深圳地区妊娠期孕妇肝内胆汁淤积症发病率现状及其发病影响因素分析

Analysis of the incidence of intrahepatic cholestasis in pregnant women in shenzhen and its influencing factors

目的了解深圳地区妊娠期孕妇肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)发病率现状,并探讨其影响因素,为ICP预防及治疗提供科学依据。方法选择2018年3月~2019年12月来医院进行产前检查及住院分娩的中、晚期妊娠期孕妇3019例,分别检测血清中总胆汁酸(TBA)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、雌二醇(E2)、总胆固醇(CHOL)及高密度脂蛋白胆固醇(HDL-C)水平,并根据2015年《妊娠期肝内胆汁淤积症诊疗指南》计算妊娠期孕妇ICP发病率,同时对比分析ICP和非ICP妊娠期孕妇生化指标之间的差异性。结果3019例妊娠期孕妇中诊断出ICP患者272例,发病率为9.01%(272/3019),且ICP发病率随着妊娠期孕妇年龄的增大而上升,不同年龄段妊娠期孕妇ICP发病率之间差异有统计学意义(P<0.05);不同孕周妊娠期孕妇ICP发病率之间差异有统计学意义(P<0.05),其中以35~40W孕妇ICP发病率最高为10.63%;ICP妊娠期孕妇血清中TBA、ALT、AST、E2及CHOL水平分别为49.06±21.52μmol/L、82.05±34.67U/L、76.28±29.54U/L、89.05±14.63ng/L及4.31±0.82mmol/L,明显高于非ICP妊娠期孕妇的7.32±5.39μmol/L、37.41±9.18U/L、40.25±10.30U/L、47.18±9.56ng/L及2.50±0.64mmol/L,而HDL-C水平为1.27±0.34mmol/L,明显低于非ICP妊娠期孕妇的2.43±0.58mmol/L,差异有统计学意义(P<0.05);ICP发病影响因素通过二元Logistic回归方程分析,其中年龄、孕周、TBA、ALT、AST、E2及CHOL为ICP独立危险因素,而HDL-C为其保护因素(P<0.05)。结论深圳地区妊娠期孕妇ICP有较高的发病率,且血清中TBA、ALT、AST、E2及CHOL水平升高和HDL-C水平降低的妊娠期孕妇ICP发病率明显升高。因此,加强以上指标检测对ICP患者的预防及治疗具有一定临床参考价值。

Objective:To understand the incidence of intrahepatic cholestasis of pregnancy(ICP)in pregnant women in shenzhen,and to explore its influencing factors,so as to provide scientific basis for ICP prevention and treatment.Method:From March 2018 to December 2019,3,019 pregnant women in the middle and third trimester of pregnancy came to the hospital for prenatal examination and in-hospital delivery,Respectively to detect the serum total bile acid(TBA),alanine aminotransferase(ALT),aspertate aminotransferase(AST),estradiol(E2),triglyceride(CHOL)and high-density lipoprotein cholesterol(HDL-C)levels,and according to the 2015 pregnancy intrahepatic cholestasis disease diagnosis and treatment guidelines computation pregnant women during pregnancy incidence of ICP,at the same time comparative analysis between ICP and biochemical indicators of ICP pregnant women during pregnancy.Results:Among the 3019 pregnant women,272 were diagnosed with ICP,with the incidence of 9.01%(272/3019),and the incidence of ICP increased with the increase of the pregnant women′s age.The difference of ICP incidence among pregnant women in different age groups was statistically significant(P<0.05).The incidence of ICP in pregnant women with different gestational weeks was statistically significant(P<0.05),among which the highest was 10.63%in pregnant women with 35~40W.the levels of TBA,ALT,AST,E2 and CHOL in pregnant women during pregnancy were 49.06±21.52μmol/L,82.05±34.67U/L,76.28±29.54U/L,89.05±14.63ng/L and 4.31±0.82mmol/L,which were significantly higer than 7.32±5.39μmol/L、37.41±9.18U/L、40.25±10.30U/L、47.18±9.56ng/L及2.50±0.64mmol/L in in non-icp pregnant women,while the level of HDL-C was 1.27±0.34mmol/L,which was significantly lower than 2.43±0.58mmol/L in non-icp pregnant women,the difference was statistically significant(P<0.05).Affecting factors of ICP incidence were analyzed by binary Logistic regression equation,in which age,gestational age,TBA,ALT,AST,E2 and CHOL were the independent risk factors for ICP,while HDL-C was the protective factor(P<0.05).Conclusion:There was a high incidence of ICP in pregnant women during pregnancy in shenzhen,and the incidence of ICP in pregnant women during pregnancy was significantly increased when serum TBA,ALT,AST,E2 and CHOL levels were increased and hdl-c levels were decreased.Therefore,strengthening the detection of the above indicators has a certain clinical reference value for the prevention and treatment of ICP patients.