摘要目的 分析早发型妊娠期肝内胆汁淤积症(ICP)患者的围生结局.方法 选取2015年10月至2017年10月湘乡市人民医院收治的妊娠期肝内胆汁淤积症患者100例,根据患者ICP发病孕周分为早发型组(发病孕周<28周)39例和晚发型组(发病孕周≥28周)61例;再根据甘胆酸(CG)或胆汁酸(TBA)水平,分为轻度ICP组(78例)和重度ICP组(22例).选取同期健康产检者100例作为对照组.对所有分组实施回归性分析法.结果 从生化指标角度分析,轻度ICP组、重度ICP组的葡萄糖负荷试验(GCT)、丙氨酸氨基转移酶(ALT)、总胆红素(TBiL)、天冬氨酸氨基转移酶(AST)、TBA均高于对照组(P均<0.05),轻度ICP组GCT、ALT、TBiL、AST、TBA水平低于重度ICP组(P<0.05);从发病时间角度分析,早发型组患者病情重度率高于晚发型组(P<0.05);从分娩指标角度分析,轻度ICP组Apgar评分、新生儿体质量、产后出血量、分娩孕周等情况优于重度ICP组(P<0.05),轻度ICP组、重度ICP组分娩孕周短于对照组(P<0.05),产后出血量多于对照组(P<0.05),新生儿体质量低于对照组(P<0.05),Apgar评分低于对照组(P<0.05);从围生结局角度分析,对照组围生结局优于轻度ICP组、重度ICP组(P<0.05),而轻度ICP组生产结局优于重度ICP组(P<0.05).结论 ICP患者越早发病,预后效果越差,对此还需加强生化指标检测,了解病情发展情况,从而给予相应干预,改善妊娠结局.

abstractsObjective To analyze the perinatal outcomes of patients with early-onset intrahepatic cholestasis of pregnancy (ICP).Methods A total of 100 pregnant women with ICP who were treated in Xiangxiang People 's Hospital from October 2015 to October 2017 were divided into early-onset group (39 cases, onset time<28 weeks of pregnancy ) and late-onset group (61 cases, onset time≥28 weeks of pregnancy ) according to onset weeks of ICP; and then , enrolled patients were divided into mild ICP group (78 cases) and severe ICP group (22 cases) according to levels of cholyglycine (CG) and total bile acid ( TBA) .Another 100 healthy preagnant women who underwent examination during the same period were selected as control group .Regression analysis were performed on all groups .Results In iochemical indexes, the levels of glucose challenge test (GCT), alanine aminotransferase (ALT), total bilirubin ( TBiL) , aspartate aminotrasferase ( AST) , TBA in mild ICP and severe ICP group were higher than those in control group (P<0.05);and the levels of GCT, ALT, TBiL, AST and TBA in mild ICP group were significantly lower than those in severe ICP group ( P<0.05 ) .In the aspect of onset time , the severity rate of early-onset group was significantly higher than that of late-onset group ( P<0.05) .In labor indexes , the Apgar score , newborn body weight and postpartum bleeding volume and gestational weeks of delivery of mild ICP group were superior to those of severe ICP group ( P<0.05 ) .Compared with those indicators in control group , gestational week in mild ICP group and severe ICP group was shorter , postpartum bleeding volume was more , and newborn body weight was lower and Apgar score was lower ( all P<0.05) .In perinatal outcome , the perinatal outcome of control group was better than that of mild ICP and severe ICP group ( P<0.05 ) , while the perinatal outcome of mild ICP group was better than that of severe ICP group ( P<0.05) .Conclusions The earlier onset of ICP disease , the worse the prognosis become in the patients with ICP .It is necessary to strengthen the detection of biochemical indexes and understand the development of the disease so as to give corresponding intervention and improve the outcome of pregnancy .