妊娠期肝内胆汁淤积症对母儿的影响及其机制-论文.pdf

《妊娠期肝内胆汁淤积症对母儿的影响及其机制-论文.pdf》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。

1、·154·国际妇产科学杂志2014年4月第41卷第2期JlntObstetGynecol，April2014，Vo1．41，No．2·综述·妊娠期肝内胆汁淤积症对母儿的影响及其机制伍思玲，邵勇，何芳【摘要】妊娠期肝内胆汁淤积症(ICP)~母儿均有不良影响。ICP患者妊娠中晚期体内激素水平异常、基因变异、免疫损伤及致痒源释放增多可引起母体皮肤瘙痒、胆汁酸水平升高及肝功能异常、凝血功能障碍及产后出血，孕妇预后佳，主要危及胎儿。类固醇物质代谢障碍、胆汁酸浓度升高可增加子宫肌层对催产素的敏感性、促进宫颈成熟，诱发早产；胆汁酸在组织器官中沉积导致胎盘绒毛血管痉挛、胎盘储备能力下降，通过

2、胎儿心脏及肺脏毒性作用引起胎儿窘迫、死产及新生儿死亡。【关键词】胆汁淤积，肝内；胆汁酸类和盐类；胎儿窘迫；呼吸窘迫综合征，新生儿；妊娠期肝内胆汁淤积症IntrahepaticCholestasisofPregnancy：MechanismandImpactsinPregnancyandFetalOutcomesWUSi—ling．SHA0Yong，HEFang．DepartmentofObstetricsandGynecology，TheFirstAfiliatedHospitalofChongqingMedicalUniversity，Chongqing400016，Chi

3、na(WUSi—ling，SHAOYong)；DepartmentofObstetricsandGynecology，FulingHospitalofTrandhionalChineseMedicine，Chongqing408000，China(HEFang)Correspondingauthor：SHA0y0，E—mail：cqshaoyong@163．corn【Abstract】Intrahepaticcholestasisofpregnancyischaracterizedwithunexplainedpruritus，elevatedconcentrationoft

4、otalbileacidandlivertransaminases，whichareinfluencedbyabnormalhormonelevelinthesecondorthirdtrimester，genemutation，immuneinjuryandincreasedreleaseofprnritogens．Ahhoughithasgoodprognosisonpregnantwomen，itplaysanimportantroleonincreasedriskofadversefetaloutcomes，includingpretermdelivery，fetal

5、distress，fetalmortalityandneonatalrespiratorydistresssyndrome．TheabnormalmetabolismofsteroidsandelevatedtotalbileacidincreasemyometrialsensitivityforoxytocinandpromotecervicalripeningSOastoinduceprematuredelivery．Bileaciddespositionintheplacentaleadstospasmofplacentalvillousvesselsanddecrea

6、singplacentalreservecapacity．Also，bileacidaccumulationcanplayatoxinroleonfetalheartandlung，resuhingincardiacconductiondysfunctionandreducedsynthesisofpulmonarysurfactant．Allthesecontributetoincreasedrateoffetaldistress，fetaldeathandneonatallunginjury．【Keywords】Cholestasis，intrahepatic；Bilea

7、cidsandsalts；Fetaldistress；Respiratorydistresssyndrome，newborn；Intrahepaticcholestasisofpregnancy(JIntObstetGynecol，2014，41：154一l57)妊娠期肝内胆汁淤积症(intrahepaticcholestasis1ICP对母体的影响ofpregnancy，ICP)主要发生在妊娠中晚期，以皮肤瘙1．1皮肤瘙痒ICP患者皮肤瘙痒主要由胆汁酸、痒、胆汁酸和(或)转氨酶升高为主要特征，孕妇预后