[1]肖凤莲,郑英如.妊娠期肝内胆汁淤积症总胆汁酸水平及终止妊娠时间与围产儿结局的关系[J].第三军医大学学报,2018,40(11):1028-1032.
 XIAO Fenglian,ZHENG Yingru.Relationship of total bile acid level and timing of termination with perinatal outcomes in intrahepatic cholestasis of pregnancy [J].J Third Mil Med Univ,2018,40(11):1028-1032.
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妊娠期肝内胆汁淤积症总胆汁酸水平及终止妊娠时间与围产儿结局的关系(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第11期
页码:
1028-1032
栏目:
临床医学
出版日期:
2018-06-15

文章信息/Info

Title:
Relationship of total bile acid level and timing of termination with perinatal outcomes in intrahepatic cholestasis of pregnancy
 
作者:
肖凤莲郑英如
陆军军医大学(第三军医大学)第三附属医院(野战外科研究所)妇产科
Author(s):
XIAO Fenglian ZHENG Yingru

Department of Gynecology and Obstetrics, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China

关键词:
妊娠并发症肝内胆汁淤积总胆汁酸终止妊娠围产儿结局
Keywords:
pregnancy complications intrahepatic cholestasis total bile acid termination perinatal outcomes
分类号:
R446; R714.25; R722
文献标志码:
A
摘要:

目的    探讨妊娠期肝内胆汁淤积症(intrahepatic cholestasis pregnancy,ICP)不同血清总胆汁酸(total bile acid,TBA)水平及不同终止妊娠时间对围产儿结局的影响。 方法    回顾性分析2013年3月至2017年6月我院住院分娩的198例ICP孕妇,根据血TBA水平分为10~<40 μmol/L组(Ⅰ组)、40~<100 μmol/L组(Ⅱ组)以及≥100 μmol/L组(Ⅲ组),又根据终止妊娠孕周分为<36周组(A组)、36~36+6周组(B组)以及≥37周组(C组),统计各组围产儿不良结局发生情况。结果     与ⅠB组及ⅠC组相比,ⅠA组的围产儿不良结局显著增高(P<0.05);与ⅠC组相比,ⅠB组低体质量儿发生率显著增高(P<0.05),NICU入住和近期并发症发生率低,但差异无统计学意义(P>0.05);与ⅡB组及ⅡC组比较,ⅡA组的围产儿不良结局显著增高(P<0.05);与ⅡC组相比,ⅡB组低体重儿及近期并发症发生率高,但差异无统计学意义(P>0.05),两组新生儿均未入住NICU。Ⅲ组发病孕周均早于34周,终止妊娠孕周<36者,围产儿不良结局发生率高。结论    当血TBA在10~<40 μmol/L时妊娠满37周终止妊娠有利于降低围产儿不良结局发生率;当TBA在40~<100 μmol/L时,妊娠36周终止妊娠是降低围产儿不良结局的节点;当TBA≥100 μmol/L应根据胎儿成熟度斟酌利弊终止妊娠。   

Abstract:

Objective    To determine the association of the perinatal outcomes with the level of total bile acid (TBA) and timing of termination in intrahepatic cholestasis of pregnancy (ICP). Methods    A retrospective study was conducted among 198 women suffering from ICP treated in our hospital from March 2013 to June 2017. According to the level of TBA, the women were divided into 3 groups, that is, 10~39.99 μmol/L (group Ⅰ), 40~99.99 μmol/L (group Ⅱ) and ≥100 μmol/L (group Ⅲ). On the basis of termination, the cases were also divided into 3 groups, <36 weeks gestation (group A), 36~36+6 weeks (group B), and ≥37 weeks gestation (group C). The adverse perinatal outcomes of low birth weight, meconium-stained amniotic fluid (MSAF), neonatal intensive care unit (NICU) admission, neonatal myocardial damage, pneumonia, hyperbilirubinemia, neonatal respiratory distress syndrome (NRDS) of perinatal infant were analyzed. Results    The incidence of adverse perinatal outcomes in group ⅠA was significantly higher than those of groups ⅠB and ⅠC (P<0.05). The incidence of low birth weight in group ⅠB was significantly higher than that in group ⅠC (P<0.05). The incidence of NICU admission in group ⅠB was lower than that in group ⅠC, but without statistical difference (P>0.05). The incidence of adverse perinatal outcomes in group ⅡA was notably higher than those in groups ⅡB and ⅡC (P<0.05). The incidences of low birth weight and recent complications in group ⅡB were higher than those in group ⅡC, but there was no significant difference (P>0.05). No newborns in groups ⅡB andⅡC entered in the NICU. The gestational age of onset in group Ⅲ was shorter than 34 weeks, and the incidence of adverse outcomes in the perinatal infants was higher when the gestational age was shorter than 36 weeks. Conclusion    When serum TBA ranged from 10 to 40 μmol/L, termination of 37 weeks gestation is recommended to decrease the adverse perinatal outcomes of ICP, and when the range was 40~100 μmol/L, 36 weeks gestation of termination is a strategy. While, for the women with TBA ≥100 μmol/L, termination should depend on maturation of the fetus.

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更新日期/Last Update: 2018-06-14