妊娠期肝内胆汁淤积症孕妇的胎儿不良结局的危险因素分析

摘要

目的 探讨妊娠期肝内胆汁淤积症(ICP)孕妇的胎儿不良结局的危险因素.方法 将2014年1月至2016年6月在成都市妇女儿童中心医院产科住院治疗的471例ICP孕妇纳入研究,采取回顾性分析方法 分析ICP孕妇的胎儿不良结局的危险因素.结果 单因素分析中,ICP孕妇的孕周(χ2=38.834,P=0.000)、发病时间(χ2=21.470,P=0.000)、多胎妊娠(χ2=19.529,P=0.000)、合并高血压(χ2=10.963,P=0.001)、合并糖尿病(χ2=7.098,P=0.008)、合并乙肝(χ2=5.879,P=0.015)、ICP既往史(χ2=7.193,P=0.007)、生化指标(TBA:χ2=23.410,P=0.000;ALT、AST:χ2=6.114,P=0.013;TBIL:χ2=8.204,P=0.004;DBIL:χ2=5.361,P=0.021)水平与胎儿不良结局的发生率具有相关性;进一步经多因素Logistic回归分析,孕妇发病时间(OR=2.92,95%CI=1.37~6.22)、多胎妊娠(OR=2.29,95%CI=1.42~3.71)、合并高血压(OR=2.41,95%CI=1.09~5.33)、合并糖尿病(OR=1.95,95%CI=1.07~3.56)、TBA水平(OR=2.05,95%CI=1.05~4.01)是ICP孕妇的胎儿不良结局的高危因素,其中发病孕周是ICP最重要的危险因素.结论 孕妇发病时间、多胎妊娠、合并高血压、合并糖尿病、TBA水平是ICP孕妇的胎儿不良结局的高危因素,早期发现,对ICP孕妇的胎儿加强监护及采取治疗,结合孕周、病情变化评估是否需要终止妊娠和合适的分娩方式,可改善孕产妇及围产儿结局.%Objective To investigate the risk factors of abnormal fetuses caused by ICP in pregnant women during pregnancy. Methods Totally 471 ICP pregnant women were selected in Chengdu Women' s and Children' s Central Hospital from January 2014 to June 2016, and retrospective analysis was conducted to analyze the risk factors of abnormal fetuses of ICP pregnant women. Results Single factor analysis showed that gestational weeks of ICP pregnant women (χ2 =38. 834,P=0. 000), occurrence time (χ2 =21. 470, P=0. 000), multiple pregnancy (χ2 =19. 529, P=0. 000), complicated by hypertension (χ2 =10. 963, P=0. 001), gestational diabetes mellitus (χ2 =7. 098, P=0. 008), complicated by hepatitis b (χ2 =5. 879, P =0. 015), ICP previous history (χ2 =7. 193, P =0. 007), biochemical indexes(TBA:χ2 =23. 410, P=0. 000; ALT, AST: χ2 =6. 114, P=0. 013; TBIL:χ2 =8. 204, P=0. 004; DBIL: χ2 =5. 361, P=0. 021) had relationship with occurrence rate of abnormal fetuses. Further multiple Logistic regression analysis revealed that occurrence time (OR =2. 92, 95%CI:1. 37 -6. 22), multiple pregnancy (OR =2. 29, 95%CI:1. 42 -3. 71), complicated by hypertension (OR=2. 41, 95%CI:1. 09-5. 33), gestational diabetes mellitus (OR=1. 95, 95%CI:1. 07-3. 56), TBA level (OR=2. 05,95%CI:1. 05-4. 01) were high risk factors of abnormal fetuses of ICP pregnant women. And gestational age of onset was the most important risk factor. Conclusion Occurrence time, multiple pregnancy, complicated by hypertension, gestational diabetes mellitus and TBA level are high risk factors of abnormal fetuses. Early detection, extensive monitoring and therapy for fetuses of ICP pregnant women, assessing whether pregnancy should be terminated and choosing suitable delivery mode according to gestational weeks and disease can improve maternal and perinatal outcomes.