with total bile acid concentration in cord blood.