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目的:探讨不同发病孕周与妊娠期肝内胆汁淤积症(ICP)胎儿预后的关系。方法:采用回顾性方法,对我院2004年1月～2010年1月收治的无其它合并症的506例ICP患者的临床资料进行回顾性系统分析。按照发病时间不同分为:≤28孕周组(104例),28+1-32孕周组(124例),32+1-36+6孕周组(203例),≥37孕周组(75例);根据是否治疗,各组又被分为治疗组和未治疗组。结果:死胎(3例,0.59%),胎儿生长受限(14例,2.76%),胎儿窘迫(85例,16.79%),早产(80例,13.83%),发生胎儿窘迫和/或发生早产的ICP患者甘胆酸(CG)、总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(BIL)水平明显增高,与围产结局好的ICP患者相比,差异有统计学意义(P<0.05);≤28孕周和28+1-32孕周发病并且接受治疗的患者CG、TBA、ALT、AST、BIL、直接胆红素(CB)、间接胆红素(UCB)、碱性磷酸酶(ALP)水平低于未治疗者,差异有统计学意义(P<0.05);早产主要集中在≤28孕周和28+1-32孕周发病并且未治疗的患者,分娩孕周分别为(35.50±2.19)周和(36.37±1.96)周,并且与对应的治疗组相比,早产发生率差异有统计学意义(P<0.05);各组胎儿窘迫发生率比较均无统计学意义(P>0.05);结论:病程长是胎儿不良预后的重要影响因素,孕期监测甘胆酸和肝功能变化是评估胎儿宫内情况的有效指标,早期诊断早期治疗可以通过改善肝脏功能,降低胆酸浓度,从而延长胎龄,减少早产的发生,但是,及时剖宫产终止妊娠仍然是减少死胎和胎儿窘迫最重要的手段。
Objective: To investigate the relationship between gestational age and gestational intrahepatic cholestasis (ICP) fetus prognosis. Methods: A retrospective analysis of 506 patients with ICP without other complications admitted to our hospital from January 2004 to January 2010 was retrospectively analyzed. According to the time of onset, the patients were divided into two groups according to the time of onset: ≤28 gestational weeks group (104 cases), 28 + 1-32 gestational weeks group (124 cases), 32 + 1-36 + 6 gestational weeks group (203 cases) (75 cases); according to whether the treatment, each group was divided into treatment group and untreated group. Results Fetal fetal distress and / or preterm labor occurred in 3 (0.5%) patients with fetal growth restriction (14 cases, 2.76%), fetal distress (85%, 16.79%), premature birth (80 cases, 13.83% The levels of CG, TBA, ALT, AST and BIL in ICP patients were significantly higher than those in controls CG, TBA, ALT, AST, BIL in patients with onset and treatment of 28 + 1-32 weeks of gestation were significantly higher than those with good outcome (P <0.05) The levels of bilirubin (CB), indirect bilirubin (UCB) and alkaline phosphatase (ALP) were lower than those of untreated patients (P <0.05) + 1-32 weeks gestational age and untreated patients, gestational weeks were (35.50 ± 2.19) weeks and (36.37 ± 1.96) weeks, and compared with the corresponding treatment group, the incidence of preterm birth was statistically significant ( P <0.05). There was no significant difference in the incidence of fetal distress between groups (P> 0.05). Conclusion: Long course of disease is an important factor affecting fetal prognosis. The changes of glycocholic acid and liver function during pregnancy were evaluated in intrauterine Effective indicators of the situation, Diagnosis and early treatment can improve liver function, reduce the concentration of bile acids, thus extending the gestational age, reduce the incidence of premature delivery, however, remains timely cesarean section termination of pregnancy to reduce stillbirths and fetal distress is the most important means.