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Objective To investigate the change of umbilical cord and thevasoactive substance in umbilical vein in intrehepatic cholestasis ofpregnancy.Methods Use HE staining method to analyze the patho- change ofumbilical cord of 25 ICP with fetal distress group, 25 ICP with out fetaldistress group, 26 normal pregancies with fetal distress and 27 normalpregnancies with out fetal distress（control group）; the NOS/ET-1 weredetected in HUVEC of those four groups by immunohistochemistrymethod, Analyze the dependability between umbilical vein TBA andNOS/ET-1, use Griess method to detect metabolic product of NO（NO2-）in umbilical vein, and use radioimmunoassay method to detectET-1 in umbilical vein.Result1、There is remarkable high TBA level was found in umbilical veinin ICP, and the ICP with fetal distress group（19.02±2.32μmol/L） is higherthan ICP without fetal distress group （9.02±1.73μmol/L）,P＜0.05. There isno difference between the normal pregnancies with（4.34±1.81μmol/L）and without（4.39±1.55μmol/L） fetal distress group, P＞0.05.2、significant difference is found in the endotheliocytes of umbilicalvein in ICP. The ratio of the appearance of pathological changes in ICPwith fetal distress group（96%） is higher than ICP without fetal distressgroup（76%）. The occurrence of the pathological changes is associatedwith TBA.3、The express of eNOS in ICP with fetal distress group （0.09±0.06）is lower than in ICP without fetal distress group（0.21±0.08）, P＜0.05. ICPwithout fetal distress group is lower than control group （0.47±0.07）, P＜0.05. There is no difference in the group of preggancies with fetaldistress （0.50±0.06）and control group, P＞0.05.On contrast, the express ofET-1 in ICP with fetal distress group （0.49±0.08） is higher than in ICPwithout fetal distress group （0.32±0.07）, P＜0.05. ICP without fetaldistress group is higher than control group （0.14±0.06）, P＜0.05. There isno difference in the group of preggancies with fetal distress （0.50±0.06）and control group, P＞0.05. The express of iNOS in ICP group with fetaldistress （0.20±0.04） and ICP without fetal distress group （0.21±0.05） islower than in control group （0.26±0.04）, P＜0.05, but no significantdifference is found in ICP with fetal distress group and ICP without fetaldistress group, P＞0.05, also no difference is found in control group andthe group of preggancies with fetal distress, P＞0.05.4、The express of eNOS , iNOS and ET-1 is correlate with umbilicalvein TBA in ICP, the coefficient of correlation is r1=-0.88, r2=-0.45r3=0.79, P＜0.01, relatively.5、The level of NO2- in ICP with fetal distress group, ICP withoutfetal distress group, control group, and group of normal preggancies withfetal distress is 1.35±0.46μmol/L、2.65±0.36μmol/L、4.24±0.46μmol/L、4.38±0.40μmol/L. ICP with fetal distress group is lower than ICP withoutfetal distress group, P＜0.05. ICP without fetal distress group is lower thancontrol group, P＜0.05. no significant difference is found in the group ofpregganeies with fetal distress and control group,P＞0.05. The level ofET-1 in ICP with fetal distress group, ICP without fetal distress group,control group, and group of normal preggancies with fetal distress is:65.16±2.35pg/ml、58.77±1.15pg/ml、34.91±2.18pg/ml, 34.07±1.22pg/ml.ICP with fetal distress group is higher than ICP without fetal distress group,P＜0.05, ICP without fetal distress group is higher than control group, P＜0.05, no significant difference is found in the group of normalpreggancies with fetal distress and control group, P＞0.05. The ratio ofNO2-/ET-1 in umbilical vein in four group is: 0.031±0.007、0.046±0.005、0.124±0.018、0.121±0.006. ICP with fetal distress group is lower than ICPwithout fetal distress group, P＜0.05. ICP without fetal distress group islower than control group, P＜0.05, no significant difference is found in thegroup of normal preggancies with fetal distress and control group,P＞0.05.Conclusion High level of TBA in ICP injures the umbilical veinendothelium, the active compound of endothelium derived relaxing factorand endothelium constracting factor is disbalance in ICP. The expressionof ET-1 is raised,and the synthetase of NO-eNOS, iNOS is downregulation. So we conclude that the pathology change of umbilical veindisbalance is out of control in ICP, it may lead to the spasmo-constractionof umbilical vein endothelium and the disbanance of constraction-relaxation function may be one cause of fetal distress in ICP.
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