文章摘要
葛星,徐叶清,黄三唤,黄锟,毛雷婧,潘维君,郝加虎,牛影,严双琴,陶芳标.妊娠期肝内胆汁淤积症对分娩结局影响的出生队列研究[J].中华流行病学杂志,2016,37(2):187-191
妊娠期肝内胆汁淤积症对分娩结局影响的出生队列研究
Intrahepatic cholestasis of pregnancy and fetal outcomes:a prospective birth cohort study
投稿时间:2015-06-19  
DOI:10.3760/cma.j.issn.0254-6450.2016.02.007
中文关键词: 妊娠期肝内胆汁淤积症;早产;低出生体重;胎儿窘迫;羊水粪染
英文关键词: Intrahepatic cholestasis of pregnancy;Preterm birth;Low birth weight;Fetal distress;Meconium-stained amniotic fluid
基金项目:国家自然科学基金(81330068,81373012);安徽医科大学博士科研项目(XJ201205)
作者单位E-mail
葛星 230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级重点实验室  
徐叶清 243000 安徽省马鞍山市妇幼保健院院部办公室  
黄三唤 230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级重点实验室  
黄锟 230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级重点实验室  
毛雷婧 230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级重点实验室  
潘维君 243000 安徽省马鞍山市妇幼保健院妇产科  
郝加虎 230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级重点实验室  
牛影 230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级重点实验室  
严双琴 243000 安徽省马鞍山市妇幼保健院保健部  
陶芳标 230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级重点实验室 fbtao@ahmu.edu.cn 
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中文摘要:
      目的 探讨孕中期和孕晚期妊娠期肝内胆汁淤积症(ICP)对分娩结局的影响。方法 在马鞍山市优生优育队列(MABC)中,将孕周≤14周、符合入组标准的孕妇共3 474人纳入队列,在首次产检时收集孕妇的一般人口学信息,并收集孕中期和孕晚期血清总胆汁酸(TBA)的检测结果,符合临床诊断的作为病例,采用logistic回归分析孕中期和孕晚期ICP对分娩结局的影响。结果 最终分析的样本人数为2 978人,ICP发生率为6.5%(n=196),其中孕中期和孕晚期ICP发生率分别为1.4%(n=43)和5.1%(n=153)。控制了潜在的混杂因素后,孕中期和孕晚期ICP均增加胎儿早产、低出生体重(LBW)、胎儿窘迫和羊水粪染的风险,OR值(95% CI)分别为6.42(2.59~15.93)和3.73(2.07~6.72);6.52(2.19~19.45)和4.90(2.43~9.90);2.91(1.27~6.67)和1.88(1.11~3.19);2.34(1.19~4.61)和1.66(1.11~2.48),并且孕中期ICP组发生上述不良分娩结局的风险远远高于孕晚期ICP组。结论 孕中期和孕晚期ICP均显著增加胎儿不良分娩结局的风险,孕中期ICP尤其值得关注,早期发现和干预对降低不良分娩结局的发生意义重大。
英文摘要:
      Objective To evaluate the relations between the second and third trimesters intrahepatic cholestasis of pregnancy(ICP) and the fetal outcomes, in order to provide medical advice for early detection and intervention on ICP.Methods A prospective cohort study was conducted in Ma'anshan, Anhui, China(Ma'anshan Birth Cohort, MABC).Pregnant women within 14 weeks of gestation were consecutively recruited when standards were met.Anthropometrics were collected in early pregnancy.Maternal serum total bile acid level(TBA) was collected in the second and third trimesters, and women were viewed as cases if the results were accorded with clinical diagnosis.Logistic regressions were conducted to examine the associations of the second and third trimester ICP, and fetal outcomes.Results A total of 2 978 pregnant women were included in this study.The rate of ICP was 6.5%(n=196), and the rates of the second and third trimesters were 1.4%(n=43) and 5.1%(n=153) respectively.After controlling for potential confounders, we found that ICP from both the second and third trimesters could increase the risks of preterm birth, low birth weight(LBW), fetal distress and meconium-stained amniotic fluid.OR values(95% CI) were 6.42(2.59-15.93) and 3.73(2.07-6.72) for preterm birth while 6.52(2.19-19.45) and 4.90(2.43-9.90) for LBW, 2.91(1.27-6.67) and 1.88(1.11-3.19) for fetal distress and 2.34(1.19-4.61) and 1.66(1.11-2.48) for meconium-stained amniotic fluids, respectively.The risk of adverse fetal outcomes caused by the second trimester ICP appeared significantly higher than the third trimester ICP.Conclusion ICP from the second and third trimesters significantly increased the risk of adverse fetal outcomes, suggesting that clinicians should put more attention to the second trimester ICP.Both early detection and intervention were of great importance in reducing the adverse fetal outcomes.
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