关键词: 妊娠期肝内胆汁淤积症, 不良妊娠结局, 危险因素, 围生期干预

Abstract: Objective To analyze the risk factors of adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy (ICP) and to provide reference for perinatal prevention and intervention measures. Methods A total of 72 pregnant female patients with ICP were enrolled and divided into adverse pregnancy outcome group (n=23) and non-adverse pregnancy outcome group (n=49) according to whether adverse pregnancy outcome occurred. The baseline data and clinical indicators of the subjects were collected, and the risk factors for adverse pregnancy outcomes in pregnant women with univariate and Logistic multi-factor ICP were identified, and the predictive value of each risk factor was analyzed. Results Among 72 ICP pregnant women, 23 cases had adverse pregnancy outcome (31.94%). The family history of ICP, increase index of body mass index (BMI) during pregnancy, incidence of gestational diabetes mellitus (GDM), fibrinogen (FIB), total bilirubin (TBil), direct bilirubin (DBil), total bile acid (TBA) levels in the adverse pregnancy outcome group were 21.74%, 1.23, 4.56±0.67 g/L, 16 .64±1.95 μmol/L, 7.26±1.15 μmol/L, 36.72±6.18 μmol/L, It was higher than that in the group without adverse outcome (8.16%, 1.11, 4.37±0.53 g/L, 14.73±1.67 μmol/L, 6.34±1.02 μmol/L, 21.68±4.35 μmol/L). The gestational age and levels of 25 hydroxyvitamin D [25- (OH) D₃] in the adverse pregnancy outcome group were 30.46±2.38 w and 22.16±4.03 μg/mL, which were lower than those in the control group (32.85±2.56w and 29.75±4.58 μg/mL), and the difference was statistically significant (t/χ²=4.263, 9.596, 3.537, 5.652, 5.239, 5.725, 9.236, 5.461, 7.382 were all P<0.05). logistics regression analysis showed that increased BMI and TBA during pregnancy were independent risk factors for adverse pregnancy outcomes in ICP pregnant women, and 25- (OH) D₃ were protective factors (95%CI 2.342-7.016, 3.267-9.584, 2.958-8.263). OR=3.852, 5.025, 4.286, all P<0.05). ROC analysis showed that the area under the curve (AUC) of BMI increase index, TBA and 25- (OH) D₃ during pregnancy were 0.746, 0.853 and 0.812, respectively, and the sensitivity was 73.91%, 86.96% and 78.26%. The specificity was 69.57%, 78.26%, 82.61% (all P<0.01). Conclusion The increase of BMI, the increase of TBA and the decrease of 25- (OH) D₃ during pregnancy are risk factors for adverse pregnancy outcomes in ICP patients, offered a reliable basis for the formulation of programs and intervention measures to improve pregnancy outcomes.

Key words: ICP, Adverse pregnancy outcomes, Risk factors, Perinatal intervention