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目的 探讨妊娠期肝内胆汁瘀积症 (ICP)血脂变化的特点及其临床意义。 方法 收集 74例妊娠晚期 ICP患者和 71例正常孕妇空腹血清 ,测定其血脂和载脂蛋白 ,进行比较 ;并观察ICP血脂变化与肝功能异常、母婴并发症及妊娠结局的关系。 结果 (1) ICP组总胆固醇、甘油三酯、低密度脂蛋白、极低密度脂蛋白及载脂蛋白 B分别为 (7.3± 1.6 )、(4.4± 1.6 )、(3.9± 1.8)、(2 .0± 0 .8)和 (1.7± 0 .3) mm ol/ L ,显著高于正常妊娠组 (5 .9± 1.0、3.4± 1.6、2 .9± 1.0、1.6± 0 .8)和(1.0± 0 .3) m m ol/ L,(P均 <0 .0 5 ) ,高密度脂蛋白为 (1.2± 0 .5 ) m m ol/ L,显著低于正常妊娠组 (1.6± 0 .4) mm ol/ L,(P<0 .0 5 ) ;(2 )如将 95 %正常妊娠妇女血脂数值作为正常值范围 ,把 ICP病例分成血脂正常和异常组 ,则 ICP中血脂异常组丙氨酸转氨酶和碱性磷酸酶水平 (190 .3± 15 7.5和 334 .4±147.4) u/ L高于血脂正常组 (12 9.9± 10 7.1)和 (2 81.6± 10 2 .9) u/ L ,(P<0 .0 5 ) ,其羊水污染、胎儿窘迫、早产及新生儿并发症发生率显著增高 ,产后出血及围产儿死亡亦有增多的趋势。 结论 ICP患者血脂多有异常 ,能反映病情的严重性 ,应做为 ICP常规监测指标。
Objective To investigate the changes of intrahepatic cholestasis in pregnancy (ICP) and its clinical significance. Methods Serum lipids and apolipoproteins of 74 pregnant women with ICP in the third trimester and 71 normal pregnant women were collected and compared. The relationship between ICP blood lipids and abnormal liver function, maternal and infant complications and pregnancy outcome were also observed. Results (1) The levels of total cholesterol, triglyceride, low density lipoprotein, very low density lipoprotein and apolipoprotein B were (7.3 ± 1.6), (4.4 ± 1.6), (3.9 ± 1.8) and .0 ± 0 .8) and (1.7 ± 0.3) mm ol / L were significantly higher than those in normal pregnancy group (5.9 ± 1.0,3.4 ± 1.6,2.9 ± 1.0,1.6 ± 0.8) and (1.0 ± 0.3) mm ol / L, P <0.05, high density lipoprotein was (1.2 ± 0.5) mm ol / L and significantly lower than that of normal pregnancy group (1.6 ± 0. 4) mm ol / L, (P <0.05). (2) If the blood lipids of 95% of normal pregnant women were taken as the normal range, the ICP patients were divided into normal and abnormal lipid groups, (190.3 ± 15 7.5 and 334.4 ± 147.4) u / L were higher than those of the normal blood lipids group (12.9 ± 10 7.1) and (2 81.6 ± 102.9) u / L (P <0.05). The incidences of amniotic fluid contamination, fetal distress, premature birth and neonatal complications were significantly increased, with postpartum hemorrhage and perinatal mortality also increasing. Conclusion ICP patients with abnormal blood lipids, can reflect the severity of the disease, ICP routine monitoring should be done.