妊娠合并肝脏疾病237例临床分析  

Clinical analysis of 237 cases of pregnant women with liver diseases

作　　者：陈艳红[1] 李凯铭 张乐鸿 陈子恩 闻琦 刘养奇 张春芳[1] CHEN Yanhong;LI Kaiming;ZHANG Lehong;CHEN Zien;WEN Qi;LIU Yangqi;ZHANG Chunfang(The Third Affiliated Hospital of Guangzhou Medical University,Guangdong Guangzhou 510150,China;The Third Clinical School of Guangzhou Medical University,Guangdong Guangzhou 510182,China)

机构地区：[1]广州医科大学附属第三医院,广东广州510150 [2]广州医科大学第三临床学院,广东广州510182

出　　处：《中国妇幼健康研究》2020年第10期1393-1399,共7页Chinese Journal of Woman and Child Health Research

基　　金：广东省临床教学基地教学改革研究资助项目(2018JD033);广州医科大学教育科学规划课题资助项目(20180101)。

摘　　要：目的探讨妊娠合并肝脏疾病对孕产妇及围产儿结局的影响。方法对2017年1月1日至2018年12月31日在广州医科大学附属第三医院住院并分娩的237例妊娠合并肝脏疾病孕产妇的临床资料进行回顾性分析,比较不同类型的肝脏疾病对孕产妇及围产儿的影响。结果237例妊娠合并肝脏疾孕产妇中,妊娠期肝内胆汁淤积症(ICP)150例,占63.29%;妊娠期急性脂肪肝(AFLP)56例,占23.63%;妊娠期合并乙型肝炎23例,占9.70%;妊娠合并自身免疫性肝炎(AIH)2例,占0.84%;其他肝病6例,占2.53%。ICP、AFLP、妊娠合并乙型肝炎、妊娠合并AIH、妊娠合并其他肝脏疾病孕产妇的不定期产检率、剖宫产率、转重症监护病房(ICU)率比较差异均有统计学意义(χ^2值分别为11.496、14.624、45.549,均P<0.05),其中AFLP的剖宫产率、转ICU率最高,分别为80.36%、37.50%,其次是妊娠合并乙型肝炎,分别为78.26%、17.39%。妊娠合并不同肝脏疾病孕妇的新生儿出生体重、1min Apgar评分、抢救率、转新生儿重症监护病房(NICU)率比较差异均有统计学意义(F/χ^2值分别为2.611、3.156、14.070、16.967,均P<0.05),其中AFLP的新生儿抢救率、转NICU率较高,分别为26.56%、43.75%,其次是妊娠合并乙型肝炎,分别为22.22%、44.44%。结论AFLP、妊娠合并乙型肝炎、ICP的孕产妇剖宫产率均高;AFLP、妊娠合并乙型肝炎孕产妇的转ICU率、新生儿抢救率和转NICU率均高。需加强对妊娠合并肝脏疾病孕产妇的母胎监护,早期识别与诊治,降低不良妊娠结局的发生率,改善母儿预后。Objective To investigate how liver diseases affect the maternal outcomes and neonatal outcomes.Methods The clinical data of 237 pregnant women with liver diseases who were hospitalized and delivered in the Third Affiliated Hospital of Guangzhou Medical University from January 1,2017 to December 31,2018 were retrospectively analyzed.The effects of different types of liver diseases on pregnant women and perinatal children were compared.Results Among 237 pregnant women with liver disease,150(63.29%)cases were intrahepatic cholestasis(ICP)of pregnancy;56(23.63%)cases were acute fatty liver(AFLP)of pregnancy;23(9.70%)cases were hepatitis B during pregnancy;2(0.84%)cases were pregnancy complicated with autoimmune hepatitis(AIH);and 6(2.53%)cases were other liver diseases.There were significant differences in irregular check-up,cesarean section rate and intensive care unit(ICU)rate among pregnant women with hepatic diseases such as ICP,AFLP,pregnant women with hepatitis B,pregnant women with AIH and other liver diseases(χ^2=11.496,14.624 and 45.549,respectively,all P<0.05).Among them,AFLP had the highest rates of cesarean section and transfer to ICU,80.36%and 37.50%,respectively,followed by pregnancy with hepatitis B,78.26%and 17.39%,respectively.There were significant differences in birth weight,1 min Apgar score,salvage rate and transfer rate to neonatal intensive care unit(NICU)(χ^2=2.611,3.156,14.070 and 16.967,respectively,all P<0.05).Among them,AFLP had the highest rates of neonatal rescue and the transfer to NICU,26.56%and 43.75%,respectively,followed by pregnancy with hepatitis B,22.22%and 44.44%,respectively.Conclusion The cesarean section rate of AFLP,chronic viral hepatitis B,ICP were all high.The ICU transfer rate,neonatal rescue rate and NICU transfer rate of AFLP,pregnancy with chronic viral hepatitis B were all high.It is necessary to strengthen the maternal and fetal monitoring of pregnant women with liver diseases.Early recognition and diagnosis and treatment can reduce adverse pregnancy outcomes and

关 键 词：妊娠 妊娠期肝内胆汁淤积症 妊娠期急性脂肪肝 妊娠合并病毒性肝炎 自身免疫性肝炎 围产儿结局 

分 类 号：R714.255[医药卫生—妇产科学]