121例妊娠期肝内胆汁淤积症的病例对照分析

A case-control study on 121 cases of intrahepatic cholestasis of pregnancy

目的探讨妊娠期肝内胆汁淤积症对围产儿结局的影响。方法以2008年1-9月在我院住院分娩的121妊娠期肝内胆汁淤积产妇为研究对象，按照1：1配对设定对照组，记录两组人口统计学特征、临床诊断，追踪分娩情况，分析两组间围产儿不良结局差异。结果ICP组与对照组产妇的户籍、年龄、自评家庭经济状况、文化程度等人口统计学因素分布差异均无统计学意义（P〉0．05）；两组产妇胎儿性别、产后出血发生率、羊水过少、新生儿窒息发生率差异均无统计学意义（P〉0．05）。ICP组产妇的胎膜早破发生率（10．7％）低于对照组（17．5％）；ICP组产妇的剖宫产率（81．8％）高于对照组（63．6％）；经配对t检验分析发现ICP组围生儿出生体重（3032．3±392．0）g低于对照组（3222．3±469．6）g；围生儿羊水粪污发生率（31．4％）高于对照组（15．7％），P〈0．05。ICP产妇的血胆酸值与围生儿孕周、出生体重均呈负相关关系（r=-0．435，P=0．000；r=-0．248，P=0．006），与剖宫产、早产均呈正相关关系（r=0．281，P=0．002；r=0．297，P=0．001）；与羊水粪污及窒息发生均无相关关系（P〉0．05）。结论控制混杂因素的ICP产妇剖宫产、早产、羊水污染发生率均较高，且胆酸值的高低影响围生儿结局。

Objective To analyze the impact of intrahepatic cholestasis of pregnancy （ICP） on adverse perinatal outcomes. Methods 121 cases of intrahepatic cholestasis of pregnancy women who delivered from January to September 2008 in Anhui Province maternal and child health care hospital were selected as case group,121 normal cases were matched as control group. Socio-demographic data,clinical diagnosis information and delivery information were recordsed. Differences of main adverse perinatal outcomes were compared by statistic analysis between the two groups. Results There were no significant differences in socio-demographic information between ICP group and control group（P 〉 0.05）. Also there were no significant difference of parity,fetal gender,postpartum hemorrhage,severe asphyxia between the two groups（P 〉 0.05）. The rate of remature rupture of membranes in ICP group（10.7%） was lower than that in control group（17.5%）;the rate of caesarean delivery was 81.8% in ICP group,higher than that in control group （63.6%）;amniotic fluid pollution rate of ICP group（31.4%） was higher than that in control group （15.7%） ;birth weight in ICP group（3 032.3± 392.0）g were lower than that in control group（3 222.3 ±＋ 469.6）g; These differences were all of statistical significance （P 〈 0.05）. Correlation analysis for ICP groups manifested that the level of cholic acid negatively correlated with gestational age and birth weight（r=-0.435,P=0.000;r=-0.248,P=0.006）,and positively correlated with caesarean delivery and premature （r=0.281,P=0.002;r=0.297,P=0.001）. Other outcomes were not found to be associated with the level of cholic acid （P 〉 0.05 ）. Conclusion After controlling the confounding factors,ICP may have adverse effect on perinatal outcomes including high rates of caesarean delivery,premature and amniotic fluid pollution. Higher level the cholic acid may reflect the severity of the desease.