胆汁酸水平对妊娠期肝内胆汁淤积症产妇和围产儿结局的影响

摘要/Abstract

摘要： 目的探讨血清胆汁酸水平对不同发病时间妊娠期肝内胆汁淤积症(ICP)孕妇妊娠结局及围产儿结局的影响。方法收集2022年1月至2025年12月扬州大学附属扬州妇幼保健院ICP孕妇临床资料,共纳入115例。根据发病孕周将其分为早发型ICP和晚发型ICP,并依据血清总胆汁酸(TBA)水平分为轻度ICP和重度ICP,最终分为早发型轻度组(n=15)、早发型重度组(n=10)、晚发型轻度组(n=62)和晚发型重度组(n=28)。比较不同类型ICP孕妇的临床特征、实验室指标、妊娠结局及围产儿结局。结果 4组孕妇在年龄及孕前体质指数方面差异无统计学意义(P>0.05)。早发型ICP孕妇诊断孕周明显早于晚发型ICP孕妇[(24.6±2.1)周 vs. (33.8±2.6)周,P<0.05]。重度ICP孕妇血清TBA水平显著高于轻度ICP孕妇[早发型:(82.4±21.6)μmol/L vs. (24.6±7.8)μmol/L;晚发型:(76.3±18.9)μmol/L vs. (22.9±6.5)μmol/L,均P<0.05]。妊娠结局方面,早发型重度组剖宫产率和早产发生率最高(分别为80.0%、70.0%),显著高于早发型轻度组(40.0%、26.7%)、晚发型轻度组(35.5%、14.5%)及晚发型重度组(60.7%、39.3%)(P<0.05)。围产儿结局分析显示,早发型重度组新生儿出生孕周(33.4±2.6)周和出生体质量(1 980±510)g最低,低出生体质量(60.0%)、胎儿窘迫(50.0%)、新生儿重症监护病房转入率(70.0%)及新生儿窒息发生率(30.0%)最高,均显著高于其他3组(P<0.05)。结论血清TBA水平与ICP孕妇肝功能损害程度、妊娠结局及围产儿预后密切相关。早发型重度ICP是母胎不良结局风险最高的亚型,应加强孕期监测并实施个体化管理。

关键词: 妊娠期肝内胆汁淤积症, 总胆汁酸, 早发型ICP

Abstract: Objective To investigate the effects of serum bile acid levels on pregnancy and perinatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP) with different times of disease onset. Methods Clinical data of pregnant women with ICP from January 2022 to December 2025 in Yangzhou Maternal and Child Health Care Hospital Affiliated to Yangzhou University were collected, including a total of 115 cases. According to the gestational age at onset, patients were classified as early-onset or late-onset ICP, and further stratified into mild or severe ICP based on serum total bile acid (TBA) levels. The patients were ultimately divided into four groups: early-onset mild (n=15), early-onset severe (n=10), late-onset mild (n=62), and late-onset severe (n=28). General clinical characteristics, laboratory parameters, pregnancy outcomes, and perinatal outcomes were compared among the groups. Results The results showed that there were no significant differences among the four groups in maternal age or pre-pregnancy body mass index (P>0.05). The gestational age at diagnosis was significantly earlier in women with early-onset ICP than in those with late-onset ICP [(24.6±2.1) weeks vs. (33.8±2.6) weeks, P<0.05)]. Serum TBA levels were significantly higher in women with severe ICP than in those with mild ICP [early-onset: (82.4±21.6) μmol/L vs. (24.6±7.8) μmol/L; late-onset: (76.3±18.9) μmol/L vs. (22.9±6.5) μmol/L; all P<0.05]. Regarding pregnancy outcomes, the early-onset severe ICP group had the highest rates of cesarean delivery and preterm birth, at 80.0% and 70.0%, respectively, which were significantly higher than those in the early-onset mild group (40.0% and 26.7%), late-onset mild group (35.5% and 14.5%), and late-onset severe group (60.7% and 39.3%) (P<0.05). Analysis of perinatal outcomes showed that neonates in the early-onset severe ICP group had the lowest gestational age at birth (33.4±2.6) weeks and birth weight (1980±510) g. This group also exhibited the highest incidences of low birth weight (60.0%), fetal distress (50.0%), neonatal intensive care unit admission (70.0%), and neonatal asphyxia (30.0%), all of which were significantly higher than those in the other three groups (P<0.05). Conclusion Serum bile acid levels are closely associated with the severity of liver dysfunction, pregnancy outcomes, and perinatal prognosis in women with ICP. Early-onset severe ICP represents the highest-risk subtype for adverse maternal and fetal outcomes and warrants intensified prenatal surveillance and individualized management.

Key words: Intrahepatic cholestasis of pregnancy, Total bile acids, Early-onset ICP

赵秋霞, 吴万粉, 王红. 胆汁酸水平对妊娠期肝内胆汁淤积症产妇和围产儿结局的影响[J]. 肝脏, 2026, 31(5): 737-740.

ZHAO Qiu-xia, WU Wan-fen, WANG Hong. Impact of bile acid levels on maternal and perinatal outcomes in intrahepatic cholestasis of pregnancy[J]. Chinese Hepatolgy, 2026, 31(5): 737-740.

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