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目的探讨早发型妊娠期肝内胆汁淤积症(ICP)患者与围生结局的关系,并分析各项生化指标对ICP患者围生结局的预测价值。方法收集住院分娩的89例ICP患者临床资料进行回顾性分析。按照ICP发病的孕周不同分为早发型ICP组(妊娠<28周,42例)及晚发型ICP组(妊娠≥28周,47例),分析两组ICP患者围生结局,并分析血清总胆汁酸(TBA)、甘胆酸(CG)、总胆红素(TBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)6项生化指标对ICP患者围生结局的预测价值。结果两组患者平均年龄比较差异无统计学意义(P>0.05);与晚发型ICP组相比,早发型ICP组患者分娩孕周较小、孕晚期的TBA最高值水平明显较高,差异具有统计学意义(P<0.05),TBA均数已达重度ICP。而围生结局中早发型ICP组仅早产发生率高于晚发型ICP组,差异有统计学意义(P<0.05);其他羊水胎粪污染等围生结局两组比较差异无统计学意义(P>0.05)。(1)胎儿窘迫及新生儿窒息:当TBA为59.80μmol/L时,预测胎儿窘迫及新生儿窒息的敏感性为66.7%,特异性为88.7%。(2)低出生体重儿:当TBA为52.50μmol/L时,预测低出生体重儿的敏感性为88.9%,特异性为81.2%。(3)早产:当TBA为41.35μmol/L时,预测早产的敏感性为72.4%。特异性为65.0%。(4)其他新生儿合并症:当TBIL(治疗后)为8.05μmol/L时,预测其他新生儿合并症的敏感性为78.9%,特异性为55.7%;当TBA为38.95μmol/L时,预测其他新生儿合并症的敏感性为78.9%,特异性为50.0%。结论早发型ICP患者较容易在孕晚期发展为重型ICP患者,但如果治疗及时,并不比晚发型ICP患者明显增加不良围生结局。TBIL及TBA的指标对于ICP患者不良围生结局有预测意义。
Objective To investigate the relationship between perinatal outcome and early-onset intrahepatic cholestasis of pregnancy (ICP), and to analyze the predictive value of biochemical markers on the outcome of ICP patients. Methods The clinical data of 89 patients with ICP who were hospitalized for delivery were retrospectively analyzed. According to ICP gestational age, the incidence of ICP was divided into early onset ICP group (pregnancy <28 weeks, 42 cases) and late onset ICP group (pregnancy ≥28 weeks, 47 cases), analysis of the perinatal outcome of two groups of ICP patients, and analysis of total serum Six biochemical indexes including TBA, CG, TBIL, ALT, AST, ALP Predictive value of perinatal outcome in patients with ICP. Results There was no significant difference in average age between the two groups (P> 0.05). Compared with late-onset ICP group, gestational age was lower in early-onset ICP group and highest in third trimester pregnancy group, with significant difference Statistical significance (P <0.05), TBA mean has reached a severe ICP. However, the rate of preterm birth in early-onset ICP group was higher than that in late-onset ICP group in perinatal outcome (P <0.05). There was no significant difference in perinatal outcome among other amniotic fluid meconium-stained groups (P > 0.05). (1) Fetal distress and neonatal asphyxia: When TBA was 59.80μmol / L, the sensitivity and predictability of fetal distress and neonatal asphyxia were 66.7% and 88.7% respectively. (2) Low birth weight children: When the TBA is 52.50μmol / L, the sensitivity of low birth weight children is 88.9% and the specificity is 81.2%. (3) Preterm birth: When the TBA was 41.35μmol / L, the sensitivity of predicting premature labor was 72.4%. Specificity was 65.0%. (4) Other neonatal complications: When TBIL (after treatment) was 8.05μmol / L, the sensitivity and specificity of other neonatal complications were predicted to be 78.9% and 55.7%, respectively. When TBA was 38.95μmol / L, The sensitivity of other neonatal complications was predicted to be 78.9% with a specificity of 50.0%. Conclusions Early-onset ICP patients are more likely to develop severe ICP in their third trimester, but their treatment does not significantly increase the adverse perinatal outcome if compared to late-onset ICP patients if treated promptly. The indexes of TBIL and TBA have predictive value for the poor perinatal outcome of ICP patients.