| | | 妊娠肝内胆汁淤积症患者雌孕激素水平及免疫功能的变化
| | 医学社会实践论文【摘要】 目的医学社会实践论文 探讨雌孕激素水平及免疫功能变化与妊娠肝内胆汁淤积症（ICP）的医学社会实践论文关系。方法 采用放射免疫法、单向免疫扩散法、碱性磷酸酶及抗碱性磷酸酶法（APAAP）检测ICP孕妇50例(ICP组)及正常妊娠妇女50例(对照组）雌孕激素水平的变化、体液免疫和细胞免疫功能的水平。 结果 ICP组雌激素水平(25.89±6.85 μg/L)较对照组(16.92±4.98 μg/L)明显升高, (P＜0.01)，孕激素水平差异无显著性(P＞0.05)；ICP组细胞毒性-抑制性T细胞（CD8+）水平（19.06±1.93%)较对照组(26.43±2.89%)降低(P＜0.05），辅助性-诱导性T细胞（CD4+）与CD8+比值(2.23±0.38)较对照组(1.73±0.23)升高(P＜0.05)；雌激素水平与CD8+呈负相关，与CD4+/CD8+比值呈正相关。 结论 ICP患者雌激素水平增高，雌激素通过CD8+上的雌激素受体而发挥作用，导致免疫功能的改变，而引起ICP的发生。
【Abstract】 Objective To explore the effects of estrogen, progesterone and the function of immune system on intrahepatic cholestasis of pregnancy (ICP).Methods Fifty women with ICP and fifty normal pregnant women were enrolled in the study. The levels of their serum estradiol (E2) and progesterone (P) were measured and cellular immunity and humoral immunity were determined. Radioimmunoassay was used to detect the levels of E2 and P, and APAAP was used to detect cellular immunity.Results (1)The level of estrodiol was significantly increased in ICP group than those of normal control group (25.89±6.85 μg/L, 16.92±4.98 μg/L, P＜0.01). (2)The level of CD8+ was decreased (19.06±1.93%, 26.43±2.89%)and the ratio of CD4+/ CD8+ was increased significantly in ICP group than those of control group (2.23 ±0.38, 1.73 ±0.23, P＜0.05). (3)There were negative correlation between E2 and CD8+, and positive correlation between E2 and the ratio of CD4+/ CD8+.Conclusion These results suggest that the high level of E2 of ICP patients may result in functional disorder of immune system by the means of estrogen receptor on CD8+. This may be a factor of ICP development.
【Key words】 Cholestasis,intrahepatic Pregnancy Estrogens Progesterone Immunity, cellular
妊娠肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)是一种妊娠后期以皮肤瘙痒、胆汁淤积和黄疸为特征的疾病。ICP患者预后良好，但胎儿可发生早产、宫内窘迫、胎死宫内等。关于ICP发病原因，存在许多学说：如雌激素诱导的ICP学说、家族遗传学说、外源性因素学说等。随着神经内分泌免疫学的发展，国外一些学者对神经内分泌免疫调节在ICP发生过程中的作用越来越重视。我们对雌、孕激素水平及免疫功能改变与妊娠肝内胆汁淤积症的相关性进行了研究。现报道如下。
资料与方法
一、研究对象
选择1996年6月～1997年1月华西医科大学附属第二医院门诊及住院者中，ICP患者50例(ICP组)及正常妊娠妇女50例(对照组)，两组产妇年龄分别为27.3±2.4岁，27.03±2.9岁，孕周分别为36.9±1.6周，36.50±2.5周，均为单胎初产妇。ICP组纳入标准：(1)妊娠前无肝脏、胆道等急慢性疾病史；(2)妊娠期出现躯干及四肢皮肤瘙痒；(3)实验室检查，血清总胆酸升高，转氨酶有轻度或中度升高；总胆红素及直接胆红素正常或升高；(4)无皮肤病者；(5)分娩后上述症状及实验室检查均逐渐恢复正常。
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