[妊娠早期肝内胆汁淤积症的临床特征及围产结局分析]

[Analysis of clinical characteristics and perinatal outcome of early-onset intrahepatic cholestasis of pregnancy].

作者信息

Zhou Lan, Qi Hong-bo, Luo Xin

机构信息

Department of Obstetrics and Gynecology, Chongqing Medical University, Chongqing, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2013 Jan;48(1):20-4.

PMID:23531246

Abstract

OBJECTIVE

To analyze the clinical characteristics and perinatal outcome of early-onset intrahepatic cholestasis of pregnancy (ICP).

METHODS

A total of 305 ICP cases were collected in the First Affiliated Hospital of Chongqing Medical University between June 2006 and May 2012. According to the onset time of ICP, patients were divided into early-onset ICP group (onset time < 28 gestational weeks) and late-onset ICP group (onset time ≥ 28 gestational weeks). The late-onset ICP group was further divided into 28 - 31(+6) gestational weeks and ≥ 32 gestational weeks according to the onset time. The biochemical indices and perinatal outcome of each group were assessed.

RESULTS

(1) When the diagnosis was made for the first time, the maternal serum concentrations of total bile acid (TBA) and total bilirubin (TBIL) in early-onset ICP group were (41 ± 9) and (32 ± 9) µmol/L, respectively; while TBA and TBIL in late-onset ICP group were (32 ± 6) and (22 ± 9) µmol/L, and the difference between the two groups was statistically significant (P < 0.05). (2) There was no significant difference in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) between early-onset ICP group and late-onset ICP group (P > 0.05). The ALT of early-onset ICP group and late-onset ICP group were (159 ± 50) and (145 ± 52) U/L, respectively; and AST were (151 ± 49) and (138 ± 44) U/L, respectively. (3) The early-onset ICP group had significant higher (P < 0.05) incidence of meconium staining (18.8% vs. 7.4%), fetal distress (22.9% vs. 8.9%), newborn asphyxia (14.6% vs. 5.4%), premature delivery (33.3% vs. 15.6%), developing into severe ICP (41.7% vs. 25.3%) and cesarean section (91.7% vs. 78.6%) when compared to the late-onset ICP group. No significant difference in the incidence of premature delivery, developing into severe ICP and cesarean section was found between the two types of late-onset ICP. (4) There was significant differences in average birth weight and gestational weeks at delivery between the two groups [early-onset ICP group: (3113 ± 443) g and (36.3 ± 2.6) weeks]; late-onset ICP group: [(3513 ± 450) g and (37.7 ± 1.6) weeks].

CONCLUSION

The early-onset ICP patients presented worse clinical manifestations than late-onset ICP patients, and early-onset ICP is more likely to lead to premature delivery and fetal distress.

摘要

目的

分析早发型妊娠期肝内胆汁淤积症（ICP）的临床特征及围产结局。

方法

收集2006年6月至2012年5月重庆医科大学附属第一医院收治的305例ICP患者。根据ICP发病时间，将患者分为早发型ICP组（发病时间<28孕周）和晚发型ICP组（发病时间≥28孕周）。晚发型ICP组再根据发病时间分为28 - 31(+6)孕周组和≥32孕周组。评估各组的生化指标及围产结局。

结果

（1）首次诊断时，早发型ICP组孕妇血清总胆汁酸（TBA）和总胆红素（TBIL）浓度分别为（41±9）和（32±9）µmol/L；晚发型ICP组TBA和TBIL分别为（32±6）和（22±9）µmol/L，两组差异有统计学意义（P<0.05）。（2）早发型ICP组与晚发型ICP组谷丙转氨酶（ALT）和谷草转氨酶（AST）比较，差异无统计学意义（P>0.05）。早发型ICP组和晚发型ICP组ALT分别为（159±50）和（145±52）U/L；AST分别为（151±49）和（138±44）U/L。（3）早发型ICP组胎粪污染（18.8% vs. 7.4%）、胎儿窘迫（22.9% vs. 8.9%）、新生儿窒息（14.6% vs. 5.4%）、早产（33.3% vs. 15.6%）、发展为重度ICP（41.7% vs. 25.3%）及剖宫产（91.7% vs. 78.6%）的发生率均显著高于晚发型ICP组。两种晚发型ICP在早产、发展为重度ICP及剖宫产发生率方面差异无统计学意义。（4）两组平均出生体重及分娩孕周比较，差异有统计学意义[早发型ICP组：（3113±443）g和（36.3±2.6）周]；晚发型ICP组：[（3513±450）g和（37.7±1.6）周]。