探讨血清甘胆酸、总胆汁酸(TBA)、丙氨酸转氨酶(ALT)及促甲状腺激素(TSH)水平在妊娠期肝内胆汁淤积症(ICP)诊断中的临床价值。

选择2015年1月至12月，于湖北省天门市第一人民医院住院的62例ICP孕妇(纳入ICP组)，以及同期在门诊产前检查的1 160例健康孕妇(纳入对照组)为研究对象。测定2组受试者血清甘胆酸、TBA、ALT及TSH水平，并统计学比较2组受试者之间及不同程度ICP患者两两之间上述4项指标水平差异，以及2组高龄(≥35岁)孕妇比例差异。2组孕妇体重及孕龄等一般临床资料比较，差异无统计学意义(P>0.05)。

ICP组孕妇血清甘胆酸、TBA、ALT及TSH水平均较对照组高，且差异均有统计学意义(P<0.05)。轻型ICP患者血清甘胆酸含量，较中型者低，较对照组高，且差异均有统计学意义(P<0.05)，而轻型ICP患者分别与中型者或对照组血清TBA、ALT及TSH水平比较，差异则无统计学意义(P>0.05)；轻型ICP患者血清甘胆酸、TBA、ALT及TSH水平均较重型者低，且差异均有统计学意义(P<0.05)。ICP组高龄孕妇比例高于对照组，且差异有统计学意义(74.2% vs 34.2%，χ²＝195.87，P＝0.002)。

血清甘胆酸、TBA、ALT及TSH水平监测，对ICP的诊断具有重要价值，血清甘胆酸含量检测还可用于早期轻型ICP的诊断。

To investigate the clinical diagnosis value of serum glycocholic acid, total bile acid(TBA), alanine transarninase(ALT) and thyroid stimulating hormone(TSH) levels in intrahepatic cholestasis of pregnancy(ICP).

From January to December 2015, a total of 62 cases of ICP pregnant women(included in ICP group) and 1 160 healthy pregnant women at the same time in outpatient for antenatal examination(included in control group) in Tianmen First People′s Hospital of Hubei, were chosen as study objects.Detection serum glycocholic acid, TBA, ALT and TSH levels of all subjects.Compared the differences of 4 index levels above mentioned between two groups of pregnant women and parewise compared the 4 index between patients with different degrees of ICP by statistical method, also compared the difference of proportion of advanced age(≥35 years old) between two groups. There were no significant differences between two groups of pregnant women in general clinical data such as weight and gestational age, etc.(P>0.05).

The serum glycocholic acid, TBA, ALT and TSH levels of ICP group patients were higher than those of control group, and the differences were statistically significant(P<0.05). The serum glycocholic acid content of mild ICP patients was lower than that of moderate ICP patients and higher than that of control group, and the differences were statistically significant(P<0.05). There were no significant differences between mild and moderate ICP patients or between mild ICP patients and control group in serum TBA, ALT and TSH levels(P>0.05). Serum glycocholic acid, TBA, ALT and TSH levels of mild ICP patients were lower than those of severe ICP patients, and the differences were statistically significant(P<0.05). The proportion of advanced age pregnant women of ICP group was higher than that of control group, and the difference was statistically significant(74.2% vs 34.2%, χ²= 195.87, P=0.002).

Serum glycocholic acid, TBA, ALT and TSH levels′ monitoring have significant value for the diagnosis of ICP. The detection of serum glycocholic acid content also can be used for the diagnosis of early mild ICP.