摘要
目的探究妊娠期肝内胆汁淤积症(ICP)产妇产前总胆汁酸(TBA)水平、胎儿头围与产后母婴结局的相关性。方法选择2018年1~12月在上海市松江区妇幼保健院妇产科正规产检并分娩的120例单胎ICP产妇作为观察组,以同期120例正常单胎妊娠产妇作为对照组。根据病情严重程度将观察组产妇分为轻度组68例、重度组44例和极重度组8例。采用酶循环法检测产前TBA水平,采用超声测量胎儿头围。Spearman秩检验分析母体和胎儿TBA水平间的相关性;采用Logistic回归分析不良母婴结局的预测因素。结果极重度组和重度组产妇使用药物比例明显高于轻度组产妇,差异均有统计学意义(P<0.05);TBA、天冬氨酸转氨酶、丙氨酸转氨酶、碱性磷酸酶、总胆红素水平随着ICP病情严重程度的增加而上升,两两比较差异均有统计学意义(P<0.05);与对照组比较,极重度组产妇的新生儿体质量较轻,选择性剖腹产、早产、胎粪污染、产后出血、围产期死亡比例较高,差异均有统计学意义(P<0.05);极重度组产妇产后出血比例高于轻度组,新生儿体质量和早产、胎粪污染比例明显低于重度组,差异均有统计学意义(P<0.05);分娩时产妇TBA水平由高至低为极重度组、重度组、轻度组、对照组,胎儿头围由大到小为对照组、轻度组、重度组、极重度组,两两比较差异均有统计学意义(P<0.05);Spearman秩相关性分析结果显示,最高测量的母体TBA和脐带TBA间、产妇分娩时TBA和脐带TBA间存在显著正相关(r=0.452、0.432,P<0.05);Logistic回归结果显示,TBA是影响自发性早产、围产期死亡及胎粪污染的独立危险因素(P<0.05)。结论ICP产妇产前TBA水平、胎儿头围与产后母婴结局相关。
Objective To explore the correlation of prenatal total bile acid(TBA)level,fetal head circumference and postpartum maternal and infant outcomes in pregnant women with intrahepatic cholestasis of pregnancy(ICP).Methods A total of 120 singleton ICP parturients with normal birth examination and delivery in Department of Gynecology and Obstetrics,Shanghai Songjiang Maternal and Child Health Hospital from Jan.2018 to Dec.2018 were selected as the observation group,and 120 normal single pregnant women in the same period served as control group.According to the severity of the disease,the observation group was divided into mild group(68 cases),severe group(44 cases),and extremely severe group(8 cases).Enzyme circulation method was used to detect the level of prenatal TBA,and ultrasound was used to measure the fetal head circumference.Spearman test was used to analyze the correlation between maternal and fetal TBA levels.Logistic regression was used to analyze the predictive factors of adverse maternal and infant outcomes.Results The proportion of drug use in extremely severe group and severe group was significantly higher than that in mild group(P<0.05).TBA,aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,and total bilirubin increased with the severity of ICP,and the differences were statistically significant(P<0.05).Compared with the control group,the neonatal weight of the extremely severe group was lighter,and the proportion of selective caesarean section,premature delivery,meconium contamination,postpartum hemorrhage and perinatal death was higher,with statistically significant differences(P<0.05).The proportion of postpartum hemorrhage in severe group was higher than that in mild group,and the proportion of neonatal weight,premature delivery,and meconium contamination in severe group was significantly lower than that in severe group(P<0.05).The levels of TBA in parturient women at delivery from high to low were extremely severe group,severe group,mild group and control group,and the fetal head circumference from large to small were control group,mild group,severe group and extremely severe group,with statistically significant differences(P<0.05).Spearman rank correlation analysis showed that there was a significant positive correlation between maternal TBA and umbilical TBA,and between maternal TBA and umbilical TBA at delivery(r=0.452,0.432,P<0.05).Logistic regression showed that TBA was an independent risk factor for spontaneous preterm birth,perinatal death and meconium contamination(P<0.05).Conclusion The level of TBA and fetal head circumference were related to maternal and infant outcomes.
作者
黄方
张辉
冯小月
HUANG Fang;ZHANG Hui;FENG Xiao-yue(Department of Gynecology and Obstetrics,Shanghai Songjiang Maternal and Child Health Hospital,Shanghai 201600,CHINA)
出处
《海南医学》
CAS
2021年第12期1560-1564,共5页
Hainan Medical Journal
基金
上海市松江区科学技术攻关项目(编号:19STKJGG59)。
关键词
妊娠期肝内胆汁淤积症
总胆汁酸
胎儿头围
母婴结局
围产儿
Intrahepatic cholestasis of pregnancy
Total bile acid
Fetal head circumference
Maternal and child outcomes
Perinatal infant
