妊娠期无症状高胆汁酸血症的临床特点分析

A clinical analysis of asymptomatic hypercholanaemia of pregnancy

摘要:

目的：探讨妊娠期无症状高胆汁酸血症（asymptomatic hypercholanaemia of pregnancy，AHP）的临床特点并与妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）进行对比分析。方法：收集2015年7月至2018年4月重庆医科大学附属第一医院的94例AHP孕妇、257例ICP孕妇和284例正常孕妇的临床资料，并对其进行回顾性分析。结果：①早发型（<28周）AHP孕妇所占比例高于早发型ICP孕妇（44.7% vs. 13.2%，P<0.05）。②AHP组不良妊娠结局的发生率（28.7%）高于对照组（10.9%），低于ICP组（50.2%），差异有统计学意义（P<0.017）。③在ICP孕妇中，高水平血清总胆汁酸（total bile acid，TBA，TBA≥40 μmol/L）组医源性早产、自发性早产、羊水粪染、胎儿窘迫和转新生儿重症监护病房（neonatal intensive care unit，NICU）的发生率均高于低水平TBA（TBA<40 μmol/L）组（P<0.05）。而AHP孕妇的高水平TBA组与低水平TBA组比较，其不良妊娠结局均无统计学差异（P>0.05）。④在高水平TBA孕妇中，AHP孕妇医源性早产和转NICU发生率均明显低于ICP孕妇（P<0.05）；在低水平TBA孕妇中，AHP孕妇羊水粪染发生率明显低于ICP孕妇（P<0.05）。结论：AHP孕妇的临床特点不同于ICP孕妇，可增加不良妊娠结局风险。

Abstract:

Objective：To investigate the clinical characteristics of asymptomatic hypercholanaemia of pregnancy（AHP），and to compare them with those of intrahepatic cholestasis of pregnancy（ICP）. Methods：The clinical data were collected from 94 women with AHP，257 women with ICP，and 284 normal pregnant women admitted to the First Affiliated Hospital of Chongqing Medical University from July 2015 to April 2018；then the clinical data were analyzed retrospectively. Results：The proportion of women with early-onset（<28 weeks） AHP was significantly higher than that of women with early-onset ICP （44.7% vs. 13.2%，P<0.05）. The incidence rate of ad－verse pregnancy outcome in the AHP group was significantly higher than that in the control group，but was significantly lower than that in the ICP group（28.7%，10.9%，and 50.2%，respectively，P<0.017）. The ICP group with high serum total bile acid（TBA）（≥40 μmol/L） had significantly higher incidence rates of iatrogenic preterm labor，spontaneous preterm birth，amniotic fluid turbidity，fetal distress，and transfer to neonatal intensive care unit（NICU） compared with the ICP group with low TBA（<40 μmol/L）（P<0.05）. There were no significant differences in the incidence rates of adverse pregnancy outcomes between the AHP groups with high and low TBA（P>0.05）. The incidence rates of iatrogenic preterm labor and transfer to NICU were significantly lower in the AHP group with high TBA than in the ICP group with high TBA（P<0.05）；the incidence rate of amniotic fluid turbidity was significantly lower in the AHP group with low TBA than in the ICP group with low TBA（P<0.05）. Conclusion：The clinical characteristics of wom－en with AHP are different from those of women with ICP，which may increase the risk of adverse pregnancy outcome.