A Study Of The Correlation Between The Level Of Total Bile Acid And Fetal Pulmonary Surfactant In Intrehepatic Cholestasis Of Pregnancy

Objective To evaluate the association of the concentration fetal total bile acid(TBA) with fetal pulmonary surfactant in intrahepatic cholestasis of pregnancy(ICP).Methods The concentration of TBA in maternal blood,the cord blood and amniotic fluid were measured by enzyme method in 29 fetuses with maternal ICP(ICP group) and 23 fetuses of normogravidas(control group) after elective cesarean section.The concentration of SP-A in the cord blood was investigated by Enzyme-Linked Immunosorbent Assays (ELISA)and Phospholipids in amniotic fluid by High performance liquid chromatography system.Result(1) The concentration of TBA in maternal blood in ICP group was significantly higher than that of controls[(29.69±8.92)mmol/L vs(4.79±2.17)mmol/L,P＜0.05].The concentration of TBA in the cord blood in ICP group was significantly higher than that of controls [(9.21±3.07)mmol/L vs(4.90±0.86)mmol/L,P＜0.05].The concentration of TBA in amniotic fluid in ICP group was significantly higher than that of controls[(3.89±1.99)mmol/L vs(1.43±1.14) mmol/L,P＜0.05].(2)The concentration of SP-A in the cord blood in ICP group was higher than that of controls[(30.26±7.01)mmol/L vs(22.63±7.42) mmol/L,P＜0.05]. (3)The concentration of TBA in the cord blood was positively related to that of the maternal blood(r=0.746,P＜0.05).The concentration of SP-A in the cord blood was positively related to the concentration of TBA in the cord blood(r=0.422,P＜0.05).(4)The concentration of TBA of pathological perinatal fetus in ICP group was significantly higher than that of normal fetus in ICP group[(10.03±2.14)mmol/L vs(8.52±2.19) mmol/L,P＜0.05].The concentration of SP-A in the cord blood in pathological perinatal fetus of ICP group was higher than that of normal fetus in ICP group[(30.80±4.34)ng/ml vs(27.69±3.16) ng/ml,P＜0.05].(5) The level of PC,PI in amniotic fluid in ICP group was significantly lower than that of controls[(65.71±7.23)μg/ml,(3.87±0.65)μg/ml vs(69.70±3.68)μg/ml,(4.28±0.74)μg/ml,P＜0.05].The level of LPC in amniotic fluid in ICP group was significantly higher than that of controls [(4.72±0.86)μg/ml vs(4.21±0.64)μg/ml,P＜0.05].There was no significant difference between the level of SM in amniotic fluid in ICP group and that of controls[(3.63±0.66)μg/ml vs(3.95±0.53)μg/ml,P＞0.05].The ratio of PC/LPC in ICP group were significantly lower than that in controls[(14.40±3.14) vs(16.90±2.52),P＜0.05].(6)The Concentration of TBA in the cord blood was nagtively related to the level of PC,PI and SM[(r₁=-0.536,r₂=-0.387,r₃=-0.438),P＜0.05]and was no relationship to the level of LPC(r₄=0.260,P＞0.05).Conclusions The concentration of fetal TBA both in the cord blood and amniotic fluid increases when the mother suffers from ICP and is positively correlated with the concentration of maternal TBA.ICP can cause the change of pulmonary surfactant and this change is related to the cord blood TBA value.