2005-2014年妊娠期肝损害病因变迁分析

Etiological Change of Pregnancies with Liver Dysfunction during 2005-2014

【目的】本研究旨在探讨妊娠肝损害的病因分布、特点、病因构成变化趋势。【方法】收集中山大学附属第三医院2005-2014年近10年间收治的妊娠肝损害患者及同期正常妊娠者临床资料,分析两组临床特点的差异、病例组的病因构成及变化。【结果】本研究收集到符合标准的病例共1 241例(晚期妊娠859例),正常对照组1 432例(晚期妊娠983例)。病例组平均年龄(28.30±4.44)岁,双胎妊娠3.7%,试管婴儿1.2%;病例组较对照组双胎妊娠比例高(P<0.05),两组年龄、试管婴儿比例、生育史无统计学差异。在所有病例中乙肝808例,65.1%;妊娠期肝内胆汁淤积症(ICP)228例,18.4%;妊娠期急性脂肪肝(AFLP)50例,4.0%;溶血、肝酶升高和血小板减少综合征(HELLP综合征)有38例,3.1%。妊娠肝衰竭病例共有65例,主要为乙肝30例,占46.2%,晚期妊娠22例和AFLP22例,占38.5%,晚期妊娠21例。对比2005-2009年和2010-2014年两个时间段,乙肝的比例有所下降(72.9%vs 60.5%,P<0.05),而ICP的比例有所上升(6.9%vs 25.2%,P<0.05),不明原因性妊娠肝损害也有所下降(10.4%vs 4.2%,P<0.05)。【结论】在10年间,我院住院妊娠肝损害患者主要为乙肝,但其比例有下降趋势;其次为ICP,其比例有上升趋势。妊娠期肝损害的病因变化研究有助于临床医生对妊娠期肝损害的早期识别和治疗,从而预防严重产科合并症的发生。

[ Objectives] To analyze the etiologies of liver dysfunction in pregnancy, clinical features and the proportional changes over 10 consecutive years. [ Methods ] Retrospectively collect the clinical data of hospitalized pregnant women with liver dysfunction in the Third Affiliated Hospital of Sun Yat-sen University from year 2005 to 2014, as well as the normal pregnant. To compare the clinical differences between the two groups, and analyze the etiological composition and the proportional changes of the case group. [Results] There were 1241 cases collected totally, of which 859 were in third trimester of pregnancy, and 1432 in control group, of which 983 were in third trimester. The proportion of twin pregnancy was higher in the case group than the control group （P 〈 0.05）. There were no statistically significant differences in the mean age, the proportion of in vitro fertilization and embryo transfer （IVF- ET）, childbearing history between the two groups. In all cases, the main causes were hepatitis B （808 cases, 65.1%）, followed by intrahepatic cholestasis during pregnancy （ICP） （228 cases, 18.4% ）. Pregnancy with acute fatty liver （markers） was the third largest cause of pregnancy liver damage （50 cases, 4.0%）. HELLP syndrome had 38 cases （3.1%）. Hepatic failure had a total of 65 cases of pregnancy, mainly for hepatitis B （30 cases, accounting for 46.2%, 22 cases in the third trimester） and AFLP （22 cases accounting for 38.5%, 21eases in the third trimester）. Compared to 2005-2009 and 2010-2009 two periods, the proportion of hepatitis B declined（72.9% vs 60.5%, P〈 0.05）, while the proportion of ICP increased （6.9% vs 25.2%, P 〈 0.05）, and unknown causes liver damage pregnancy also declined （10.4% vs 4.2%, P 〈 0.05）. [Conclusion] In recent ten years, from 2005 to 2014 in our hospital,the most important cause for liver dysfunction in pregnancy is hepatitis B, but the proportion has a downwam trena ; w rme tt~ , u,~ second cause, has a rising trend. The research on the cause of liver damage during pregnancy can help clinicians for early recognition and treatment, thereby to prevent the occurrence of severe obstetric complications.