Intrahepatic cholestasis of pregnancy:: Relationships between bile acid levels and fetal complication rates
Intrahepatic cholestasis of pregnancy:: Relationships between bile acid levels and fetal complication rates
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DOI：
10.1002/hep.20336
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发表时间：
2004-08-01
期刊：
影响因子：
13.5
通讯作者：
Mattsson, LÅ
中科院分区：
文献类型：
--
作者：
Glantz, A;Marschall, HW;Mattsson, LÅ
妊娠期肝内胆汁淤积症（ICP）的特征是妊娠后半段出现瘙痒，对胎儿的风险增加。本研究旨在确定ICP的发病率和胎儿并发症发生率，并确定风险增加的人群。在1999年2月1日至2002年1月31日进行的一项前瞻性队列研究中，对瑞典一个特定地区（Vastra Gotaland）的所有45，485例妊娠进行了ICP筛查，ICP定义为不明原因的妊娠瘙痒症，并伴有空腹血清胆汁酸水平大于或等于10 mumol/L。937例（2.1%）女性报告瘙痒，693例（1.5%）诊断为ICP。简单的逻辑回归分析显示，胎儿并发症（自发性早产、窒息事件和羊水、胎盘和胎膜的胎粪染色）的概率每增加mumol/L血清胆汁酸增加1%-2%。补充分析表明，胎儿并发症不会出现，直到胆汁酸水平大于或等于40 μ mol/L。胆结石病和ICP家族史显著（P = 40 μ mol/L）。在胆汁酸水平< 40 mumol/L的ICP患者中未检测到胎儿风险增加，我们建议对这些妇女进行预期管理，这将显著降低医疗费用。
Intrahepatic cholestasis of pregnancy (ICP), characterized by pruritus in the second half of pregnancy, entails an increased risk to the fetus. This study was designed to determine the incidence and fetal complication rates in ICP, and to define groups at increased risk. In an prospective cohort study conducted between February 1, 1999, and January 31, 2002, all 45,485 pregnancies in a defined region of Sweden (Vastra Gotaland) were screened for ICP, defined as otherwise unexplained pruritus of pregnancy in combination with fasting serum bile acid levels greater than or equal to10 mumol/L. Pruritus was reported by 937 (2.1%) women, and ICP was diagnosed in 693 (1.5%). Simple logistic regression analyses showed that the probability of fetal complications (spontaneous preterm deliveries, asphyxial events, and meconium staining of amniotic fluid, Placenta, and membranes) increased by 1%-2% per additional mumol/L of serum bile acids. Complementary analyses showed that fetal complications did not arise until bile acid levels were greater than or equal to40 mumol/L. Gallstone disease and a family history of ICP were significantly (P = 40 mu mol/L. No increase in fetal risk was detected in ICP patients with bile acid levels < 40 mumol/L, and we propose that these women be managed expectantly, which would significantly reduce the costs of medical care.