辅助生殖技术对双胎妊娠者并发ICP及围生期并发症发生率的影响

Effect of assisted reproductive technology on twin pregnancy complicated with intrahepatic cholestasis of pregnancy and incidence rates of perinatal complications

目的对比分析辅助生殖技术(ART)与自然受孕者双胎妊娠期间肝内胆汁淤积症(ICP)发生率及围生期并发症发生率。方法分析2014年8月-2017年9月在厦门市解放军第一七四医院产科进行住院分娩的623例双胎妊娠产妇临床资料,将ART双胎妊娠257例中并发ICP产妇26例分为A组,将自然双胎妊娠366例中并发ICP产妇59例分为B组,将自然受孕的正常双胎妊娠产妇48例分为C组。比较ART与自然受孕产妇ICP发生率及围产期结局,比较3组产妇的一般资料及生化检测指标。结果 ICP在ART中的发病率10.1%明显低于在自然受孕者中的发病率16.1%,且前者重度ICP发生率19.2%明显低于后者52.5%,差异均有统计学意义(P<0.05)。3组产妇的一般资料差异无统计学意义(P>0.05)。A、B两组产妇的TBA、TBIL、AST及ALT水平明显高于C组,差异均有统计学意义(P<0.05);A、B两组产妇的TBA、TBIL、AST及ALT水平差异无统计学意义(P>0.05)。A组新生儿体重明显高于B组,差异有统计学意义(P<0.05)。结论与自然受孕相比,ART并不会增加双胎妊娠者ICP及围产期并发症发生率。

Objective To compare and analyze the incidence rates of intrahepatic cholestasis of pregnancy（ ICP） and perinatal complications among twin pregnant women conceived naturally and via assisted reproductive technology（ ART）. Methods The clinical data of 623 twin pregnant women who gave birth to their babies in Department of Obstetrics in China PLA 174 Hospital from August 2014 to September 2017 was analyzed,then the twin pregnant women were divided into group A（ including 26 twin pregnant women complicated with ICP among 257 twin pregnant women conceived via ART）,group B（ including 59 twin pregnant women complicated with ICP among 366 twin pregnant women conceived naturally）,and group C（ including 48 normal twin pregnant women conceived naturally）. The incidence rates of ICP and perinatal outcomes of twin pregnant women conceived naturally and via ART were compared,the general information and biochemical indexes in the three groups were also compared. Results The incidence rate of ICP among the twin pregnant women conceived via ART was 10. 1%,which was statistically significantly lower than that among the twin pregnant women conceived naturally（ 16. 1%）. The incidence rate of severe ICP among the twin pregnant women conceived via ART was 19. 2%,which was statistically significantly lower than that among the twin pregnant women conceived naturally（ 52. 5%）（ P0. 05）. There was no statistically significant difference in general information among the three groups（ P0. 05）. The levels of total bile acid（ TBA）,total bilirubin（ TBIL）,aspartate aminotransferase（ AST）,and alanine transaminase（ ALT） in group A and group B were statistically significantly higher than those in group C（ P0. 05）. There was no statistically significant difference in the levels of TBA,TBIL,AST,and ALT between group A and group B（ P0. 05）. Neonatal weight in group A was statistically significantly higher than that in group B（ P0. 05）. Conclusion Compared with the twin pregnant women conceived naturally,ART doesn＇t increase the incidence rate of ICP and perinatal complications.