妊娠期肝内胆汁淤积症早产预测指标的临床研究

Predictors of premature delivery in patients with intrahepatic cholestasis of pregnancy

目的探讨临床症状和生化指标对妊娠期肝内胆汁淤积症患者（ICP）的早产预测价值。方法观察60例已确诊为ICP的患者，将妊娠不满37足周分娩的早产患者通过Logistic回归分析统计结果，并计算其优势比（OR，95％置信区间）。结果60例ICP患者平均孕期为（38．1±1．7）周，无死胎现象。早产8例（13．3％），与孕足月妊娠ICP患者相比，早产ICP患者的血清胆汁酸更高[（47．8±15．2）μmol／Lvs（41．0±10．0）μmol／L，P〈0．05]，出现全身瘙痒症状的时间更早[（29.0±3、9）周VS（31．6±3．3）周，P=0．057]。Logistic回归分析显示，全身瘙痒症状的首次出现时间（OR1．7，95％CI1．23～2．95，P=0．038）和血清胆汁酸（OR2．13，95％CI1．13～2．25，P=0．013）是两个早产的独立预测因子。结论在ICP患者中，孕妇瘙痒症状的首发时间及血清胆汁酸浓度是对早产的两个较好的预测指标。

Objective To evaluate the predictive value of clinical symptoms and biochemical parameters for prematurity inintrahepatic cholestasis of pregnancy（ICP）. Methods 60 symptomatic patients with ICP were included in this retrospective analysis. Preterm delivery was defined as delivery before 37 weeks gestation. Predictors of preterm delivery were disclosed by binary multivariate logistic regression analysis. Results Mean time of delivery was （38. 1 ± 1.7） weeks. No stillbirths occurred. Premature delivery was observed in eight （13.3%）patients. Total fasting serum bile acids were higher[ （47. 8 ±15.2） μmol/L vs（41.0 ± 10. 0）μmol/ L, P 〈 0.05 ] , and pruritus tended to start earlier[ （ 29.0 ±3.9 ） weeks vs （ 31.6±3.3 ） weeks, P = 0. 057 ] in patient with premature delivery when compared to those with term delivery. Binary multivariate logistic regression analysis revealed that early onset of pruritus（ OR 1.7,95% CI 1.23-2.95 ,P = 0. 038 ）and serum bile acid（ OR 2.13,95% CI 1. 13-3.25 ,P =0. 013 ） were independent predictors of preterm delivery. Conclusion Early onset of pruritus and high levels of serum bile acids predict preterm delivery in ICP,and define a subgroup of patients at risk for poor neonatal outcome.