妊娠早期肝功能与分娩孕周和早产风险的关系  

Relationship between liver function in early pregnancy and gestational week of delivery and risk of preterm birth

作　　者：吴雅 蒲柳艳 黄满仙 沈娜 洪开听 黄烨 邱逸文 吴金华 WU Ya;PU Liu-yan;HUANG Man-xian;SHEN Na;HONG Kai-ting;HUANG Ye;QIU Yi-wen;WU Jin-hua(Zhoushan Women and Children Hospital,Zhoushan,Zhejiang 316000,China;不详)

机构地区：[1]舟山市妇女儿童医院,浙江舟山316000 [2]浙江大学公共卫生学院流行病学与卫生统计室

出　　处：《中国妇幼保健》2024年第1期1-6,共6页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科研基金项目(2021KY383,2023KY1304)。

摘　　要：目的探讨妊娠早期肝功能与分娩孕周和早产风险的关系,为妊娠早期合并肝功能异常的临床诊治提供理论依据。方法采用回顾性研究方法,选取2020年1月—2023年5月舟山市妇女儿童医院综合电子病历系统(EMRS)中符合纳入和排除标准的孕妇作为研究对象。采用4结点的限制性立方样条分析肝功能与分娩孕周和早产风险的关系,采用线性回归和二项logistic回归分析肝功能与分娩孕周和早产的关联。结果共纳入6088例孕妇,其中足月分娩孕妇5708例,占93.8%;早产孕妇380例,占6.2%。限制性立方样条曲线显示:γ-谷氨酰转移酶(GGT)水平与孕周之间存在非线性相关性(P<0.05),谷丙转氨酶(ALT)、天门冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)及胆汁酸(TBA)与孕周之间无显著非线性相关性(均P>0.05)。调整孕妇年龄、孕前体质量指数(BMI)、教育程度、孕次、产次、分娩方式、吸烟情况、饮酒情况及肝功能检测孕周等因素后,线性回归模型分析结果显示:与ALT正常的孕妇相比,ALT升高(ALT>45 U/L)的孕妇分娩孕周更短(β=-0.368,P<0.05),AST、GGT、ALP、TBA水平与孕周均无相关性(均P>0.05)。在限制性立方样条图中未观察到妊娠早期ALT、ALP及TBA与早产存在非线性关系,但AST和GGT与早产存在显著的剂量反应相关性(均P<0.05),当AST和GGT水平升高时,早产的风险显著增加。调整孕妇年龄、孕前BMI、教育程度、孕次、产次、分娩方式、吸烟情况、饮酒情况及肝功能检测孕周等因素后,二项logistic回归模型分析结果显示:与ALT为7~45 U/L的孕妇相比,ALT>45 U/L的孕妇早产风险增加1.09倍(OR=2.09,95%CI:1.43~2.98);与AST为13~40 U/L的孕妇相比,AST>40 U/L的孕妇早产风险增加1.34倍(OR=2.34,95%CI:1.34~3.88)。TBA、GGT及ALP与早产无相关性(均P>0.05)。结论妊娠早期肝功能水平异常孕妇可能是早产的高危群体,建议在围生保健监测过程中,加强对孕早期肝功能�Objective To explore the relationship between liver function in early pregnancy and gestational week of delivery and risk of preterm birth,and to provide theoretical basis for clinical diagnosis and treatment of liver function abnormalities in early pregnancy.Methods Pregnant women who met the inclusion criteria and exclusion criteria in the integrated electronic medical record system(EMRS)of Zhoushan Women and Children Hospital from January 2020 to May 2023 were selected as the study objects.A 4-node restricted cubic spline was used to analyze the relationship belween liver function and gestational age and the risk of preterm delivery.The linear regression and binomial logistic regression were used to analyze the association of liver function with gestational week and preterm birth.Results A total of 6088 pregnant women were included in the study,including 5708(93.8%)full-term delivery and 380(6.2%)preterm delivery.The restricted cubic spline curve showed that there was a nonlinear correlation between-glutamyltransferase(GGT)level and gestational age(P<0.05),but no significant nonlinear correlation between alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),bile acid(TBA)and gestational age(al P>0.05).Afier adjusting for pregnant women's age,pre-pregnancy body mass index(BMI),education level,pregnancy time,delivery time,method of delivery,smoking status,drinking status and gestational age detection of liver function,the linear regression model analysis results showed:Compared with pregnant women with normal ALT,pregnant women with elevated ALT(ALT>45 U/L)had shorter gestation weeks(β=-0.368,P<0.05),and there was no correlation between AST,GGT,ALP,TBA levels and gestation weeks(all P>0.05).No nonlinear relationship between ALT,ALP,TBA and preterm birth was observed in the restricted cubic spline plot,but there was a significant dose-response correlation between AST,CCT and preterm birth(all P<0.05).When AST and GCT levels were elevated,the risk of preterm birth was significant

关 键 词：妊娠 肝功能异常 早产 

分 类 号：R714.2[医药卫生—妇产科学]