Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy
Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy
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DOI：
10.1002/hep.20534
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发表时间：
2005-02-01
期刊：
影响因子：
13.5
通讯作者：
Lee, SP
中科院分区：
文献类型：
--
作者：
Ko, CW;Beresford, SAA;Lee, SP
胆结石与女性的生育率较高密切相关。这项研究前瞻性地评估了陆军医疗中心 3,254 名妇女在怀孕期间和产后胆泥和结石的发病率、自然史和危险因素。先前接受过胆囊切除术或在第一次研究超声检查时患有结石的女性被排除在外。在每个孕期和产后 4 至 6 周进行胆囊超声检查和受试者问卷调查。在妊娠 26 至 28 周时测量血清葡萄糖、血脂、胰岛素、瘦素、雌二醇和黄体酮。进行了一项巢式病例对照研究，以检查血清瘦素和胰岛素对胆囊疾病的影响。至少有 3,254 名女性接受了两次超声波研究。至少在一项超声波研究中发现淤泥或结石的比例在孕中期为 5.1%，在孕晚期为 7.9%，在产后 4 至 6 周为 10.2%。淤泥和结石的消退很常见，4.2% 的产妇在产后超声检查中出现了新的淤泥或结石。 28 名女性 (0.8%) 在产后第一年内接受了胆囊切除术。孕前体重指数是发生胆囊疾病的有力预测因子 (P < .001)。即使在调整体重指数后，血清瘦素与胆囊疾病独立相关（每增加 1 ng/dL，优势比为 1.05；95% CI，1.01，1.11）。总之，胆囊淤泥和结石在怀孕和产后很常见，胆囊切除术通常在产后第一年内进行。孕前肥胖和血清瘦素是妊娠相关胆囊疾病的重要危险因素。
Gallstones are strongly associated with higher parity in women. This study prospectively assessed the incidence, natural history, and risk factors for biliary sludge and stones during pregnancy and the postpartum in 3,254 women at an army medical center. Women with a prior cholecystectomy or with stones at their first study ultrasound were excluded. Gallbladder ultrasound and subject questionnaires were obtained in each trimester and at 4 to 6 weeks postpartum. Serum glucose, lipids, insulin, leptin, estradiol, and progesterone were measured at 26 to 28 weeks' gestation. A nested case-control study was done to examine the effects of serum leptin and insulin on incident gallbladder disease. At least two study ultrasounds were available for 3,254 women. Sludge or stones had been found on at least one study ultrasound in 5.1% by the second trimester, 7.9% by the third trimester, and 10.2% by 4 to 6 weeks postpartum. Regression of sludge and stones was common, such that overall 4.2% had new sludge or stones on the postpartum ultrasound. Twenty-eight women (0.8%) underwent cholecystectomy within the first year postpartum. Prepregnancy body mass index was a strong predictor of incident gallbladder disease (P < .001). Serum leptin was independently associated with gallbladder disease (odds ratio per 1 ng/dL increase, 1.05; 95% CI, 1.01, 1.11), even after adjusting for body mass index. In conclusion, incident gallbladder sludge and stones are common in pregnancy and the postpartum, and cholecystectomy is frequently done within the first year postpartum. Prepregnancy obesity and serum leptin are strong risk factors for pregnancy-associated gallbladder disease.