摘要
目的探讨双胎妊娠孕产妇并发肝内胆汁淤积症(ICP)危险因素并分析其临床特征。方法选择合肥市妇幼保健院妇产科2019年10月-2021年10月分娩的双胎妊娠孕产妇为研究对象,将孕产妇分为ICP组(n=37)和非ICP组(n=193);从非ICP组中随机抽取37例孕产妇,收集其总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)数据;统计胎儿预后。结果共37例发生ICP(16.09%);其中34例为轻度ICP,3例为重度ICP,ICP发生孕周<28周5例,28~32周7例,超过32周27例。单因素分析结果显示,双胎妊娠孕产妇发生ICP与个人或家族ICP史、孕前BMI以及孕期体质量增加有关(P<0.05);多元logistics回归分析结果显示,个人或家族ICP史、孕前BMI以及孕期体质量增加均为双胎妊娠孕产妇发生ICP的独立影响因素(P<0.05);ICP组胎儿窘迫(21.62%)、羊水粪染(13.51%)、早产(35.14%)和转入NICU(24.32%)发生率显著高于非ICP组(P<0.05);两组吸入性肺炎、新生儿死亡发生率比较差异无统计学意义(P>0.05);ICP组血清TBA[(23.49±12.91)μmol/L]、ALT[(71.01±61.04)U/L]、AST[(68.25±56.37)U/L]、TBil[(12.17±5.44)μmol/L]和LDL-C[(4.67±1.44)mmol/L]水平高于非ICP组,HDL-C水平[(1.77±0.39)mmol/L]低于非ICP组(P<0.05)。结论双胎妊娠孕产妇ICP发生率较高,其影响因素与ICP与个人或家族ICP史、孕前BMI以及孕期体质量增加有关,且并发ICP胎儿窘迫、羊水粪染、早产和转入NICU风险显著增加。
Objective To explore the risk factors of intrahepatic cholestasis(ICP)in twin pregnancies and analyze its clinical features.Methods In this study,twin-pregnancy women who delivered in the Department of Obstetrics and Gynecology at our hospital between October 2019 and October 2021 were recruited,and were divided into ICP group(n=37)and non-ICP group(n=193);In the ICP group,37 perinatal women were randomly selected,for data collection.The information on various biochemical markers including total bile acid(TBA),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)were recorded.Along with these data,the fetal prognosis for each case was also recorded.Results Out of the total subjects,37 cases(16.09%)had ICP;of these,34 cases were mild ICP,and 3 cases were severe,ICP occurrence was observed at different stages of gestation:5 cases before 28weeks,,7 cases between 28-32 weeks,and 25 cases beyond 32 weeks.Univariate analysis revealed that the incidence of ICP in pregnant women with twin pregnancies was significantly associated with a personal or family history of ICP,pre-pregnancy Body Mass Index(BMI)and weight gain during pregnancy(P<0.05).Moreover,weight gain was identified as an independent risk factor for ICP in twin pregnancies(P<0.05);The ICP group showed significantly higher rates of fetal distress(21.62%),meconium-stained amniotic fluid(13.51%),premature birth(35.14%)and transfer to the Neonatal Intensive Care UnitNICU(24.32%)compared to the non-ICP group(P<0.05).However,there was no significant difference in the incidence of aspiration pneumonia and neonatal death between the two groups(P>0.05);The levels of serum TBA(23.49±12.91μmol/L),ALT(71.01±61.04 U/L),AST(68.25±56.37 U/L),TBil(12.17±5.44μmol/L)and LDL-C(4.67±1.44 mmol/L)in the ICP group were elevated compared to the non-ICP group,Conversely,HDL-C level(1.77±0.39 mmol/L)was lower in the ICP group(P<0.05).Conclusion The incidence of ICP in women with twin pregnancies is notably high,Key influencing factors include a personal or family history of ICP,pre-pregnancy BMI,and increased weight gain during pregnancy.Additionally,the presence of ICP significantly elevates the risk of complications such as fetal distress,meconium-stained amniotic fluid,preterm birth and the need for transfer to the NICU.
作者
苏双艳
陈媛媛
陈先侠
SU Shuang-yan;CHEN Yuan-yuan;CHEN Xian-xia(Obstetrics of Emergency Center of Hefei Maternal and Child Health Hospital,Anhui 230000,China;Critical obstetric department of Hefei Maternal and Child Health Hospital,Anhui 230000,China)
出处
《肝脏》
2023年第8期973-976,982,共5页
Chinese Hepatology
基金
安徽省重点研究与开发计划项目(1804h08020295)。
关键词
双胎妊娠
孕产妇
肝内胆汁淤积症
危险因素
新生儿结局
Twin pregnancies
Pregnant women
Intrahepatic cholestasis
Risk factors
Neonatal outcome
