基于166例妊娠期肝内胆汁淤积症孕妇高危因素的研究

The study on the high-risk factors of 166 pregnant women with intrahepatic cholestasis of pregnancy

目的探讨妊娠期肝内胆汁淤积症(ICP)的高危因素及其对发病孕周的影响。方法收集166例ICP孕妇的临床资料,根据入院时血清总胆汁酸水平、分娩孕周、发病孕周进行分组,分为轻度ICP组(n=133)和重度ICP组(n=33)与相关的临床资料、产前血液生化指标、妊娠结局等进行统计分析。结果重度ICP的孕妇其早产的发生率、剖宫产率、羊水粪染率均显著升高(P<0.01),新生儿出生体质量较轻,且近半数的新生儿后续需转入NICU治疗(P<0.001)。双胎妊娠、孕期使用过孕激素保胎、ICP发病时间较早(孕24周前)的孕妇更易早产(P<0.01),早产的孕妇其血清总胆汁酸水平要高于足月产的孕妇(P<0.001)。高危因素中的乙型肝炎疾病史、孕期使用孕激素保胎史对ICP的发病孕周具有影响,且在以孕34周作为诊断早发型ICP的截止孕周时两者均具有统计学意义(P<0.05)。结论对于有乙型肝炎疾病史、孕期使用孕激素保胎史的孕妇,在孕34周前产检时需定期筛查肝功能,以尽早地诊断ICP,改善ICP孕妇的围产儿结局。

Objective To investigate the high-risk factors of intrahepatic cholestasis of pregnancy(ICP)and its effect on gestational weeks.Methods The clinical data of 166 pregnant women with ICP were collected and grouped according to the level of serum total bile acid at admission,gestational weeks of delivery and gestational weeks of onset.The relevant clinical data,prenatal blood biochemical indexes and pregnancy outcomes were statistically analyzed.Results The incidence of premature delivery,cesarean section rate and amniotic fluid fecal staining rate of pregnant women with severe ICP were significantly increased(P<0.01).In the severe ICP group,the birth weight of newborns was relatively light,and nearly half of newborns needed to be transferred to NICU for follow-up treatment(P<0.001).Pregnant women with twin pregnancy,using progesterone during pregnancy and earlier onset of ICP(before 24 weeks of pregnancy)were more likely to give birth prematurely(P<0.01).Pregnant women born preterm have higher serum total bile acid levels than those born at term(P<0.001).The history of hepatitis B disease in high-risk factors and the history of pregnancy using progesterone to protect the fetus during pregnancy had an impact on the gestational weeks of ICP,and both had statistical significance when the 34th week of pregnancy was taken as the deadline for the diagnosis of early-onset ICP(P<0.05).Conclusion For pregnant women with a history of hepatitis B disease and a history of using progesterone during pregnancy,liver function should be regularly screened during prenatal examination before 34 weeks of pregnancy,so as to diagnose ICP as soon as possible and improve the perinatal outcome of ICP pregnant women.