妊娠期肝内胆汁淤积症的母儿结局及影响因素研究

摘要

目的 评估妊娠期肝内胆汁淤积症(ICP)的母儿预后与孕妇总TBA、孕妇血清TBA指标的关系,以确认ICP孕妇TBA水平与胎儿预后的相关性.方法 选取在本院妇产科分娩的ICP孕妇256例.根据2015年中华医学会制定的ICP指南将孕妇分为重度组(n=84)与轻度组(n=172);检测并比较两组孕妇总胆汁酸、丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转氨酶、丙氨酸转氨酶与总胆红素水平;采用Logistics回归分析计算TBA指标与母儿结局的相关性;采用Pearson相关分析方法检验与母儿TBA指标相关的因素.结果 重度组的总胆汁酸、丙氨酸转氨酶、天冬氨酸转氨酶、y-谷氨酰转氨酶与总胆红素水平显著高于轻度组,差异有统计学意义(均P＜ 0.001);重度组分娩时孕周显著短于轻度组,差异有统计学意义(P=O.003).重度组Ⅲ度羊水污染发生率显著高于轻度组[25(29.8％)比27(15.7％),P=0.009].重度组新生儿1 min与5 min Apgar评分均显著低于轻度组,差异均有统计学意义(P=0.025、P=0.049).重度组新生儿转儿科发生率显著高于轻度组[59(73.8％)比85(50.6％),P＜0.001].多因素分析表明,孕妇TBA水平与产后出血、胎膜早破、新生儿心肌损害、Ⅲ度羊水污染、早产与胎儿窘迫相关(P＜0.05),与死胎风险不相关(P=0.226).Pearson相关分析表明,孕妇产前最后一次TBA水平与新生儿TBA呈正相关(r=0.511,P=0.006).结论 TBA既是病情分度与病情诊断的指标,也是预测胎儿预后的指标.%Objective To evaluate the relationship between mother and child prognosis and the total TBA and serum TBA in women with intrahepatic cholestasis of pregnancy (ICP) and to confirm the correlation of TBA level of women with ICP with fetal prognosis.Methods 256 women with ICP were selected fromour hospital.According to the 2015 ICP guidelines of Chinese Medical Association,they were divided into a severe group (n=84) and a mild group (n=172).The levels of total bile acid,alanine aminotransferase,aspartate aminotransferase,γ-glutamyltransferase,alanine aminotransferase,and total bilirubin in the two groups were detected and compared.Logistic regression analysis was used to analyzed the correlation between TBA and maternal and child outcomes.Results The levels of total bile acid,alanine aminotransferase,aspartate aminotransferase,gamma-glutamine transaminase,and total bilirubin were significantly higher in the severe group than in the mild group,with statistical differences (all P ＜ 0.001).The gestational age was significantly shorter in the severe group than in the mild group,with a statistical difference (P=0.003).The incidence of Ⅲ degree anniotic fluid pollution significantly higher in the severe group than in the mild group [25 (29.8％) vs.27 (15.7％)],with a statistical difference (/=0.009).The 1 and 5 min Apgar scores of the neonates in the severe group were significantly lower than those in the mild group (P =0.025 and P =0.049).More neonates were transferred to the department of pediatrics in the severe group than in the mild group [59 (73.8％) vs 85 (50.6％),P ＜0.001].Multivariate analysis showed that the pregnant women's level of TBA correlated with postpartum hemorrhage,premature rupture of membranes,neonatal myocardial damage,Ⅲ degree amniotic fluid pollution,premature birth,and fetal distress (P ＜0.05) but not with stillbirth risk (P=0.226).Pearson correlation analysis showed that the final TBA level in prenatal women positively correlated with neonatal TBA (r=0.511,P=0.006).Conclusion TBA is the disease severity indicator and the disease diagnosis indicator and also predicts the fetuses' prognosis.