妊娠期肝内胆汁淤积症患者不良妊娠结局的危险因素分析

肝脏 ›› 2023, Vol. 28 ›› Issue (5): 576-580.

妊娠期肝内胆汁淤积症患者不良妊娠结局的危险因素分析

陈文丹, 韩凤琼, 张金凤, 林悦, 郭俊豪, 宋爱峰, 潘海燕

523808 东莞广东医科大学流行病与卫生统计学教研室(陈文丹,林悦,郭俊豪,宋爱峰,潘海燕);广东医科大学顺德妇女儿童医院(韩凤琼,张金凤)

收稿日期:2022-10-12 出版日期:2023-05-31 发布日期:2023-08-29
通讯作者: 潘海燕,Email: panhaiyan@ gdmu. edu. cn;韩凤琼
基金资助:
广东省自然科学基金面上项目( 2019A1515010875);广东省普通高校重点科研平台重点领域专项项目( 2020ZDZX3007) ;东莞市科技特派员项目(20201800500082)

Analysis of risk factors for adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy

CHEN Wen-dan¹, HAN Feng-qiong², ZHANG Jin-feng², LIN yue¹, GUO Jun-hao¹, SONG Ai-feng¹, PAN Hai-yan¹

1. Department of Epidemiology and Medical Statistics,Guangdong Medical University,Dongguan,Guangdong 523808, China;
2. Shunde Women and Children's Hospital of Guangdong Medical University, Foshan 528300, China

Received:2022-10-12 Online:2023-05-31 Published:2023-08-29
Contact: PAN Hai-yan,Email: panhaiyan@ gdmu. edu. cn

摘要/Abstract

摘要： 目的了解妊娠期肝内胆汁淤积症(ICP) 患者发生不良妊娠结局的危险因素。方法纳入2019年6月至2021年12月广东医科大学顺德妇女儿童医院的ICP孕妇365例。根据ICP孕妇是否发生不良妊娠结局进行分组,观察两组临床特征差异, logistic 回归分析ICP孕妇发生不良妊娠结局的危险因素。结果单因素分析结果显示,ICP发病时间、年龄、总胆汁酸、直接胆红素、AST、ALT、双胎妊娠、胚胎移植等与不良妊娠结局有关(t/χ²=29.369、2.342、4.006、2.111、2.622、2.089、27.801、11.795,P<0.05);产妇类型、BMI、妊娠期糖尿病等与不良妊娠结局无关(t/χ²=0.193、0.517、1.321,P＞0. 05)。logistic回归分析显示,年龄(OR=1.087, 95%CI: 1.021~1.157, P=0.009)、总胆汁酸(OR=1.031, 95%CI:1.015~1.047, P<0.01)、股骨长度(OR=0.781, 95%CI:0.689~0.886, P<0.001)、双胎妊娠(OR=9.262,95%CI:1.055~81.284, P=0.045)、AST(OR=1.015, 95%CI:1.002~1.029, P=0.023)及尿酸(OR=1.005, 95%CI:1.001~1.008, P=0.008)是ICP孕妇发生不良妊娠结局的独立危险因素。结论年龄、总胆汁酸、股骨长度、双胎妊娠、AST及尿酸是ICP孕妇发生不良妊娠结局的危险因素。

关键词: 妊娠期肝内胆汁淤积症, 不良妊娠结局, 危险因素, 胆汁酸

Abstract: Objective To investigate the risk factors associated with the occurrence of adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy (ICP).Methods Three hundred and sixty-five pregnant women with ICP who delivered at Shunde Women and Children's Hospital of Guangdong Medical Universityt, Foshan, Guangdong Province, from June 2019 to December 2021 were selected. Pregnant women with ICP were grouped according to whether they had adverse pregnancy outcomes, and the differences in clinical characteristics between the two groups were observed.Results Univariate analysis showed that time of ICP onset, age, total bile acid, direct bilirubin, glutamic oxalacetic transaminase, glutamic alanine transaminase, twin pregnancy, and embryo transfer were associated with adverse pregnancy outcome ( t/χ²=29.369、2.342、4.006、2.111、2.622、2.089、27.801、11.795,P＜0.05); maternal type, BMI, and gestational diabetes were not associated with adverse pregnancy outcome (t/χ²=0.193、0.517、1.321,P>0.05). logistic regression analysis showed that age(31.04±5.13year),total Bile acid (37.17±30.70μmol/L), femur length(64.88±6.52 mm),twin pregnancy, glutathione (34.51±46.37 U/L)and uric acid(369.69±117.78 μmol/L) were independent risk factors for adverse pregnancy outcome in pregnant women with ICP (P<0.05).Conclusion Age, total bile acids, femur length, twin pregnancy, glutathione and uric acid are high risk factors for adverse pregnancy outcomes in pregnant women with ICP.

Key words: Intrahepatic cholestasis of pregnancy, Adverse pregnancy outcomes, Risk factors, Total bile acid

陈文丹, 韩凤琼, 张金凤, 林悦, 郭俊豪, 宋爱峰, 潘海燕. 妊娠期肝内胆汁淤积症患者不良妊娠结局的危险因素分析[J]. 肝脏, 2023, 28(5): 576-580.

CHEN Wen-dan, HAN Feng-qiong, ZHANG Jin-feng, LIN yue, GUO Jun-hao, SONG Ai-feng, PAN Hai-yan. Analysis of risk factors for adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy[J]. Chinese Hepatolgy, 2023, 28(5): 576-580.

参考文献

[1] Cui Y, Xu B, Zhang X, et al. Diagnostic and therapeutic profiles of serum bile acids in women with intrahepatic cholestasis of pregnancy-a pseudo-targeted metabolomics study. Clin Chim Acta, 2018, 483:135-141.
[2] Smith DD, Rood KM. Intrahepatic cholestasis of pregnancy. Clin Obstet Gynecol. 2020,63(1):134-151.
[3] 刘娟. 135例妊娠期肝内胆汁淤积症孕妇妊娠结局临床分析. 医学理论与实践,2017,30(20):3060-3061.
[4] 夏显,漆洪波.美国母胎医学会《妊娠期肝内胆汁淤积症指南(2020版)》解读.实用妇产科杂志,2021,37(08):587-590.
[5] Herrera CA, Manuck TA, Stoddard GJ, et al. Perinatal outcomes associated with intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med,2018,31(14):1913-1920.
[6] 胡翠芳,朱大伟,李力.妊娠期肝内胆汁淤积症的研究进展.中国实用妇科与产科杂志,2021,37(02):248-252.
[7] 张建华,李秀华.胎盘胆汁酸转运体及核受体与妊娠期肝内胆汁淤积症的研究进展.中国生育健康杂志,2020,31(01):87-89.
[8] 中华医学会妇产科学分会产科学组.妊娠期肝内胆汁淤积症诊疗指南(2015).中华妇产科杂志,2015,50(07):481-485.
[9] 王宏亮.妊娠期肝内胆汁淤积症患者相关生化指标的检测及临床意义.中国医药指南,2019,17(23):65-66.
[10] 热依汗古丽·买买提,刘海燕,等.妊娠期肝内胆汁淤积症对早产发生率的影响.中华流行病学杂志,2017,38(10):1415-1418.
[11] 刘秋霞,张慧雅.血清MMP-2和MMP-9水平检测作为诊断妊娠期肝内胆汁淤积症新的生物标志物的价值研究.现代检验医学杂志,2019,34(03):82-85+90.
[12] 冯云倩,霍艳,王爽.琥珀酸氢化可的松联合腺苷蛋氨酸对妊娠期肝内胆汁淤积症患者肝功能及妊娠结局的影响.国际医药卫生导报,2021,27(06):799-801.
[13] Cui D, Zhong Y, Zhang L, et al. Bile acid levels and risk of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy: a meta-analysis. J Obstet Gynaecol Res, 2017, 43(9):1411-1420.
[14] 徐小芬,周俊俊,徐彬彬.不同程度子痫前期孕妇血尿酸水平比较及对母婴结局的影响.中国妇幼保健,2021,36(03):505-507.
[15] 李春容.腺苷蛋氨酸联合糖皮质激素治疗高龄产妇妊娠期肝内胆汁淤积症的疗效及对肝功能、妊娠结局的影响.中国妇幼保健,2019,34(22):5167-5170.
[16] 沈娜,章波儿,鲍铮铮,等.医学营养干预对高龄妊娠期糖尿病患者妊娠结局及围生儿影响的队列研究.中国妇幼保健,2020,35(08):1401-1403.
[17] 马翠,杨光琼,马润玫,等.208例妊娠期肝内胆汁淤积综合症临床分析.昆明医科大学学报,2018,39(04):117-120.
[18] 郑丽,杨爱华.临床药师参与妊娠期肝内胆汁淤积症患者药学监护的实践和方法研究.中国实用医药,2019,14(32):148-150.
[19] Ovadia C, Seed PT, Sklavounos A,et a1.Association of adverse perinatal outcomes of intrahepatic cho1estasis of pregnancy with biochemical markers:results of aggregate and individual patient data meta-analyses. Lancet, 2019, 393(10174): 899-909.