肝内胆汁淤积症孕妇总胆汁酸水平与妊娠不良结局的相关性分析  

Correlation between total Bile Acid Level and adverse Pregnancy Outcome in pregnant Women with intrahepatic Cholestasis

作　　者：王萍 WANG Ping(Department of Obstetrics and Gynecology,Sui Country people's Hospital,Shangqiu Henan 476900,China)

机构地区：[1]睢县人民医院妇产科,河南商丘476900

出　　处：《临床研究》2022年第8期23-26,共4页Clinical Research

摘　　要：目的探究血清总胆汁酸(TBA)水平在预测妊娠期肝内胆汁淤积症(ICP)产妇和围生儿的不良妊娠结局中的应用价值。方法研究对象选取为2019年9月至2021年3月在睢县人民医院分娩的ICP孕妇77例,按照ICP孕妇的TBA水平进行分组,分为低水平组(TBA<40μmol/L)42例和高水平组(TBA≥40μmol/L)35例,对比两组ICP孕妇肝功能[总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)]、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)]。活化部分凝血活酶时间(APTT]、不妊娠良结局及两组围生儿的不良结局,采用Spearman模型分析血清TBA与ICP孕妇不良妊娠结局和围生儿不良结局相关性,并绘制受试者工作特征(ROC)曲线评价血清TBA分别对母婴不良结局预测价值。结果高水平组ICP孕妇TBA、TBIL、ALT、AST、APTT、TT、FIB明显高于低水平组,差异有统计学意义(P<0.05);而两组ICP孕妇的PT水平对比,差异无统计学意义(P>0.05)。高水平组ICP孕妇的死胎、剖宫产、产后出血发生率显著高于低水平组,两组对比,差异有统计学意义(P<0.05);高水平组围生儿宫内窘迫、新生儿呼吸窘迫综合征发生率显著高于低水平组,两组对比,差异有统计学意义(P<0.05)。Spearman相关性分析结果显示,血清TBA与ICP孕妇不良妊娠结局和围生儿不良结局相关性均为正相关,差异有统计学意义(P<0.05)。ROC曲线分析结果显示:血清TBA预测ICP孕妇不良妊娠结局ROC曲线下面积为0.866[95%CI(0.785,0.946)],预测临界值为32.95μmol/L,敏感度为86.10%,特异度为75.60%;血清TBA预测围生儿不良结局ROC曲线下面积为0.927[95%CI(0.871,0.984)],预测临界值为41.70μmol/L,敏感度为79.50%,特异度为92.10%。结论血清TBA水平在预测ICP产妇和围生儿的不良妊娠结局中有一定的临床应用价值,临床应当重视孕妇的血清TBA水平并积极治疗,减少Objective To explore the value of serum total bile acid(TBA)level in predicting the adverse pregnancy outcomes of pregnant women and perinatal infants with intrahepatic cholestasis of pregnancy(ICP).Methods A total of 77 pregnant women with ICP who delivered in Sui Country people's Hospital from September 2019 to March 2021 were selected for the study.They were divided into low-level group(TBA<40μmol/L,42 cases)and high-level group(TBA≥40μmol/L)according to the TBA level of ICP pregnant women,Liver function[total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST)],coagulation function indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)],adverse pregnancy outcomes and adverse perinatal outcomes were compared between the two groups.Adverse pregnancy outcomes and adverse perinatal outcomes in the two groups were analyzed by Spearman model.and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum TBA for adverse maternal and infant outcomes respectively.Results TBA,TBIL,ALT,AST,APTT,TT,FIB in ICP pregnant women with high-level group were significantly higher than those in low-level group(P<0.05);There was no significant difference in PT levels between the two groups of ICP pregnant women(P>0.05).The incidence of stillbirth,cesarean section and postpartum hemorrhage of ICP pregnant women in the high-level group was significantly higher than that in the low-level group,the difference between the two groups was statistically significant(P<0.05);The incidence of perinatal intrauterine distress and neonatal respiratory distress syndrome in the high-level group was significantly higher than that in the low-level group,there was significant difference between the two groups(P<0.05).Spearman correlation analysis showed that serum TBA was positively correlated with adverse pregnancy outcomes of ICP pregnant women and adverse perinatal outcomes,and the difference was statistically significant(P<0.

关 键 词：肝内胆汁淤积症 妊娠 总胆汁酸 妊娠结局 围生儿结局 

分 类 号：R714.25[医药卫生—妇产科学]