Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid
Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid
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DOI：
10.1371/journal.pone.0176504
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发表时间：
2017-04-24
期刊：
影响因子：
3.7
通讯作者：
Macias, Rocio I. R.
中科院分区：
文献类型：
--
作者：
Estiu, Maria C.;Frailuna, Maria A.;Macias, Rocio I. R.
妊娠期肝内胆汁淤积症（Intrahepatic Cholestasis of Pregnancy，ICP）是妊娠期最常见的肝脏疾病.不良胎儿结局的风险与诊断后母亲高胆血症的严重程度有关。目的探讨高胆血症的严重程度和发病时间与羊水粪染（MSAF）和不良新生儿事件的风险之间是否存在关系。研究设计2009年6月至2013年12月期间，根据诊断时高胆血症的严重程度将患者分为三组：轻度（10-19.9 μ mol/L）、中度（20-39.9 μ mol/L）和重度（>= 40 μ mol/L）。他们的临床特点和妊娠结局进行了调查，在一个前瞻性的观察study.ResultsHigher风险MSAF时，观察ICP出现在妊娠早期或高胆血症时更严重。考虑到这两个参数，定义了MSAF风险因子（MRF）。基于阳性/阴性预测值模型，选择MRF = 3的临界点，其优先考虑灵敏度与特异性。在MRF>3的ICP患者中，MSAF的概率增加4倍。MSAF的频率增加也与较高的血清水平在诊断丙氨酸转氨酶，碱性磷酸酶和直接bilirubin.ConclusionsThe风险MSAF不仅与高胆血症的诊断，但也与孕早期发病的母亲血清胆汁酸的幅度。
BackgroundIntrahepatic cholestasis of pregnancy (ICP) is the commonest gestational liver disease. The risk of adverse fetal outcome has been associated with the severity of maternal hypercholanemia after diagnosis.ObjectiveTo investigate whether there is a relationship between the severity and timing of onset of hypercholanemia and the risk of meconium-stained amniotic fluid (MSAF) and adverse neonatal events.Study designThe study included 382 pregnancies complicated by ICP managed at a referral hospital in Buenos Aires (Argentina) between June 2009 and December 2013. The patients were classified into three groups according to the severity of hypercholanemia at diagnosis; mild (10-19.9 mu mol/L), moderate (20-39.9 mu mol/L) and severe (>= 40 mu mol/L). Their clinical characteristics and pregnancy outcomes were investigated in a prospective observational study.ResultsHigher risk of MSAF was observed when ICP appeared early in gestation or when hypercholanemia was more severe. Taking both parameters into account an MSAF risk factor (MRF) was defined. Based on a model of positive/negative predictive values, a cut-off point of MRF = 3 was selected, which prioritized sensitivity versus specificity. In ICP patients with MRF>3, the probability of MSAF was enhanced 4-fold. An increase in the frequency of MSAF was also associated with higher serum levels at diagnosis of alanine transaminase, alkaline phosphatase and direct bilirubin.ConclusionsThe risk of MSAF is associated not only with the magnitude of hypercholanemia at diagnosis but also with the early gestational onset of raised maternal serum bile acids.