慢性乙型肝炎患者妊娠期并发肝内胆汁淤积症的风险因素模型建立和验证

摘要/Abstract

摘要： 目的探讨慢性乙型肝炎(CHB)患者妊娠期并发肝内胆汁淤积症(ICP)的风险因素,并建立相应的风险预测模型,为临床早期干预和管理提供依据。方法本研究选择2021年3月至2024年3月在商丘市妇幼保健院就诊的149例妊娠期CHB患者为研究对象,根据患者是否患ICP分为两组,对比其临床资料。先进行单因素分析筛选显著变量,再行多元logistic回归分析,构建列线图模型并验证。结果共纳入149例CHB妊娠患者,其中21例患者为ICP组(14.09%),128例为非ICP组(85.91%)。单因素分析显示,治疗后ICP组患者的胆石症占比为42.86%(9/21),妊娠高血压占比为23.81%(5/21),TBA为(15.51±2.31)μmol/L,ALT为(115.72±12.29)U/L,HBV pgRNA为(5.40±0.69)lg拷贝/mL,均高于非ICP组的胆石症占比21.88%(28/128)、妊娠高血压占比7.81%(10/128)、TBA(11.19±3.24)μmol/L、ALT(85.62±8.81)U/L、HBV pgRNA(4.28±0.51)lg拷贝/mL(P<0.05)。多元logistic回归分析显示,胆石症 [OR=15.340(95% CI:1.124~209.390)]、妊娠高血压 [OR=15.618(95% CI:1.310~186.220)]、高TBA[OR=1.438(95% CI:1.074~1.924)]、高ALT[OR=1.233(95% CI:1.107~1.373)]、高HBV pgRNA[OR=40.620(95% CI:2.253~732.301)]是CHB妊娠患者并发ICP的危险因素。ROC曲线表明,各项联合预测具有较高的价值,AUC值为0.988,灵敏度为95.2%,特异度为96.1%,构建的列线图及校正曲线,具有良好拟合度。结论胆石症、妊娠高血压、TBA、ALT、HBV pgRNA等因素是CHB妊娠期患者发生ICP的主要危险因素,可为临床医生提供有价值的预测依据。

关键词: 慢性乙型肝炎, 妊娠期, 胆汁淤积, 风险因素, logistic回归分析

Abstract: Objective To investigate the risk factors for intrahepatic cholestasis of pregnancy (ICP) patients with chronic hepatitis B (CHB) during pregnancy, and to establish a corresponding risk prediction model, to furnish a basis for early clinical intervention and management. Methods A total of 149 pregnant patients with chronic hepatitis B (CHB) treated at Shangqiu Maternal and Child Health Hospital from March 2021 to March 2024 were selected. They were grouped by the presence or absence of ICP. Significant variables were screened via univariate analysis, followed by multivariate Logistic regression analysis. A nomogram model was constructed and validated. Results A total of 149 pregnant patients with CHB were included, among which 21 patients were in the ICP group (14.09%), and 128 patients were in the non- ICP group (85.91%). Univariate analysis revealed that the ICP group had a higher prevalence of cholelithiasis [42.86% (9/21) vs. 21.88% (28/128)], gestational hypertension [23.81% (5/21) vs. 7.81% (10/128)], elevated TBA (15.51 ± 2.31 μmol/L vs. 11.19 ± 3.24 μmol/L), elevated ALT (115.72 ± 12.29 U/L vs. 85.62 ± 8.81 U/L), and elevated HBV pgRNA (5.40 ± 0.69 lg copies/mL vs. 4.28 ± 0.51 lg copies/mL) compared to the non-ICP group (P<0.05). Multivariate logistic regression analysis showed that cholelithiasis [OR=15.340 (95% CI: 1.124~209.390)], pregnancy-induced hypertension [OR=15.618 (95% CI: 1.310~186.220)], high TBA [OR=1.438 (95% CI: 1.074~1.924)], high ALT [OR=1.233 (95% CI: 1.107~1.373)], and high HBV pgRNA [OR=40.620 (95% CI: 2.253~732.301)] were risk factors for ICP patients with CHB. Receiver operating characteristic (ROC) curve analysis indicated that the combined prediction of all items had a high value, with an area under the curve (AUC) value of 0.988, a sensitivity of 95.2%, and a specificity of 96.1%. A nomogram and a calibration curve were constructed, which showed a good fit. Conclusion Cholelithiasis, pregnancy - induced hypertension, TBA, ALT, and HBV pgRNA are the main risk factors for ICP in pregnant patients with CHB, providing valuable prediction basis for clinicians.

Key words: Chronic hepatitis B, Pregnancy, Intrahepatic cholestasis of pregnancy, Risk factors, Logistic regression

刘丽, 张蕊, 王潇伟. 慢性乙型肝炎患者妊娠期并发肝内胆汁淤积症的风险因素模型建立和验证[J]. 肝脏, 2025, 30(6): 857-861.

LIU Li, ZHANG Rui, WANG Xiao-wei. Establishment and validation of a risk factor model for intrahepatic cholestasis of pregnancy in patients with chronic hepatitis B[J]. Chinese Hepatolgy, 2025, 30(6): 857-861.

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