熊去氧胆酸治疗不同绒毛膜性双胎合并ICP的围产结局分析

Perinatal Outcomes of Using Ursodeoxycholic Acid to Treat Monochorionic and Dichorionic Twin Pregnancy Complicated by Intrahepatic Cholestasis of Pregnancy

目的比较熊去氧胆酸治疗不同绒毛膜性双胎合并妊娠期肝内胆汁淤积症(ICP)的效果以及围产结局。方法收集四川大学华西第二医院2015年1月1日−2018年11月1日双胎妊娠合并ICP孕产妇406例,分析单绒毛膜双羊膜囊(monochorionic diamniotic,MCDA)和双绒毛膜双羊膜囊(dichorionic diamniotic,DCDA)双胎ICP的临床资料,比较单用熊去氧胆酸或联合用药降低胆汁酸的效果及围产结局。结果对比MCDA双胎与DCDA双胎孕产妇的胆汁酸水平、早发型ICP、单用熊去氧胆酸或联合用药方案相似,且新生儿Apgar评分、出生体质量及住院率、剖宫产率、围产儿死亡差异均无统计学意义。分析MCDA双胎和DCDA双胎妊娠的孕产妇年龄、体质量指数、瘢痕子宫、试管妊娠、子痫前期、复杂性双胎比例差异具有统计学意义,进一步对比胆汁酸轻度和重度升高的双胎之间新生儿早产率差异有统计学意义(P<0.05)。结论单用熊去氧胆酸或联合用药对不同绒毛膜双胎ICP的治疗效果相同,单绒毛性及复杂性双胎、妊娠合并症仍是影响双胎ICP妊娠结局的主要因素,血清总胆汁酸轻度升高的双胎ICP按照重度管理可能与治疗性早产有关。

Objective To study the effect of using ursodeoxycholic acid(UDCA)to treat monochorionic and dichorionic twin pregnancies complicated by intrahepatic cholestasis of pregnancy(ICP)and to examine the differences in perinatal outcomes.Methods A total of 406 twin-carrying pregnant women who had ICP and received care at West China Second Hospital,Sichuan University between January 1,2015 and November 1,2018 were included in the study.The clinical data of monochorionic diamniotic(MCDA)and dichorionic diamniotic(DCDA)twins with ICP were analyzed.Analysis was done to compare the treatment effect for lowering serum total bile acid(TBA)and the perinatal outcomes with simple UDCA medication or combination medication.Results There were no statistically significant differences in TBA levels,early-onset ICP,simple UDCA medication or combination medication,neonatal Apgar score,birth weight,length of hospital stay,C-section rate,and perinatal mortality between the MCDA and the DCDA twin groups with ICP.However,maternal age,BMI,scarred uterus,in vitro fertilization-embryo transfer,preeclampsia,twin comorbidity rate of the two groups showed statistical differences.Further comparison between twin pregnancies with mildly-elevated TBA and those with severely-elevated TBA showed significant difference in preterm birth rate(P<0.05).Conclusion Simple UDCA medication or combination medication may have the same therapeutic effect on MCDA and DCDA twin pregnancies with ICP.Monochorionic twin pregnancy,twin comorbidities and pregnancy complications were still important factors affecting pregnancy outcomes of twin pregnancies with ICP.Twin pregnancies with slightly elevated TBA have been managed as severe ICP,which may be associated with increased iatrogenic preterm births.