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目的探讨妊娠肝内胆汁淤积症(ICP)分度诊断和处理的临床意义。方法将1995年1月至2004年12月,在我院产前检查并诊为ICP的患者556例,根据ICP患者的血清胆红素、肝转氨酶和甘胆酸水平分为轻度与重度ICP。并进行分度诊断和分度处理,观察其妊娠结局与分度诊断前后的围生儿病死率。结果轻度ICP患者为384例(轻度组),重度ICP患者为172例(重度组)。重度组和轻度组ICP患者终止妊娠的平均孕周分别为(36．0±1．8)周和(38．1±1．7)周,两组比较有非常显著性差异(P＜0．01)。重度组和轻度组ICP分度诊断后,期待治疗的时间为(9．1±6．9)d和(17．9±7．1)d,两组比较有非常显著性差异(P＜0．01)。重度组ICP患者羊水粪染、新生儿窒息和新生儿转入重症监护室的发生率分别为38．4%(66/172)、13．4%(23/172)、15．1%(26/172),明显高于轻度组的9．1%(35/384)、4．4%(17/384)、9．6% (37/384)。采用分度诊断前围生儿病死率为1%～11%,分度诊断后围生儿病死率为0．7%,两者比较有非常显著性差异(P＜0．01)。结论对ICP患者进行分度诊断和处理,有助于改善围生儿预后。
Objective To investigate the clinical significance of diagnosis and treatment of intrahepatic cholestasis of pregnancy (ICP). Methods From January 1995 to December 2004, 556 patients were examined in our hospital and were diagnosed with ICP. According to the levels of serum bilirubin, hepatic transaminase and glycocholic acid in ICP patients, mild and severe ICP . And carry on indexing diagnosis and indexing treatment to observe the pregnancy outcome and index of perinatal mortality before and after diagnosis. Results Mild ICP patients were 384 (mild) and severe ICP patients were 172 (severe). The gestational weeks of termination of pregnancy in severe and mild ICP patients were (36.0 ± 1.8) weeks and (38.1 ± 1.7) weeks, respectively, with significant differences between the two groups (P <0. .01). After the diagnosis of severe and mild ICP, the expected treatment time was (9.1 ± 6.9) days and (17.9 ± 7.1) days, respectively. There was a significant difference between the two groups (P < 0.01). The incidences of meconium-stained amniotic fluid, neonatal asphyxia and neonatal intensive care unit in patients with severe ICP were 38.4% (66/172), 13.4% (23/172), 15.1% (26 / 172), which was significantly higher than that of mild group (9.1% (35/384), 4.4% (17/384), 9.6% (37/384)). The diagnosis of perinatal mortality was 1% ~ 11%, and the perinatal mortality was 0.7% after indexing. There was a significant difference between the two (P <0.01). Conclusion The diagnosis and treatment of ICP patients with sub-degree diagnosis will help to improve the prognosis of perinatal children.