【作者】 刘雨；

【导师】 邵勇；

【作者基本信息】 重庆医科大学 ， 妇产科学， 2010， 硕士

【摘要】 目的探讨妊娠期肝内胆汁淤积症(ICP)不同分度标准孕妇肝功能指标异常,脐血胆汁酸谱和妊娠结局。方法高效液相色谱法检测ICP脐血胆汁酸谱,包括牛磺熊脱氧胆酸(TUDCA)、牛磺胆酸(TCA)、甘氨胆酸(GCA)、甘氨石胆酸(GLCA)、牛磺鹅脱氧胆酸(TCDCA)、牛磺脱氧胆酸(TDCA)、甘氨鹅脱氧胆酸(GCDCA)、甘氨脱氧胆酸(GDCA)。应用四种ICP分度方法比较ICP孕妇肝功能指标、脐血胆汁酸谱及妊娠结局。结果(1)正常妊娠组和轻度ICP组比较,标准三、标准四ALT、AST、TBIL、DBIL差异均有统计学意义(P<0.05),四种分度标准脐血TCA、GCA差异均有统计学意义(P<0.05),标准一和标准二脐血GLCA差异有统计学意义(P<0.05),标准四脐血GCDCA差异有统计学意义(P<0.05),标准三早产儿差异有统计学意义(P<0.05)。(2)正常妊娠组和重度ICP组比较,四种分度标准ALT、AST、TBIL、DBIL差异均有统计学意义(P<0.05),四种标准脐血TCA、GCA、GLCA、TCDCA差异均有统计学意义(P<0.05),标准一、标准二、标准四脐血GCDCA差异有统计学意义(P<0.05),标准一、标准二、标准四早产儿和羊水粪染差异有统计学意义(P<0.05)。(3)轻度ICP组和重度ICP组比较,标准一、标准二ALT、AST、TBIL、DBIL差异均有统计学意义(P<0.05),四种分度标准脐血TCA、TCDCA差异均有统计学意义(P<0.05),标准一脐血GCDCA差异有统计学意义(P<0.05),标准四脐血GLCA差异有统计学意义(P<0.05),标准一早产儿差异有统计学意义(P<0.05)。结论ICP分度反映了ICP孕妇肝功能异常的程度不同;ICP脐血胆汁酸谱的主要成分是牛磺结合型胆汁酸和甘氨结合型胆汁酸,牛磺结合型胆汁酸比甘氨结合型胆汁酸浓度高,重度ICP的脐血TCA、TCDCA和GLCA均明显高于轻度ICP和正常妊娠;重度ICP羊水粪染、早产儿发生率明显高于轻度ICP及正常妊娠。更多还原

【Abstract】 Objective To investigate the differences of liver function of pregnant women, the bile acids profile of umbilical cord blood and pregnant outcome under different grading standards of intrahepatic cholestasis of pregnancy (ICP).Methods Bile acids profiles of umbilical cord blood of intrahepatic cholestasis of pregnancy were analyzed by high performance liquid chromatography. Eight kinds of bile acids including tauroursodeoxycholic acid (TUDCA), taurocholic acid (TCA), glycocholic acid(GCA), glycolithocholic acid(GLCA), taurochenodeoxycholic acid(TCDCA), taurodeoxycholic acid(TDCA), glycochenodeoxycholic acid (GCDCA), glycodeoxycholicacid (GDCA) were involved in the study. Maternal liver function, bile acids profiles of umbilical cord blood and pregnant outcomes were analyzed under four kinds of ICP grading standard.Results (1) When compared with normal pregnancy group and mild ICP group, there were statistically significant differences of ALT, AST, TBIL, DBIL under the third ICP grading standard and the fourth standard (P <0.05), there were statistically significant differences of TCA, GCA under the four standards (P <0.05), there were significant difference of GLCA under the first standard and the second standard (P <0.05), there were significantly differences of GCDCA under the fourth standard (P <0.05), there was significantly difference of the morbidity of premature infant under the third standard (P <0.05).(2) When compared with normal pregnancy group and severe ICP group, there were significant differences of ALT, AST, TBIL, DBIL with under four standards (P <0.05), there were significant differences of TCA, GCA, GLCA, TCDCA under four standards (P <0.05), there were significant differences of GCDCA under the first standard ,the second standard and the fourth standard (P<0.05), there were significant differences of the morbidity of premature infant and meconium staining of amniotic fluid under the first standard, the second standard and the fourth standard (P <0.05).(3) When compared with mild ICP group and severe ICP group, there were significant differences of ALT, AST, TBIL, DBIL under the first standard and the second standard (P <0.05), there were significant differences of TCA, TCDCA under four standards (P <0.05), there were significantly difference of GCDCA under the first standard(P <0.05), there were significantly difference of GLCA under the fourth standard(P <0.05), there were significant difference of the morbidity of pr emature infant under the first standard (P <0.05).Conclusion The ICP grading standard reflects the differences of liver function of pregnant women with ICP. Tauro-conjugated and glyco-conjugated bile acids are the predominant increase in serum bile acids of cord blood,and the concentration of tauro-conjugated bile acid are higher than that of glyco-conjugated. TCA, TCDCA and GLCA are significant higher in the severe ICP group than the mild ICP group. The morbidity of premature infant and meconium staining of amniotic fluid are significant higher in the severe ICP group than the mild ICP group.更多还原