347例妊娠期肝内胆汁淤积症羊水性状与妊娠结局的分析

目的:探讨妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy ICP)羊水性状与妊娠结局的关系。方法:对我院2005年1月～2009年12月住院分娩的患者资料进行回顾分析,统计羊水污染率、新生儿窒息发生率、围产儿死亡率及剖宫产率等。结果:347例ICP中轻度278例,重度69例。羊水污染89例(Ⅰ级19例,Ⅱ级14例,Ⅲ级56例),羊水污染率为25.6%。重度ICP中羊水污染46例,发生率为66.7%。89例ICP羊水Ⅱ级及Ⅲ级病例中出现3例新生儿窒息。结论:ICP的羊水性状与病情程度基本一致,羊水污染预示着不良的妊娠结局,适时终止妊娠可降低围生儿病率。     

妊娠期肝内胆汁淤积症合并妊娠期糖尿病的母儿结局分析

目的:探讨妊娠期肝内胆汁淤积症(ICP)合并妊娠期糖尿病(GDM)对母儿结局的影响。方法:选取2012年1月至2013年2月在我院住院分娩的13例ICP合并GDM孕妇为ICP+GDM组,将同期住院分娩的69例单纯ICP孕妇归为ICP组,对两组孕妇的母儿结局进行回顾性比较分析。结果:两组孕妇的子痫前期、胎膜早破、剖宫产、产后出血发生率比较,无明显差异(P0.05);ICP+GDM组孕妇围产儿Apgar小于7分、新生儿肺炎、早产发生率明显高于ICP组,差异有统计学意义(P均0.05);ICP+GDM组孕妇围产儿平均出生体重低于ICP组,差异有统计学意义(P0.05)。结论:妊娠期肝内胆汁淤积症合并妊娠期糖尿病将进一步加重围产儿不良结局,对于此类孕妇,应加强监护和管理,适时终止妊娠,以改善围产儿结局。     

妊娠期肝内胆汁淤积症患者血管内皮祖细胞生物学变化

目的:研究妊娠期肝内胆汁淤积症(Intrahepatic Cholestasis of Pregnancy,ICP)患者血管内皮祖细胞(Endothelial Progenitor Cells,EPC)的生物学变化并探讨其意义.方法:40例28-40周孕妇分为ICP组(n=20)、正常组(n=20).用酶联免疫吸附试验法测定两组血胆汁酸浓度;用密度梯度离心法从外周血分离两组单个核细胞培养后进行EPC数量、增殖率、黏附及迁移能力测定并对胆汁酸与EPC相关性进行分析.结果:ICP组孕妇的EPC黏附、增殖和迁移能力明显受损;数量较正常组减少(P=0.00).结论:ICP患者血管内皮祖细胞功能受损,可能与高胆汁酸造成的细胞膜损伤有关.     

96例妊娠期肝内胆汁淤积症患者的妊娠结局分析及护理对策

目的:探讨妊娠合并肝内胆汁淤积症(ICP)对妊娠结局的影响,并探索相对应的护理策略.方法:选取在我院治疗的ICP患者96例,根据ICP分度标准分为轻度与重度型,分别观察其妊娠.结果:重型组患者新生儿窒息、羊水污染、剖宫产的发生率都明显高于轻型组患者(P＜0.05);而两组围产儿死亡率和产后出血率相比,差异无显著性意义(P＞0.05).结论:ICP对孕妇妊娠结局具有重要的不良影响作用,针对其可能导致的不良妊娠结局采取针对性的护理策略具有重要的临床意义.     

重度妊娠期肝内胆汁淤积症对母婴结局影响的临床分析

目的：分析重度妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy,ICP）对母婴结局的影响,以提高对ICP的认识与治疗水平。方法：选择ICP产妇58例,根据ICP分度标准分为轻度组（n=26例）和重度组（n=32例）,比较两组产妇的母婴结局。结果：与轻度组相比,重度组产妇剖宫产率、产后出血与平均产后出血量显著升高或增加,阴道分娩率显著降低,组间比较差异均具有统计学意义（P〈0.05）;重度组新生儿早产、胎儿窘迫、羊水污染和新生儿窒息的发生率均显著上升,新生儿平均出生体重显著降低,组间比较差异均具有统计学意义（P〈0.05）。结论：ICP对产妇及新生儿均有不良影响,对ICP严重程度进行划分,有利于临床处理。对于重度ICP产妇,应尽早采取剖宫产分娩的方式终止妊娠。     

妊娠期肝内胆汁淤积症256例临床分析

目的：探讨改善妊娠期肝内胆汁淤积症患者围生结局及围生儿预后的方法。方法：对2006年3月．2011年3月在我院住院分娩的256例ICP患者及从我院住院无并发症正常分娩的10112个患者中随机抽取的256例患者的产检情况、分娩方式、围生儿结局进行回顾性分析。结果：ICP组与对照组在分娩方式、产后出血、早产、新生儿窒息、羊水粪染、圉产儿死亡等方面比较差异均具有统计学意义（P〈0．05）;产检组与未检组在产后出血、早产、新生儿窒息、羊水粪染、围产儿死亡等方面比较差异有统计学意义（P〈0．05）。结论：妊娠期肝内胆汁淤积症可增加早产、胎儿宫内窘迫、新生儿窒息、产后出血发生率,重视产前检查和孕期保健,对ICP患者做到早发现、早诊断、早治疗,选择适当分娩方式、适时终止妊娠,对改善围生结局及围生儿预后有积极的意义。     

妊娠期肝内胆汁淤积症256例临床分析

目的:探讨改善妊娠期肝内胆汁淤积症患者围生结局及围生儿预后的方法。方法:对2006年3月-2011年3月在我院住院分娩的256例ICP患者及从我院住院无并发症正常分娩的10112个患者中随机抽取的256例患者的产检情况、分娩方式、围生儿结局进行回顾性分析。结果:ICP组与对照组在分娩方式、产后出血、早产、新生儿窒息、羊水粪染、围产儿死亡等方面比较差异均具有统计学意义(P<0.05);产检组与未检组在产后出血、早产、新生儿窒息、羊水粪染、围产儿死亡等方面比较差异有统计学意义(P<0.05)。结论:妊娠期肝内胆汁淤积症可增加早产、胎儿宫内窘迫、新生儿窒息、产后出血发生率,重视产前检查和孕期保健,对ICP患者做到早发现、早诊断、早治疗,选择适当分娩方式、适时终止妊娠,对改善围生结局及围生儿预后有积极的意义。     

妊娠肝内胆汁淤积症发生的分子机制研究进展

妊娠肝内胆汁淤积症（Intrahepatic cholestasis of pregnancy, ICP）是发生在妊娠中晚期,以皮肤瘙瘁、黄疸、血清胆汁酸升高,伴轻度肝功能损害为特征的妊娠并发症,严重影响母儿健康。ICP的发病机制尚未完全阐明,但有研究表明在遗传易感性妇女中,性激素及其代谢产物导致胆汁酸代谢异常与本病的发生密切相关。现就目前国内外有关ICP发病机制的研究进展做一综述,一方面为探寻更深层次的机制提供理论基础,另一方面为临床治疗ICP提供思路和方法。     

妊娠肝内胆汁淤积症发生的分子机制研究进展

妊娠肝内胆汁淤积症(Intrahepatic cholestasis of pregnancy,ICP)是发生在妊娠中晚期,以皮肤瘙痒、黄疸、血清胆汁酸升高,伴轻度肝功能损害为特征的妊娠并发症,严重影响母儿健康。ICP的发病机制尚未完全阐明,但有研究表明在遗传易感性妇女中,性激素及其代谢产物导致胆汁酸代谢异常与本病的发生密切相关。现就目前国内外有关ICP发病机制的研究进展做一综述,一方面为探寻更深层次的机制提供理论基础,另一方面为临床治疗ICP提供思路和方法。     

妊娠肝内胆汁淤积症胎儿猝死发病机制的研究进展

妊娠肝内胆汁淤积症（ICP）妊娠晚期胎儿猝死,难以预料和准确监测,具有高风险性。目前其机制不明。孕妇和胎儿高胆汁酸水平对胎盘功能的影响和对胎儿的损伤是当前研究的主要方向。特别是一系列胆汁酸对心肌细胞毒性作用的实验,提示胆汁酸对胎儿心脏的毒性作用可能是引起胎儿猝死的重要原因。     

Comparative Proteomics Analysis of Placenta from Pregnant Women with Intrahepatic Cholestasis of Pregnancy

Introduction

Intrahepatic cholestasis of pregnancy (ICP) usually occurs in the third trimester and associated with increased risks in fetal complications. Currently, the exact cause of this disease is unknown. In this study we aim to investigate the potential proteins in placenta, which may participate in the molecular mechanisms of ICP-related fetal complications using iTRAQ-based proteomics approach.

Methods

The iTRAQ analysis combined with liquid chromatography-tandem mass spectrometry (LC-MS/MS) was performed to separate differentially expressed placental proteins from 4 pregnant women with ICP and 4 healthy pregnant women. Bioinformatics analysis was used to find the relative processes that these differentially expressed proteins were involved in. Three apoptosis related proteins ERp29, PRDX6 and MPO that resulted from iTRAQ-based proteomics were further verified in placenta by Western blotting and immunohistochemistry. Placental apoptosis was also detected by TUNEL assay.

Results

Proteomics results showed there were 38 differentially expressed proteins from pregnant women with ICP and healthy pregnant women, 29 were upregulated and 9 were downregulated in placenta from pregnant women with ICP. Bioinformatics analysis showed most of the identified proteins was functionally related to specific cell processes, including apoptosis, oxidative stress, lipid metabolism. The expression levels of ERp29, PRDX6 and MPO were consistent with the proteomics data. The apoptosis index in placenta from ICP patients was significantly increased.

Conclusion

This preliminary work provides a better understanding of the proteomic alterations of placenta from pregnant women with ICP and may provide us some new insights into the pathophysiology and potential novel treatment targets for ICP.     

Elevated Plasma Levels of Hypermethylated RASSF1A Gene Sequences in Pregnant Women with Intrahepatic Cholestasis

Intrahepatic cholestasis of pregnancy (ICP) is associated with increased perinatal mortality and morbidity. Circulating cell-free fetal DNA has been a useful parameter for monitoring of pregnancy-associated diseases. The purpose of this study was to determine the concentrations of hypermethylated RAS-association domain family 1, isoform A (RASSF1A) gene sequences in the plasma of pregnant women with intrahepatic cholestasis. This study included 56 women in their third trimester of pregnancy, of whom 26 had ICP (study group) and 30 were healthy (control group). Real time PCR was performed to detect RASSF1A concentrations after methylation-sensitive restriction digestion with HinpII and HhaI to measure cell-free fetal DNA. Beta-actin was detected as an internal control to confirm complete enzyme digestion. The data show a significant increase in the circulating hypermethylated RASSF1A levels regarding the pregnancies complicated with ICP as compared with normal pregnancies. Circulating hypermethylated RASSF1A levels in maternal plasma related to total bile acid. Based on these observations, we suggest that the circulating hypermethylated RASSF1A levels in maternal plasma may be used as a diagnostic marker for ICP.     

妊娠期肝内胆汁淤积症的处理与预防护理研究

目的:研究妊娠期肝内胆汁淤积综合症(ICP)的产科处理及预防护理,探讨治疗对母婴预后的影响。方法:选取2009年1月至2010年1月第四军医大学西京医院妇产科收治ICP患者共67例,分为治疗组49例,经过丁烷二磺酸腺苷蛋氨酸(思美泰),对照组18例服用熊去氧胆酸治疗的孕妇。对孕妇症状、生化指标、母婴结局进行比较分析。结果:治疗组临床症状、生化指标较治疗前明显下降较对照组明显好转(p0.01),直接胆红素下降两组间无显著差异(p0.01)。将治疗组和对照组胎儿宫内窘迫率存在显著性差异(p0.01)。结论:应用丁烷二磺酸腺苷蛋氨酸(思美泰)积极正确处理ICP,可明显减轻孕妇瘙痒症状及肝功异常,同时明显降低胎儿宫内窘迫率,提高围生儿的生存质量。     

Garlic Ingestion by Pregnant Women Alters the Odor of Amniotic Fluid

Amniotic fluid samples were obtained from 10 pregnant womenundergoing routine amniocentesis procedure. Approximately 45min prior to the procedure, five of the women ingested placebocapsules, whereas the remaining five ingested capsules containingthe essential oil of garlic. Randomly selected pairs of samples,one from a woman who ingested garlic and the other from a womanwho ingested placebo capsules, were then evaluated by a sensorypanel of adults. The odor of the amniotic fluid obtained fromfour of the five women who had ingested the garlic capsuleswas judged to be stronger or more like garlic than the pairedsamples collected from the women consuming placebo capsules.Thus, garlic ingestion by pregnant women significantly altersthe odor of their amniotic fluid.