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目的探讨妊娠期肝内胆汁淤积症(ICP)合并妊娠期高血压疾病(HDCP)及妊娠期糖尿病(GDM)对妊娠结局的影响。方法选取2016年1-12月在常州市妇幼保健院住院分娩的212例ICP孕妇为ICP组,根据是否合并HDCP及GDM分为未合并组(不合并HDCP也不合并GDM)、单纯HDCP组(合并HDCP,不合并GDM)、单纯GDM组(合并GDM,不合并HDCP)、HDCP+GDM组(合并HDCP和GDM),随机抽取同期256例非ICP孕妇为对照组。比较两组孕妇一般情况、围产期结局、血清指标。结果两组分娩孕周、早产发生率、羊水Ⅱ度以上污染发生率、血清总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)水平比较差异均有统计学意义(均P<0. 05)。ICP组单纯HDCP及HDCP合并GDM发病率均明显高于对照组,差异均有统计学意义(均P<0. 05)。两组孕妇单纯GDM发病率比较差异无统计学意义(P>0. 05)。单纯HDCP组、HDCP+GDM组新生儿出生体质量及分娩孕周均低于未合并组,早产发生率、剖宫产率、血清ALT和AST水平均高于未合并组(均P<0. 05);单纯HDCP组、单纯GDM组血清TBA水平明显高于未合并组(均P<0. 05);单纯GDM组巨大儿发生率明显高于未合并组(P<0. 05);其他3组与未合并组新生儿性别、产后出血量、羊水Ⅱ度以上污染发生率比较差异均无统计学意义(均P>0. 05)。结论 ICP合并HDCP可导致孕妇不良妊娠结局。孕期应加强产检,及早发现ICP,尤其是合并HDCP及GDM的孕妇,密切关注孕妇妊娠情况,降低不良妊娠结局发生率,提高围生儿的出生质量。
Abstract：[1] Kawakita T,Parikh LI,Ramsey PS,et al. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy[J]. Am J Obstet Gynecol,2015,212(1):S295.
[2] Cui D,Zhong Y,Zhang L,et al. Bile acid levels and risk of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy:a metaanalysis[J]. J Obstet Gynaecol Res,2017,43(9):1411.
[3] Shemer EW,Marschall HU,Ludvigsson JF,et al. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes:a 12-year population-based cohort study[J]. BJOG,2013,120(6):717-723.
[4]彭华,何金兰,李梅.妊娠期肝内胆汁淤积症的临床特征及妊娠结局分析[J].中国妇幼保健,2017,32(23):5892-5894.
[5]贺晶,杨慧霞,段涛,等.妊娠期肝内胆汁淤积症诊疗指南(2015)[J].中华妇产科杂志,2015,31(7):481-485.
[6] Williamson C,Geenes V. Intrahepatic cholestasis of pregnancy[J].Obstet Gynecol,2014,124(1):120-133.
[7]聂敦利,徐雁飞,温磊.妊娠期肝内胆汁淤积合并糖尿病孕妇终止妊娠的时机及围产儿结局[J].西部医学,2016,28(5):698-701.
[8] Reyes H,Báez ME,González MC,et al. Selenium,zinc and copper plasma levels in intrahepatic cholestasis of pregnancy,in normal pregnancies and in healthy individuals, in Chile[J]. J Hepatol,2000,32(4):542-549.
[9]韦懿芸,庞丽红.妊娠期肝内胆汁淤积症90例临床分析[J].广东医学,2017,38(s1):167-169.
[10] Brouwers L,Koster MP,Page-Christiaens GC,et al. Intrahepatic cholestasis of pregnancy:maternal and fetal outcomes associated with elevated bile acid levels[J]. Am J Obstet Gynaecol,2015,212(1):e101-e100,e107
[11] Herrera CA,Manuck TA,Stoddard GJ,et al. Perinatal outcomes associated with intrahepatic cholestasis of pregnancy[J]. J Matern Fetal Neonatal Med,22018,31(14):1913-1920.
[12]杨海艳,胡敏,陈江鸿.妊娠期肝内胆汁淤积症孕妇的母儿结局及其影响因素分析[J].中华妇产科杂志,2016,51(7):535-537.
[13]洪喜萍.妊娠期肝内胆汁淤积症对围生儿不良结局的影响及高危因素分析[J].中国妇幼保健,2017,32(12):2574-2576.
[14] Raz Y,Lavie A,Vered Y,et al. Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies[J]. Am J Obstet Gynecol,2015,213(3):1-8.
[15] Martineau M,Raker C,Powrie R,et al. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes.[J]. Eur J Obstet Gynecol Reprod Biol,2014,176(1):80.
[16] Petry CJ,Ong KK,Dunger DB,et al. Age at menarche and the future risk of gestational diabetes:a systematic review and dose response meta-analysis[J]. Acta Diabetol, 2018, 55(12):1209-1219.
[17]陈鹏,史琳,杨红梅,等.妊娠期高血压、子痫前期及子痫与孕前和孕期体质量及其他因素的相关性研究[J].实用妇产科杂志,2017,33(11):848-852.
[18] Davison JM,Homuth V,Jeyabalan A,et al. New aspects in the pathophysiology of preeclampsia[J]. J Am Soc Nephrol,2016,15(9):2440.
[19] Phipps E,Prasanna D,Brima W,et al. Preeclampsia:updates in pathogenesis,definitions, and guidelines[J]. Clin J Am Soc Nephrol,2016,11(6):1102.
[20] Sweeting AN,Ross GP,Hyett J,et al. Gestational diabetes mellitus in early pregnancy:evidence for poor pregnancy outcomes despite treatment[J]. Diabetes Care,2016,39(1):75.
基本信息:
中图分类号:R714.255;R714.246
引用信息:
[1]詹爱丁,蒋国洪,孔成才.妊娠期肝内胆汁淤积症合并妊娠期高血压疾病及妊娠期糖尿病对妊娠结局的影响[J].中国妇幼保健,2019,34(18):4138-4141.
基金信息:
南京医科大学科技发展基金——面上项目(2016NJMU162)
2019-09-15
2019-09-15