1. 广州医科大学消化病研究所//广州医科大学附属第六医院//清远市人民医院消化内科,广东,清远,511518
2. 中山大学附属第三医院产科,广东,广州,510630
网络首发:2020-03-25,
纸质出版:2020
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刘东连, 邱素苈, 许成芳, 等. 妊娠晚期肝损害影响孕产妇预后的因素[J]. 中山大学学报(医学科学版), 2020,41(2).
LIU Dong-lian, QIU Su-li, XU Cheng-fang, et al. Factors Affecting the Prognosis of Women with Liver Dysfunction in the Third Trimester of Pregnancy[J]. Journal of Sun Yat-sen University (Medical Sciences), 2020, 41(2).
【目的】探讨妊娠晚期肝损害对孕产妇结局的影响,分析影响孕产妇预后的因素。【方法】收集中山大学附属第三医院2005年1月到2018年12月间收治的妊娠晚期肝损害患者(1113例)及正常妊娠组(1113例)的临床资料,比较病例组与对照组之间剖宫产、早产、胎盘早剥、产后出血、孕产妇死亡率的差异,并对病例组的临床资料进行单因素及多因素分析,应用Logistic回归分析影响预后的因素。采用受试者工作特征(ROC)曲线分析各个独立危险因素对肝损害孕产妇死亡的预测价值。【结果】病例组的剖宫产率、早产率、胎盘早剥发生率、产后出血发生率均高于正常对照组(<0.05),OR值分别为3.59、7.81、10.68和2.93;病例组孕产妇死亡率(1.2%)高于对照组(0.0%)(<0.05)。Logistic回归分析结果显示,高总胆红素(TBIL)、低凝血酶原活动度(PTA)、低空腹血糖(FPG)是影响肝功能损害的孕产妇死亡的独立危险因素。ROC曲线分析结果显示,当TBIL为235.4μmol/L时,约登指数最大(0.331),对应的灵敏度为0.818,特异度为0.513;当PTA为20.5%时,约登指数最大(0.366),对应的灵敏度为0.821,特异度为0.545;当FPG为3.11mmol/L时,约登指数最大(0.405),对应的灵敏度为0.769,特异度为0.636。【结论】妊娠晚期肝损害对孕产妇结局有不良影响,TBIL、PTA、FPG与孕产妇死亡风险相关,其对孕产妇死亡具有一定的预测价值。
【Objective】To explore the effects of liver dysfunction in the third trimester of pregnancy on maternal outcomes and identify the factors affecting the maternal prognosis.【Methods】We collected the clinical data of 1 113 women with liver dysfunction in the third trimester of pregnancy (case group) and 1 113 normal pregnancies (control group) from the Third Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2018. We compared the rates of cesarean section,premature delivery,placental abruption,postpartum hemorrhage and maternal mortality in the two groups,conducted the univariate and multivariate analysis for the case group and determined the prognostic risk factors by using Logistic regression. Receiver operating characteristic(ROC)curve analysis was applied to estimate the value of each independent risk factor for predicting liver dysfunction-related maternal mortality. 【Results】The rates of cesarean section,premature delivery,placental abruption,postpartum hemorrhage in the case group were higher than those in the control group(< 0.05),and the odds ratios(ORs)were 3.59 ,7.81 ,10.68 and 2.93 ,respectively. The maternal mortality in the case group(1.2%)was higher than that in the control group(0.0%)(< 0.05). Logistic analysis revealed that high total bilirubin(TBIL),low prothrombin activity(PTA)and low fasting plasma glucose(FPG)were independent risk factors for liver dysfunction- related maternal mortality. The ROC curve analysis indicated that when TBIL was 235.4 μmol/L,the Youden′ s index in maximum was 0.331 with sensitivity of 0.818 and specificity of 0.513. When PTA was 20.5% ,the Youden′ s index in maximum was 0.366 with sensitivity of 0.821 and specificity of 0.545. When FPG was 3.11 mmol/L,the Youden′s index in maximum was 0.405 with sensitivity of 0.769 and specificity of 0.636.【Conclusion】Liver dysfunction in the third trimester of pregnancy has adverse effects on maternal outcomes. TBIL ,PTA and FPG are the factors affecting the maternal prognosis and may have certain predictive value for maternal death.
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