妊娠期肝内胆汁淤积症患者血清总胆汁酸水平与妊娠终止时间及结局的相关性

Correlation of total bile acid level with termination time of pregnancy and perinatal outcome in intrahepatic cholestasis of pregnancy

目的探讨血清总胆汁酸(TBA)水平与妊娠期肝内胆汁淤积症患者终止妊娠时间及妊娠结局的相关性。方法选取2016年1月至2019年1月河南科技大学附属许昌市中心医院收治的住院分娩的妊娠期肝内胆汁淤积症孕妇67例,根据孕妇血清总胆汁酸水平分为低水平组(35例,总胆汁酸水平<40μmol/L)与高水平组(32例,总胆汁酸水平≥40μmol/L)。比较两组肝功能指标水平、终止妊娠时间、产妇妊娠结局及围生儿结局。血清TBA水平与终止妊娠时间相关性采用Pearson分析,与妊娠结局相关性采用Spearman分析。结果高水平组TBA、总胆红素、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶水平[(54.63±7.22)μmol/L、(36.34±8.14)mol/L、(185.26±22.67)U/L、(211.69±30.17)U/L]均高于低水平[(30.01±4.25)μmol/L、(25.09±5.97)mol/L、(110.25±16.11)U/L、(123.54±20.61)U/L],P<0.05;高水平组终止妊娠时间[孕(35.05±1.24)周]早于低水平组[孕(36.74±1.66)周],P<0.05;高水平组孕妇早产率(34.38%,11/32)高于低水平组(11.76%,4/35),P<0.05;高水平组新生儿低体质量儿发生率(53.13%,17/32)高于低水平组(28.57%,10/35),P<0.05。血清TBA水平与终止妊娠时间呈负相关(r=-0.435,P<0.05),与围生儿不良妊娠结局呈正相关(r=0.384,P<0.05)。结论血清TBA水平与妊娠期肝内胆汁淤积症孕妇终止妊娠时间及妊娠结局有显著相关性,对高血清TBA水平孕妇应采取积极治疗促进胎儿成熟并及时终止妊娠以提高围产儿存活率,减少不良结局的发生。

Objective To investigate the correlation of total bile acid(TBA)level with termination time of pregnancy and perinatal outcome in patients with intrahepatic cholestasis of pregnancy.Methods Sixty-seven cases of intrahepatic cholestasis of pregnancy treated in Xuchang Central Hospital Affiliated to Henan University of Science and Technology from January 2016 to January 2019 were enrolled in the study,and they were divided into two groups according to the TBA levels,low-level group(<40μmol/L,n=35)and high-level group(≤40μmol/L,n=32).Liver function index level,termination time,maternal pregnancy outcome and perinatal outcome of the two groups were compared.The correlation of serum TBA level with termination time of pregnancy was analyzed by Pearson analysis,and the correlation between serum TBA level and pregnancy outcome was analyzed by Spearman analysis.Results The levels of TBA,total bilirubin,aspartate aminotransferase and alanine aminotransferase in the high-level group were(54.63±7.22)μmol/L,(36.34±8.14)mol/L,(185.26±22.67)U/L,(211.69±30.17)U/L,respectively,higher than the(30.01±4.25)μmol/L,(25.09±5.97)mol/L,(110.25±16.11)U/L,(123.54±20.61)U/L in the low-level group(all P<0.05).The termination time of pregnancy in the high-level group was(35.05±1.24)weeks,earlier than the(36.74±1.66)weeks in the low-level group(P<0.05).The premature birth rate of pregnant women in the high-level group(34.38%,11/32)was higher than that in the low-level group(11.76%,4/35),P<0.05.The incidence of low birth weight infants in the high-level group(53.13%,17/32)was higher than that in the low-level group(28.57%,10/35),P<0.05.Serum TBA level was negatively correlated with termination time of pregnancy(r=-0.435,P<0.05),and positively correlated with the adverse outcomes of perinatal infants(r=0.384,P<0.05).Conclusions Serum TBA levels are significantly related to the termination time of pregnancy and pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy.For pregnant women with high serum TBA levels,active treatment should be adopted to promote fetal maturity and terminate pregnancy in time,so as to improve perinatal survival and reduce the incidence of adverse outcomes.