摘要
目的探讨妊娠期肝内胆汁淤积症(ICP)的母儿胆汁酸(TSBA)水平在评估新生儿心功能不全的应用。方法选取2021年1月至2022年1月期间于湖南省人民医院就诊的36例ICP患者(重度15例,轻度21例)和15例匹配正常对照组作为研究对象。通过超高效液相色谱串联质谱(UPLC-MS/MS)测量脐静脉血清中TSBA和心室功能障碍标志物N末端脑钠肽前体(NT proBNP);获得胎儿心电图,测量并分析PR间期长度和心率变异性(HRV)参数等。结果与对照组相比,ICP患者分娩时的胎龄、胎儿出生体重均降低(H值分别为7.594、95.603,P<0.05),引产人数、自然阴道分娩人数均增加,差异有统计学意义(P_(Fisher)<0.05);三组母体和胎儿TSBA峰值浓度、分娩时胎儿NT-proBNP浓度存在统计学差异,其中重度ICP患者各指标均高于对照组(H值分别为75.062、8.093、4.266,P<0.05);三组胎儿PR间隔长度、主动睡眠状态下胎儿SDNN值存在统计学差异,其中重度ICP患者各指标均大于对照组(H值分别为4.913、4.520,P<0.05);相关分析表明,胎儿NT-proBNP与胎儿TSBA的疏水指数(HI)之间均具有正相关性(r值分别为0.37、0.54,P<0.05);母体TSBA浓度与胎儿PR间期长度、正常到正常间隔的标准差(SDNN)值之间存在正相关性(r值分别为0.49、0.34,P<0.05)。结论ICP中胎儿和母体血清胆汁酸浓度升高与以NT-proBNP浓度、PR间期长度和HRV增加为特征的异常胎儿心脏表型相关。
Objective To investigate the application of maternal and fetal total serum bile acid(TSBA)levels in intrahepatic cholestasis of pregnancy(ICP)in assessing neonatal cardiac insufficiency.Methods 36 ICP patients(15 severe and 21 mild)and 15 matched controls who attended Hunan Provincial People s Hospital between January 2021 and January 2022 were selected as study subjects.TSBA and N-terminal pro-brain natriuretic peptide(NT-proBNP),a marker of ventricular dysfunction,were measured in umbilical vein serum by ultra-performance liquid chromatography tandem mass spectrometry(UPLC-MS/MS).Fetal electrocardiograms were obtained,and PR interval length and heart rate variability(HRV)parameters were measured and analyzed.Results Compared with the control group,the gestational age and fetal birth weight of ICP patients at delivery were reduced(H=7.594 and 95.603,respectively,P<0.05),and the number of induced labor and natural vaginal delivery were increased,with statistically significant differences(P_(Fisher)<0.05).There were statistical differences in the peak concentration of maternal and fetal TSBA and the concentration of fetal NT-proBNP at delivery among the three groups,in which each index was greater in patients with severe ICP than in the control group,in which each index was greater in atients with Severe IC than in the contrl group.(H=75.062,8.093 and 4.266,respectively,P<0.05).There were statistical differences in the length of PR interval and standard deviation of normal-to-normal intervals(SDNN)value of fetus in active sleep state among the three groups,in which each index was greater in patients with severe ICP than in the control group(H=4.913 and 4.520,respectively,P<0.05).Correlation analysis showed that there was a positive correlation between fetal NT-proBNP and the hydrophobicity index(HI)of fetal TSBA(r=0.37 and 0.54,respectively,P<0.05).There was a positive correlation between maternal TSBA concentration and fetal PR interval length and SDNN value(r=0.49 and 0.34,respectively,P<0.05).Conclusion Elevated fetal and maternal serum bile acid concentrations in ICP are associated with an abnormal fetal cardiac phenotype characterized by increased NT-proBNP concentration,PR interval length,and HRV.
作者
杨伟辉
郭叶青
刘佳
YANG Weihui;GUO Yeqing;LIU Jia(Department of Obstetrical,Hunan Provincial People s Hospital the First Affiliated Hospital of Hunan Normal University,Hunan Changsha 410005,China)
出处
《中国妇幼健康研究》
2024年第3期43-49,共7页
Chinese Journal of Woman and Child Health Research
基金
长沙市指导性科技计划项目(kzd2001054)
湖南省卫生健康委员会科研项目(20210123)。
关键词
妊娠期肝内胆汁淤积症
胆汁酸
新生儿
心功能不全
intrahepatic cholestasis of pregnancy
bile acids
neonates
cardiac insufficiency
