摘要
目的:探讨妊娠期肝内胆汁淤积症(ICP)与不良妊娠结局的相关性。方法:选择广州医科大学附属第三医院在2017年8月至2024年1月期间收治的511例单胎妊娠ICP孕妇作为研究对象,将患者分为不良妊娠结局组(n=49)和无不良妊娠结局组即对照组(n=462),对比分析两组患者的临床资料。结果:①一般情况:不良妊娠结局组患者孕次、产次、转ICU率、总住院时间、总住院费用均显著增加,而产检次数、诊断孕周和终止妊娠孕周则明显低于对照组,差异有统计学意义(P<0.05)。②临床症状:不良妊娠结局组瘙痒发生率低于对照组(10.2%vs.26.6%,P<0.05),其他症状如皮疹、乏力、黄疸、消化道症状等两组间差异无统计学意义(P>0.05)。③实验室检查:与对照组相比,不良妊娠结局组患者丙氨酸转氨酶、天门冬氨酸转氨酶、尿酸、尿素氮、甘油三酯均显著升高,而碱性磷酸酶与空腹血糖(FBG)则显著降低,差异均有统计学意义(P<0.05);余生化指标两组间差异无统计学意义(P>0.05)。④ICP分度、妊娠合并症和并发症占比情况:不良妊娠结局组早发型ICP、重度与极重度ICP的比例显著高于对照组(P<0.001);不良妊娠结局组合并妊娠期高血压疾病的比例显著高于对照组,且该组患者的早产、胎儿生长受限、羊水Ⅲ度及胎儿窘迫的发生率显著高于对照组(P<0.001)。⑤新生儿结局:不良妊娠结局组新生儿Apgar评分(1 min、5 min、10 min)及新生儿出生体质量均低于对照组(P<0.001),新生儿轻度窒息发生率则显著升高,差异有统计学意义(P<0.001)。结论:ICP的严重程度与不良妊娠结局的发生密切相关,因此临床上须重视ICP分度,密切监测总胆汁酸及肝酶等相关生化指标,尽量避免不良妊娠结局尤其是胎死宫内的发生。
Objective:To explore the correlation between intrahepatic cholestasis of pregnancy(ICP)and adverse pregnancy outcomes.Methods:A total of 511 singleton pregnant women with ICP treated at The Third Affiliated Hospital of Guangzhou Medical University from August 2017 to January 2024 were selected as the study subjects.Among them,patients were divided into the adverse pregnancy outcome group(n=49)and the control group without adverse pregnancy outcomes(n=462).The general and clinical data of the two groups were compared and analyzed.Results:①General situation:The number of pregnancies and deliveries,ICU transfer rate,total hospital stay,and total hospitalization costs were significantly higher in the adverse pregnancy outcome group compared to the control group(P<0.05).The number of prenatal check-ups,diagnostic gestational weeks,and gestational weeks at delivery were significantly lower compared to the control group(P<0.05).②Clinical symptoms:The incidence of itching in the adverse pregnancy outcome group was lower compared to the control group(10.2%vs.26.6%,P<0.05),while other symptoms such as rash,fatigue,jaundice,and gastrointestinal symptoms showed no significant difference between the two groups(P>0.05).③Laboratory examinations:Compared with the control group,patients in the adverse pregnancy outcome group had significantly the increased levels of alanine aminotransferase,aspartate aminotransferase,uric acid,urea nitrogen,and triglycerides,and significantly the decreased levels of alkaline phosphatase and fasting blood glucose,with statistical significance(P<0.05).Other biochemical indicators showed no significant difference between the two groups(P>0.05).④ICP grading and complications:The proportion of early-onset ICP,severe and very severe ICP in the adverse pregnancy outcome group was significantly higher compared to the control group(P<0.001);the proportion of adverse pregnancy outcome group with pregnancy-induced hypertension was significantly higher compared to the control group;the incidence of preterm birth,fetal growth restriction,meconium-stained amniotic fluid,and fetal distress in the adverse pregnancy outcome group was significantly higher compared to the control group(P<0.001).⑤Neonatal outcomes:The neonatal Apgar scores(1 min,5 min,10 min)and neonatal weight in the adverse pregnancy outcome group were lower compared to the control group(P<0.001),and the incidence of mild neonatal asphyxia was significantly higher,with a statistically significant difference(P<0.001).Conclusions:The severity of ICP is closely related to the occurrence of adverse pregnancy outcomes.Therefore,it is clinically necessary to pay attention to the grading of ICP,closely monitor the levels of total bile acids and liver enzymes,and try to avoid adverse pregnancy outcomes,especially intrauterine fetal death.
作者
张慧丽
江源
杜培丽
陈月娥
刘菁榆
陈楚仪
周秀花
余琳
陈敦金
马光义
ZHANG Huili;JIANG Yuan;DU Peili(Department of Obstetrics,The Third Hospital of Guangzhou Medical University,Guangdong Key Laboratory of Major Diseases of Obstetrics,Guangdong Clinical Medical Research Center for Gynecological Diseases,Guangdong-Hongkong-Macao Joint Laboratory of Maternal-fetal Medicine,Guangzhou Guangdong 510150,China;The Third College of Guangzhou Medical University,Guangzhou Guangdong 510182,China)
出处
《实用妇产科杂志》
北大核心
2025年第11期922-927,共6页
Journal of Practical Obstetrics and Gynecology
基金
国家重点研发计划(编号:2022YFC2704500)
广州医科大学第三临床学院2022-2023年度大学生科研项目(编号:2022A024)。
关键词
妊娠期肝内胆汁淤积症
不良妊娠结局
相关性分析
Intrahepatic cholestasis of pregnancy
Adverse pregnancy outcomes
Correlation analysis
