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目的:比较妊娠期肝内胆汁淤积症(ICP)和妊娠合并慢乙肝孕妇胆汁酸升高病例的生化指标及围产结局,以期为临床提供参考。方法:回顾分析2013年12月到2015年11月在上海市公共卫生临床中心妇产科产检并分娩的262例孕妇的病例资料,ICP组116例,妊娠合并CHB孕妇合并胆汁酸升高组146例,比较两组的生化指标和围产结局。结果:单纯性ICP组与妊娠合并CHB组在总胆汁酸最高状态下指标无明显差异,经治疗后生化指标均明显好转,但ICP组的转氨酶水平仍明显高于CHB组。两组的胎儿胎窘发生率分别为23.28%和14.38%,羊水胎粪污染发生率分别为34.48%和16.44%,发生早产比例分别为43.1%和19.86%,LGA发生率分别为9.84%和2.1%,差别均有统计学意义(P<0.05)。结论:单纯性ICP与妊娠合并CHB经积极治疗均得到明显改善。单纯性ICP的病情监测中,除胆汁酸外,还应重视转氨酶变化。合并胆汁酸升高的CHB孕妇如治疗效果良好,可在密切监测下适当延长孕周。
Objective: To compare the biochemical indexes and perinatal outcome of patients with intrahepatic cholestasis of pregnancy (ICP) and pregnant women with chronic hepatitis B during pregnancy, in order to provide a reference for clinical practice. Methods: A retrospective analysis of the clinical data of 262 pregnant women in obstetrics and gynecology from December 2013 to November 2015 at the Shanghai Public Health Clinical Center was conducted. There were 116 cases of ICP group, 116 cases of pregnant women with CHB complicated with elevated bile acid level Cases, biochemical indicators and perinatal outcomes were compared between the two groups. Results: There was no significant difference in index of total bile acid between simple ICP group and CHB group. After treatment, the biochemical parameters were significantly improved, but the level of transaminase in ICP group was still significantly higher than that in CHB group. The incidences of fetal distress in both groups were 23.28% and 14.38%, respectively. The incidences of amniotic fluid meconium were 34.48% and 16.44% respectively. The preterm birth rates were 43.1% and 19.86%, respectively, and the rates of LGA were 9.84% and 2.1% %, The difference was statistically significant (P <0.05). Conclusion: Both active ICP and pregnancy complicated with CHB have been significantly improved. Simple ICP disease monitoring, in addition to bile acid, but also attention to changes in transaminases. CHB with elevated bile acid, such as the treatment of pregnant women with good results, can be closely monitored in the appropriate extension of gestational age.