1340例妊娠期肝内胆汁淤积症的回顾性分析

Retrospective analysis of 1340 women with intrahepatic cholestasis of pregnancy

目的回顾分析1340例妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）患者的临床资料，探讨ICP分型对诊断和处理的临床意义。方法对我院2000年1月至2007年12月的8年中收治的1340例ICP患者病例资料进行回顾性分析，比较不同ICP分型患者的临床表现、生化结果、分娩方式、围产儿结局等指标。结果ICP患者占同期产科住院孕妇总数的8．58％（1340／15625），院内分娩孕妇的早产发生率为11．72％（124／1058）。新生儿窒息率为2．07％（23／1110），围产儿死亡率为1．08％（12／1110）。75．97％（1018／1340）的ICP孕妇以皮肤瘙痒为主要症状，轻、重型ICP患者皮肤瘙痒症状出现的比例差异无统计学意义E74．89％（522／697）和77．14％（496／643），X^2=0．94，P〉0．05]。ICP患者有、无皮肤瘙痒时的围产儿死亡率（1．02％和1．46％）、新生儿窒息率（2．30％和1．82％）和早产发生率（11．61％和12．04％）差异均无统计学意义（P均〉0．05）。甘胆酸（glycocholic，acid，CG）≥64．43umol／L与CG〈64．43p．mol／L、AST和（或）ALT≥250U／L与AST和ALT均〈250U／L、TBA≥40umol／L与TBA〈40umol／L的患者比较，前者的围产儿死亡率、新生儿窒息率和早产的发生率均低于后者（P均〈0．05）。轻型ICP患者平均分娩孕周晚于重型ICP患者[（38．3±1．9）周和（36．1±1．7）周，P〈0．05]，而剖宫产率（73．73％和97．33％）、早产率（6．13％和18．28％）、新生儿窒息率（1．05％和3．49％）和围产儿死亡率（0．18％和2．26％）均低于重型ICP患者（P均〈0．05）。结论ICP分型对终止妊娠时间、分娩方式选择有指导意义，重型ICP宜剖宫产，轻型ICP可在密切监护下阴道试产。

Objective To evaluate the clinical significance of classification for intrahepatic cholestasis of pregnancy （ICP） on diagnosis and management of ICP. Methods A retrospective analysis was conducted on 1340 cases of ICP admitted to our hospital from January 2000 to December 2007. All subjects were divided to mild and severe ICP groups. All clinical data were retrieved, and clinical manifestations, biochemical indicators, mode of delivery, perinatal outcomes were analyzed between the two groups. Results These 1340 ICP cases occupied 8.58% of all the maternity inpatients during the study period. Among those delivered in the hospital （n = 1058）, including 52 twin pregnancies, the preterm birth rate was 11.72% （124/1058）, the neonatal asphyxia rate was 2. 07% （23/1110）, and the perinatal mortality rate was 1.08% （12/1110）. Skin pruritus was the main symptom in 75.97% （1018/1340） of all cases and no significant difference was found in the proportion of women with skin pruititus between mild and severe ICP cases [74. 89% （522/697） vs 77.14%（496/643）,X^2=0.94,P〉0.05]. The perinatal mortality rate（1.02% vs 1.46%）, neonatal asphyxia rate（2.30% vs 1.82%） and preterm birth rate（11.61 vs 12.04%） showed no difference between women with and without skin pruritus among those delivered in the hospital（all P〉0.05）. Comparisons between those women with CG≥64.43umol/L vs CG（64.43 umol/L, those with AST and/or ALTO250 U/L vs both AST and ALT 〈250 U/L, those with TBA≥40 umol/L vs TBA≥40umol/L, the perinatal mortality rate, neonatal asphyxia rate and preterm birth rate were all lower in the former groups（all P〉0.05）. The average gestations at delivery was later in mild ICP women than in the severe ones [（38.3± 1.9） weeks vs （36.1 ± 1.7） weeks, P〈0.05]. And the cesarean section rate （73.73% vs 97.33%）, preterm birth rate （6.13% vs 18.28%）, neonatal asphyxia rate （1.05% vs 3.49%） and perinatal mortality rate （0. 18% vs 2.26%） in the mild ICP cases were all lower than in the severe ICP women （all P〈0.05）. Conclusions It is helpful for the management of ICP by dividing ICP cases into mild or severe ones. Cesarean section is recommended for severe ICP, and trial of labor may be possible for mild cases under close monitoring.