Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy with dichorionic diamniotic twin pregnancies
Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy with dichorionic diamniotic twin pregnancies
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DOI：
10.1080/14767058.2017.1384461
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发表时间：
2019-02-01
影响因子：
1.8
通讯作者：
He, Li
中科院分区：
文献类型：
--
作者：
Mei, Youwen;Gao, Lan;He, Li
目的：我们研究的目的是探讨妊娠期肝内胆汁淤积（ICP）伴双绒毛膜双羊膜（DCDA）双胎妊娠不良围产期结局的预测因素。方法：本研究对成都市妇女儿童中心医院诊断为ICP和DCDA双胎妊娠的妇女进行回顾性研究。根据总胆汁酸（TBA）水平将这些患者分为轻度和重度ICP组。收集并比较两组的临床特征和围产期结局。逻辑回归分析的目的是评估不良围产期结局的预测因素。结果：研究纳入约134例。轻度ICP组84例，重度ICP组50例。重度ICP组丙氨酸转氨酶（ALT）、天门冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）、总胆红素（TBIL）、直接胆红素（DBIL）水平显着高于轻度ICP组。重度ICP组的孕34周前分娩率、羊水胎粪污染率以及新生儿综合不良结局均高于轻度ICP组。调整混杂因素后，ICP 起始孕龄 (GA) 200U/l 与分娩时 GA 400U/l 相关，是胎粪染色羊水的独立危险因素。 ICP 起始 GA 结论：ICP 起始 GA 40 μmol/l、AST >200U/l 和 ALP >400U/l 与 ICP 伴 DCDA 双胎妊娠的复合不良围产期结局相关。对于具有这些特征的患者，应加强胎儿监测和治疗。
Objective: The aim of our study was to investigate the predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP) with dichorionic diamniotic (DCDA) twin pregnancies. Methods: This study was a retrospective study of women diagnosed with ICP and DCDA twin pregnancies in Chengdu's women and children's central hospital. These patients were subdivided into mild and severe ICP groups according to total bile acid (TBA) level. The clinical characteristics and perinatal outcomes were collected and compared between the two groups. Logistic regression analysis was developed to evaluate predictors of adverse perinatal outcomes. Results: About 134 cases were included in the study. Eighty-four cases were in the mild ICP group, and the other 50 cases were in the severe ICP group. Level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL), and direct bilirubin (DBIL) in the severe ICP group were significant higher than those in the mild ICP group. The rate of delivery before 34 gestational weeks, meconium-stained amniotic fluid, and composite adverse neonatal outcome were higher in the severe ICP group than those in the mild ICP group. After adjusting for confounders, ICP onset gestational age (GA) 200U/l were associated with GA at delivery 400U/l was an independent risk factor of meconium-stained amniotic fluid. ICP onset GA Conclusion: ICP onset GA 40 mu mol/l, AST >200U/l, and ALP >400U/l were associated with composite adverse perinatal outcomes in ICP with DCDA twin pregnancies. For those patients with these characteristics, fetal surveillance and treatment should be enhanced.