向华论文终稿.doc

妊娠期肝内胆汁淤积症患者胆酸水平变化对胎儿心脏的影响 张丽娟 向华 丁依玲 【摘要】目的 探讨妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）患者总胆酸（TBA）水平变化对胎儿心脏的影响。方法 对30例ICP患者（ICP组）及30例正常妊娠妇女（对照组）应用循环酶法测定母血及新生儿脐动脉血TBA水平、单克隆夹心酶联免疫法测定新生儿脐动脉血心肌肌钙蛋白（cTnI）水平、采用Acuson Sequoia 512彩色多普勒超声诊断仪测定胎儿左室心脏Tei指数。结果 (1)TBA水平：ICP组母血TBA为（36.03±9.55）μmol/L，脐血TBA为（10.08±2.04）μmol/L；分别高于对照组〔（3.82±0.94）μmol/L，（5.52±0.38μmol/L）〕，两组比较，差异均有显著统计学意义（P0.01）。ICP组母血TBA明显高于脐血TBA(P0.01),而对照组前者明显低于后者(P0.01)。（2）胎儿左室心脏Tei指数：ICP组胎儿左室心脏Tei指数（0.58±0.04）ms明显高于对照组（0.43±0.02）ms，差异有统计学意义（P0.01）。（3）脐动脉血cTnI：ICP组cTnI（0.92±0.23）μg/L明显高于对照组（0.52±0.10）μg/L，差异有统计学意义（P0.01）。（4）脐动脉血TBA与母血TBA、脐动脉血cTnI及胎儿左室心脏Tei指数均呈正相关（p0.01）；脐动脉血cTnI与胎儿左室心脏Tei指数呈正相关（p0.01）。结论 ICP患者胎儿存在左心室功能异常及心肌损伤，这种损伤可能与母体胆汁酸水平升高存在密切关系。胎儿左室心脏Tei指数可作为监测胎儿宫内心脏功能及心肌损伤的指标. 【关键词】妊娠期肝内胆汁淤积症，总胆酸，胎儿左室心脏Tei指数，心肌肌钙蛋白I Effect Of TBA on fetal cardiac from patients with intrahepatic cholestasis of pregnancy ZHANG Li-juan.，XING Hua，DIN Yi-ling，ZHOU Qi-chang．Department of Obstetrics and Gynecology，Xiangya Second Hospital，Central South University，Changsha 410011，China. Corresponding author：Zhang Li-juan， Email: zlj621116@ 基金项目：湖南省自然科学基金（07JJ5097） 作者单位：410011长沙，中南大学湘雅二医院妇产科 通信作者：张丽娟，Email:zlj621116@ 【Abstract】Objective　To study the Effect Of TBA on fetal cardiac from patients with intrahepatic cholestasis of pregnancy (ICP).Methods The concentration of TBA in the maternal blood and cord blood were measured by enzyme in 30 ICP patients (ICP group) and 30 normogravidas(control group).The cord blood cardiac troponinI (cTnI) concentration was investigated by monoclonal euzymelinked immunosorbent assay.Fetal left ventricle Tei index was surveyed by Sequia 512 Color Doppler ultrasonoscope. Results (1)The maternal and cord bloodTBA concentration in ICP group were significantly higher than that of control group [(36.03±9.55)μmol/L vs (3.82±0.94) μmol/L,(10.08±2.04) μmol/L vs (5.52±0.38μmol/L)（P0.01）.The maternal blood TBA concentration in study group was significantly higher than that of cord blood(P0.