IVF/ICSI助孕的ICP患者围产儿不良结局危险因素预测

目的通过探索辅助生殖技术获得妊娠并发孕期肝内胆汁淤积患者中围产儿不良结局的相关危险因素,为尽可能减少ART子代不良结局的发生提供依据。方法收集通过体外受精-胚胎移植和卵细胞浆内单精子注射助孕住院并发ICP的病例。回顾性分析2012年1月IVF/ICSI助孕的ICP患者围产儿不良结局危险因素预测2017年1月在我院79例患者的高危因素与围产儿不良结局之间的关系。经单因素Logistic回归分析筛选不良结局的相关因素,建立多因素Logistic回归模型来预测。结果单因素分析发现家庭年收入、既往ICP病史、诊断ICP孕周、熊去氧胆酸的使用、有无瘙痒症状、新生儿体重及出生时即刻血糖、妊娠合并、谷丙转氨酶、谷草转氨酶、胆汁酸、总胆红素、早产差异均有统计学意义(P0.05)。经多因素分析显示:新生儿出生即刻血糖、ALT、AST、TBiL与不良结局相关:新生儿血糖,OR=8.153,95%CI=2.267~29.318,P=0.001;ALT,OR=0.942,95%CI=0.900~0.987,P=0.011;AST,OR=0.934,95%CI=0.877~0.995,P=0.033;Tbi L,OR=0.948,95%CI=0.904~0.994,P=0.027。结论经校正混杂因素后,新生儿出生即刻血糖、谷丙转氨酶、谷草转氨酶、总胆红素为围生儿不良结局的危险因子,助孕相关因素不影响围产儿结局。

Prediction of risk factors for perinatal adverse outcomes in IVF / ICSI co-pregnant ICP patients

Objective To provide basis for minimizing the adverse outcome of ART offspring, through exploring the relevant risk factors of perinatal adverse outcomes in pregnant patients with intrahepatic cholestasis by assisted reproductive technology. Methods The cases of assisted reproduction inpatients complicated with ICP by in vitro fertilizationembryo transfer and intracytoplasmic sperm injection were collected. A retrospective analysis of 79 patients in our hospital from January 2012 to January 2017 was conducted to examine the association between risk factors and adverse outcomes in perinatal infants. Univariate Logistic regression analysis was used to screen the related factors of adverse outcomes, and the multivariate Logistic regression model was established to predict. Results Univariate analysis found that there were significant differences in family annual income, past history of ICP, diagnosis of ICP gestational age, use of ursodeoxycholic acid, with or without itching symptoms, weight of newborn, immediate glucose at birth, pregnancy complications, alanine aminotransferase, aspartate aminotransferase, bile acid, total bilirubin and preterm birth,differences were statistically significang(P<0.05). Multivariate analysis showed that: Newborn blood glucose immediately after birth, ALT, AST and TBiL were related to adverse outcomes: neonatal blood glucose, OR=8.153,95% CI=2.267-29.318, P=0.001; ALT,OR =0.942, 95% CI=0.900-0.987, P=0.011; AST, OR =0.934, 95% CI=0.877-0.995, 95% CI=0.904-0.994, P=0.027;TbiL,OR=0.948,95%CI=0.904-0.994,P=0.027. Conclusion Blood glucose immediately after birth, alanine aminotransferase, aspartate aminotransferase, and total bilirubin are risk factors for adverse outcomes in perinatal infants after adjustment for confounding factors. The pregnancy-related factors do not affect perinatal outcomes.