摘要
目的 探讨妊娠肝内胆汁淤积症 (ICP)患者胎儿缺氧机理及其相关因素。方法 分别测定ICP患者 (30例 ,ICP组 )及正常妊娠妇女 (30例 ,对照组 )新生儿脐动脉血胆汁酸总量 (TBA)、次黄嘌呤 (HX)、内皮素 (ET)及有核红细胞 (NRBC)计数。结果 (1)ICP组缺氧者 (10例 )脐血HX水平为(18.6 8± 15 .73) μmol/L ,明显高于ICP组无缺氧者 (2 0例 ) [(6 .87± 2 .82 ) μmol/L ]及对照组 [(6 .81±2 .83) μmol/L](P <0 .0 1) ;但NRBC[(4 .2 0± 2 .49)个 / 10 0白细胞 ,(3.40± 2 .2 6 )个 / 10 0白细胞 ,(3.5 0± 1.74)个 / 10 0白细胞 ]及ET水平 [(72 .44± 12 .2 3)ng/L ,(70 .16± 2 6 .6 1)ng/L ,(6 7.2 7± 43.5 6 )ng/L],各组相似 (P >0 .0 5 )。 (2 )ICP组缺氧者脐血TBA为 (2 3.77± 11.82 ) μmol/L ,明显高于ICP组无缺氧者 (14.86± 5 .46 ) μmol/L ,ICP组无缺氧者脐血TBA又高于对照组 [(9.2 8± 4.39) μmol/L](P <0 .0 1) ;且ICP组脐血TBA与HX水平呈正相关 (r=0 .6 89,P <0 .0 1) ;ICP组羊水胎粪污染率明显高于对照组 (5 3.3% ,13.3% ;P <0 .0 1) ,ICP组羊水胎粪污染者脐血TBA[(2 1.44± 9.92 ) μmol/L],明显高于羊水清亮者 [(13.6 9± 5 .74) μmol/L],差异有显著性 (P <0 .0 5 )。 结论 ICP时 ,
Objective To investigate the mechanism and the related factors of fetal hypoxia in intrahepatic cholestasis of pregnancy (ICP). Methods Cord blood total bile acids(TBA), hypoxanthine (HX), and endothelin (ET) concentrations were measured in 30 newborns of mothers with ICP and 30 infants of normal pregnancy as control, and the cord nucleated red blood cells (NRBC) were counted as well. Results (1)The mean cord arterious plasma HX concentration in hypoxic fetuses of mothers with ICP was significantly higher than those in fetuses without hypoxia of mothers with ICP and fetuses of normal pregnancy(18.68±15.73)μmol/L, (6.87± 2.82)μmol/L, (6.81±2.83)μmol/L( P <0.01).However, there were no differences of the cord NRBC value(4.20±2.49)/100 white blood cell,(3.40±2.26)/100 white blood cell,(3.50±1.74)/100 white blood cell; P >0.05) and the mean cord arterious plasma ET concentration (72.44±12.23) ng/L,(70.16±26.61) ng/L,(67.27±43.56) ng/L, P =0.910) among the three groups. (2) In ICP group, the mean cord serum TBA concentration in hypoxic fetuses was significantly higher than that in fetuses without hypoxia, while the latter was higher than that in control group (23.77±11.82)μmol/L,(14.86±5.46)μmol/L,(9.28±4.39)μmol/L;( P <0.01) . There was a positive correlation between the cord plasma HX concentrations and TBA concentrations in ICP ( r =0.689, P <0.01). There was higher prevalance of meconium stained amnionic fluid in ICP group than that in control group (53.3%,13.3%; P <0.01). Besides in ICP group the TBA levels of fetuses with meconium staining were significantly higher than those without [(21.44±9.92)μmol/L, (13.69±5.74)μmol/L; ( P < 0.05)]. Conclusions The results suggested that fetal hypoxia and stillbirth in ICP may be the result of acute hypoxia. Acute insufficient fetal infusion and oxygenation based on the insufficiency of fetal placental oxygen reserve resulting from the reduction in the size of the intervilous space in ICP may develope at stress such as uterine contraction and meconium passage.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2000年第10期600-601,共2页
Chinese Journal of Obstetrics and Gynecology
关键词
胆汁淤积
肝内
胎儿缺氧
次黄嘌呤
红细胞计数
Cholestasis,intrahepatic
Fetal anoxia
Hypoxanthine
Erythrocyte count
