妊娠期肝内胆汁淤积症发病危险因素及其对妊娠结局的影响分析

Risk factors of intrahepatic cholestasis of pregnancy and its influence on pregnancy outcome

目的探讨妊娠期肝内胆汁淤积症(ICP)的相关危险因素及其对妊娠结局的影响。方法收集郑州大学第二附属医院产科2013年9月—2016年9月收治的40例ICP患者的临床资料进行分析,并以同期在郑州大学第二附属医院产科分娩的70例健康孕产妇作为对照,分析ICP发病的危险因素。本研究记录了2组受试者的围产儿胎龄及出生体重,并记录和比较了2组受试者的围产儿宫内窘迫、羊水胎粪污染、早产、吸入性肺炎、窒息等妊娠不良事件以及围产期并发症的发生率。结果 ICP组患者合并乙肝或其他肝胆疾病、有ICP病史、合并双胎的比例均明显高于对照组,差异均有统计学意义(P<0.05)。ICP组胎儿宫内窘迫、羊水污染、窒息、早产、低体重儿的发生率高于对照组,差异均有统计学意义(P<0.05);ICP组孕妇围产期妊娠期高血压疾病、胎膜早破、产后出血发生率高于对照组,差异均有统计学意义(P<0.05)。结论肝胆疾病、ICP病史、双胎、妊娠合并症是孕妇妊娠期发生胆汁淤积综合征的危险因素。ICP可增加宫内窘迫、羊水胎粪污染、早产、窒息、围产期并发症发生率,影响围产儿生长发育,围产期患儿结局较差。

Objective To investigate the risk factors of intrahepatic cholestasis of pregnancy （ICP） and its influence on pregnancy outcome. Methods The clinical data of 40 patients with ICP in the second affiliated hospital of Zhengzhou university from September,2013 to September,2016 were analyzed, and 70 healthy pregnant women in the same hospital were selected as the control group, then the risk factors of ICP were analyzed. In addition,the perinatal gestational age and birth weight of both groups were recorded,and perinatal distress, amniotic fluid meconium contamination,premature deliv- ery, aspiration pneumonia, asphyxia, pregnancy adverse events and perinatal complications of both groups were recorded and compared. Results The ratio of combined with hepatitis B or other hepatobiliary disease, ICP history, concomitant twins,and pregnancy complication of the ICP group were significantly higher than those of the control group, the differences were statistically significant（ P 〈0.05 ）. The incidence rate of perinatal distress,amniotic fluid pollution,asphyxia, premature delivery and low birth weight infants of the ICP group were significantly higher than those of the control group, the differences were statistically significant（ P 〈0.05 ）. The ratio of hypertensive disease of pregnancy,premature rupture of membranes,postpartum hemorrhage of ICP group were significantly higher than those of control group, the differences were statistically significant （ P 〈 0.05 ）. Conclusion Hepatitis B or other hepatobiliary diseases, ICP history, twins, preg- nancy complications were the risk factors of cholestasis syndrome during pregnancy. ICP could increase perinatal distress, amniotic fluid meconium contamination, premature delivery, inhalation pneumonia, asphyxia and perinatal complications, efl＇ect the perinatal growth, and result in a poor outcome.