妊娠期肝内胆汁淤积症患者不良妊娠结局的危险因素研究及预测模型分析

摘要/Abstract

摘要： 目的探讨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,并构建预测模型,为临床早期干预提供理论依据。方法回顾性研究2021年9月至2024年8月在本院就诊的168例ICP患者,按照是否发生不良妊娠结局分为不良结局组54例与良好结局组114例。通过单因素和多因素logistic回归分析,筛选ICP患者发生不良妊娠结局的独立危险因素。同时用受试者工作特征曲线(ROC)评估各项危险因素对不良妊娠结局的预测价值,并结合临床参数建立预测模型。结果不良结局组的天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆汁酸(TBA)、中性粒细胞与淋巴细胞比率(NLR)、血小板体积(MPV)和部分凝血活酶时间水平分别为(38.02±6.75)U/L、(36.58±7.46)U/L、(44.85±5.33)μmol/L、(5.78±1.10)、(14.13±3.27)fL、(48.59±6.57)s,高于良好结局组的(30.38±5.95)U/L、(27.90±5.53)U/L、(42.48±5.90)μmol/L、(4.99±0.92)、(12.29±2.74)fL、(43.65±5.75)s(P<0.05)。多因素logistic回归分析结果显示,高AST、ALT、TBA、NLR、MPV和部分凝血活酶时间水平均为ICP患者发生不良妊娠结局的危险因素(P<0.05)。AST、ALT和TBA预测ICP患者发生不良妊娠结局的敏感度分别为74.1%、75.9%和50.0%,特异度分别为75.4%、79.8%和71.1%,AUC分别为0.811、0.826和0.612。而NLR、MPV和部分凝血活酶时间的敏感度分别为83.3%、44.4%和55.6%,特异度分别为45.6%、84.2%和82.5%,AUC分别为0.695、0.666和0.711。各指标联合的敏感度和特异度分别为92.6%和92.1%,AUC为0.958。结论 AST、ALT、TBA、NLR、MPV和部分凝血活酶时间是ICP患者发生不良妊娠结局的独立危险因素,这些指标的升高显著增加了不良妊娠结局的风险,可为临床早期预测和干预提供理论依据。

关键词: 妊娠期肝内胆汁淤积症, 不良妊娠结局, 危险因素, 预测模型

Abstract: Objective To investigate the risk factors for adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy (ICP) and to develop a prediction model, providing a theoretical basis for early clinical intervention. Methods A retrospective analysis was conducted on the 168 ICP patients who visited our hospital from September 2021 to August 2024. Based on whether adverse pregnancy outcomes occurred, the patients were divided into an adverse outcome group (54 cases) and a favorable outcome group (114 cases). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for adverse pregnancy outcomes in ICP patients. Furthermore, the predictive value of each risk factor for adverse pregnancy outcomes was assessed using receiver operating characteristic (ROC) curves, and a prediction model was established by combining clinical parameters. Results In the adverse outcome group, the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bile acids (TBA), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and activated partial thromboplastin time (APTT) were (38.02±6.75) U/L, (36.58±7.46) U/L, (44.85±5.33) μmol/L, (5.78±1.10), (14.13±3.27) fL, and (48.59±6.57) s, respectively, which were higher than those in the good outcome group, with values of (30.38±5.95) U/L, (27.90±5.53) U/L, (42.48±5.90) μmol/L, (4.99±0.92), (12.29±2.74) fL, and (43.65±5.75) s (P<0.05). Multivariate logistic regression analysis revealed that high levels of AST, ALT, TBA, NLR, MPV, and APTT were independent risk factors for adverse pregnancy outcomes in ICP patients (P<0.05). The sensitivities of AST, ALT, and TBA for predicting adverse pregnancy outcomes were 74.1%, 75.9%, and 50.0%, with specificity values of 75.4%, 79.8%, and 71.1%, and AUC values of 0.811, 0.826, and 0.612, respectively. The sensitivities of NLR, MPV, and PT were 83.3%, 44.4%, and 55.6%, with specificity values of 45.6%, 84.2%, and 82.5%, and AUC values of 0.695, 0.666, and 0.711, respectively. When these indicators were combined, the sensitivity and specificity were 92.6% and 92.1%, respectively, with an AUC of 0.958. Conclusion AST, ALT, TBA, NLR, MPV, and PT are independent risk factors for adverse pregnancy outcomes in ICP patients. Elevated levels of these indicators significantly increase the risk of adverse pregnancy outcomes and can provide a theoretical basis for early prediction and intervention in clinical practice.

Key words: Intrahepatic cholestasis of pregnancy, Adverse pregnancy outcomes, Risk factors, Prediction model

张俊琴, 辛玲丽, 刘丹, 王丽蓉, 侯庆香, 张亭亭. 妊娠期肝内胆汁淤积症患者不良妊娠结局的危险因素研究及预测模型分析[J]. 肝脏, 2025, 30(5): 694-699.

ZHANG Jun-qin, XIN Ling-li, LIU Dan, WANG Li-rong, HOU Qing-xiang, ZHANG Ting-ting. Risk factors for adverse pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy and prediction model analysis[J]. Chinese Hepatolgy, 2025, 30(5): 694-699.

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