121例妊娠期肝內膽汁淤積癥的病例對照分析

[摘要]目的 探討妊娠期肝內膽汁淤積癥對圍產兒結局的影響。 方法 以2008年1～9月在我院住院分娩的121妊娠期肝內膽汁淤積產婦為研究對象，按照1︰1配對設定對照組，記錄兩組人口統計學特征、臨床診斷，追蹤分娩情況，分析兩組間圍產兒不良結局差異。 結果 ICP組與對照組產婦的戶籍、年齡、自評家庭經濟狀況、文化程度等人口統計學因素分布差異均無統計學意義（P>0.05）；兩組產婦胎兒性別、產后出血發生率、羊水過少、新生兒窒息發生率差異均無統計學意義（P>0.05）。ICP組產婦的胎膜早破發生率（10.7%）低于對照組（17.5%）；ICP組產婦的剖宮產率（81.8%）高于對照組（63.6%）；經配對t檢驗分析發現ICP組圍生兒出生體重（3 032.3±392.0）g低于對照組（3 222.3±469.6）g；圍生兒羊水糞污發生率（31.4%）高于對照組（15.7%），P<0.05。ICP產婦的血膽酸值與圍生兒孕周、出生體重均呈負相關關系（r=-0.435，P=0.000；r=-0.248，P=0.006），與剖宮產、早產均呈正相關關系（r=0.281，P=0.002；r=0.297，P=0.001）；與羊水糞污及窒息發生均無相關關系（P>0.05）。 結論 控制混雜因素的ICP產婦剖宮產、早產、羊水污染發生率均較高，且膽酸值的高低影響圍生兒結局。

[關鍵詞] 妊娠期肝內膽汁淤積癥；圍生兒；妊娠結局；羊水胎糞污染

[中圖分類號] R714.255 [文獻標識碼] A [文章編號] 2095-0616（2013）13-22-03

A case-control study on 121 cases of intrahepatic cholestasis of pregnancy

ZHANG Dongsheng

Department of Obstetrics，Anhui Maternal and Child Health Care Hospital，Hefei 230001，China

[Abstract] Objective To analyze the impact of intrahepatic cholestasis of pregnancy （ICP） on adverse perinatal outcomes. Methods 121 cases of intrahepatic cholestasis of pregnancy women who delivered from January to September 2008 in Anhui Province maternal and child health care hospital were selected as case group，121 normal cases were matched as control group. Socio-demographic data，clinical diagnosis information and delivery information were recordsed. Differences of main adverse perinatal outcomes were compared by statistic analysis between the two groups. Results There were no significant differences in socio-demographic information between ICP group and control group（P>0.05）. Also there were no significant difference of parity，fetal gender，postpartum hemorrhage，severe asphyxia between the two groups（P>0.05）. The rate of remature rupture of membranes in ICP group（10.7%） was lower than that in control group（17.5%）；the rate of caesarean delivery was 81.8% in ICP group，higher than that in control group （63.6%）；amniotic fluid pollution rate of ICP group（31.4%） was higher than that in control group （15.7%） ；birth weight in ICP group（3 032.3±392.0）g were lower than that in control group（3 222.3±469.6）g； These differences were all of statistical significance （P<0.05）. Correlation analysis for ICP groups manifested that the level of cholic acid negatively correlated with gestational age and birth weight（r=-0.435，P=0.000；r=-0.248，P=0.006），and positively correlated with caesarean delivery and premature （r=0.281，P=0.002；r=0.297，P=0.001）. Other outcomes were not found to be associated with the level of cholic acid （P>0.05 ）. Conclusion After controlling the confounding factors，ICP may have adverse effect on perinatal outcomes including high rates of caesarean delivery，premature and amniotic fluid pollution. Higher level the cholic acid may reflect the severity of the desease.

[Key words] Intrahepatic cholestasis of pregnancy； Perinatal infant；Pregnancy outcome；Meconium-stained amniotic fluid

妊娠期肝內膽汁淤積癥（ICP）是妊娠期特有并發癥之一，其臨床表現有皮膚瘙癢、黃疸，并以血清膽酸值增高為特異性指標。其主要影響是對圍生兒的不良結局影響，其中最嚴重的就是胎死宮內，隨著對ICP的重視，最近國內報道胎死宮內的極少，但其對圍生兒窒息、出生體重及孕周仍有不可忽視的影響。但臨床診斷的ICP患者其各自臨床表現及膽酸值不同，有些是合并有其他產科并發癥，如羊水過少。……