【作者】 程贤鹦；

【导师】 张丽娟；

【作者基本信息】 中南大学 ， 妇产科， 2008， 硕士

【摘要】 目的：探讨妊娠肝内胆汁淤积症（ICP）胎儿总胆汁酸浓度与胎儿胰腺内分泌功能变化之间的关系及对其胎儿生长发育的影响。方法：选择ICP患者30例作为研究组、正常妊娠孕妇30例作为对照组。采用放射免疫法测量两组胎儿脐动脉血清中胰岛素、胰高血糖素含量；循环酶法测定两组胎儿脐动脉血清总胆汁酸（TBA）水平；用氧化酶-过氧化物法测定两组胎儿脐动脉血清中葡萄糖浓度；新生儿均于生后15min内进行体重、身长的测量，计算新生儿庞代络指数（PI）。结果：1．研究组胰岛素（8．96±3．29mIU／L）及胰岛素／胰高血糖素比值（0．048±0．028）均低于对照组（10．10±3．68mIU／L，0．050±0．020），差异有统计学意义（P<0．05）；脐动脉血胆汁酸（10．31±3．79umol／L）、胰高血糖素（235．32±56．59pg／ml）高于对照组（4.11±1.31umol／L，204．50±33．95pg／ml），差异有统计学意义（P<0．05）；研究组脐动脉血血糖水平（3．44±1．14mmol／L）与对照组（3．57±1．17mmol／L）比较，差异无统计学意义（P>0．05）。2．研究组新生儿体重及身长均明显低于对照组（3 162．92±478．28vs3497．97±393．00g，46．48±2．34vs49．31±1．88cm），差异均有统计学意义（P<0．01）；研究组PI（3．13±0．23）明显高于对照组PI（2．92±0．29），其差别有统计学意义（P<0．01）。3．研究组脐动脉血胆汁酸分别与胰岛素、胰高血糖素及胰岛素／胰高血糖素比值均呈直线关系，且随着胆汁酸的增加，胰岛素及胰岛素／胰高血糖素均降低，胰高血糖升高。（直线回归方程分别是Y₁=12．593-0．223X₁；Y₂=204．438+2．997X₂：Y₃=0．066-0．002X₃，P<0．01）。4．研究组脐动脉胰岛素／胰高血糖素比值、胰岛素、血糖、胰高血糖素均是影响新生儿PI的因素，且影响程度依次减弱回归方程为Y=3．136+0．01X₁-0．056X₂+0．001X₃+7．167X₄，（P<0．01）。结论：1．ICP胎儿存在胰岛素分泌不足，胰高血糖素分泌增多，胰岛素／胰高血糖素比值下降，胎儿总胆汁酸可能是引起上述变化的原因之一。2．ICP胎儿生长发育异常，与血糖、胰岛素、胰高血糖素及胰岛素／胰高血糖素比值有关，尤其与胰岛素／胰高血糖素比值关系最密切。更多还原

【Abstract】 ObjectiveTo investigate the relationship between fetal total bile acid and the change of fetal pancreatic endocrine function,and its influence to fetal growth and development in intrahepatic cholestasis of pregnancy （ICP）.MethodsThe concentration of TBA、insulin、glucagons and glucose in the cord blood were measured in 30 fetuses of ICP （case group）and 30 fetuses of normogravidas（control group）after elective cesarean section. The cord blood TBA concentration was investigated by enzyme method and the cord concentration of insulin and glucagons were investigated by radioimmunoassay. The glucose was measured by oxidase-superoxide method. The neonatal weighs length and Ponderal index were measured within 15 minutes after parturition.Results1. The cord blood insulin concentration（8.96+3.29mIU/L） and insulin-to-glucagons ratio（0.048±0.028）in case group were significantly lower than that of the control（10.10±3.68mIU/L,0.050±0.020）,The concentration of TBA（10.31±3.79umol/L）and glucagons（235.32±56.59pg/ml）in case group were obviously higher than those of the control（4.11±1.31umol/ L,204.50±33.95pg/ml）,But no difference was shown in the concentration of glucose between case and control group[（3.44±1.14mmol/l） vs.（3.57±1.17mmol/L ）,P>0.05].2. The neonatal weight and length in case group were significantly lower than those of control [3162.92±478.28vs3497.97±393.00g, 46.48±2.34 vs49.31±1.88cm, P<0.01], while the Ponderal index in case group was significantly higher than that of control （3.13±0.23vs2.92±0.29,P<0.01）.3. The cord blood TBA concentration respectively showed straight line relationship with the cord blood insulin concentration、the cord blood glucagons concentration and insulin-to-glucagons ratio in case group. With the cord blood TBA concentration increasing, the cord insulin concentration and the ratio of insulin over glucagons decreased, meanwhile the cord blood glucagons concentration raised.（Linear regression equation were Y₁=12.593-0.223X₁;Y₂=204.438+2.997X₂;Y₃=0.066-0.002X₃,P<0.01）.4 . The cord blood glucose, insulin, glucagons and insulin-to-glucagons ratio were the factors that affect neonatal PI, and the order respectively was insulin-to-glucagons ratio, insulin, glucose, glucagons（P<0.01）.General regression equation was Y=3.136+0.01X₁-0.056X₂+0.001X₃+7.167X₄ , （P<0.01）.Conclusion1.Fetal pancreatic endocrine secretion exists hypoinsulinism, glucagons oversecretion, insulin-to-glucagons ratio decline in ICP and TBA may be one of the reasons that cause above-mentioned change.2.ICP exists anomaly fetal growth and development, which is intimately correlated with cord blood glucose, insulin , glucagons and insulin-to-glucagons ratio, especially insulin-to-glucagons ratio.更多还原