Predictive factors associated with disease recurrence in patients with severe intrahepatic cholestasis of pregnancy: a retrospective study of 118 cases

To compare the clinical characteristics of pregnant women and perinatal outcomes with or without recurrent severe intrahepatic cholestasis of pregnancy (sICP), and identify possible factors associated with disease recurrence. A retrospective study of 164,603 deliveries was performed to identify pregnant women diagnosed with sICP in the previous pregnancy from January 2012 to December 2020. Eligible patients were divided into two subgroups according to the status of disease recurrence in the second pregnancy: recurrent severe ICP (r-sICP) and non-recurrent severe ICP (nr-sICP). Demographics, clinical characteristics, maternal and perinatal outcomes, and potential factors linked to disease recurrence were analyzed. Totally 118 patients were enrolled and respectively classified into the r-sICP group (<i>n</i> = 63) and the nr-sICP group (<i>n</i> = 55). The proportion of hepatitis B virus (HBV) infection (HBsAg+, HBeAg+, HBcAb+) and early-onset ICP (&lt;28 weeks) in the r-sICP group in the previous pregnancy were higher than those in the nr-sICP group. In the second delivery, neonatal outcomes in the r-sICP group were worse than those in the nr-sICP group. Logistic regression analysis of predictive factors for disease recurrence in the second delivery revealed that the combination of HBV infection and early-onset ICP in the previous delivery had the steepest receiver–operating characteristic (ROC) curve value 0.720 (95%CI: 0.629–0.812). Patients with sICP displayed a higher recurrence rate in the second pregnancy. Being &lt;28 weeks at the time of ICP diagnosis and having HBV infection in the previous delivery appear to be independent predictive factors for disease recurrence of sICP.

本研究旨在对比复发性与非复发性重度妊娠肝内胆汁淤积症（severe intrahepatic cholestasis of pregnancy, sICP）孕妇的临床特征及围生结局，并探寻与疾病复发相关的潜在危险因素。
本研究纳入2012年1月至2020年12月期间的164603例分娩案例，以筛选出既往妊娠期间确诊为重度妊娠肝内胆汁淤积症（sICP）的孕妇。
符合纳入标准的研究对象根据其第二次妊娠时的疾病复发情况分为两个亚组：复发性重度妊娠肝内胆汁淤积症（recurrent severe intrahepatic cholestasis of pregnancy, r-sICP）组与非复发性重度妊娠肝内胆汁淤积症（non-recurrent severe intrahepatic cholestasis of pregnancy, nr-sICP）组。
本研究对两组孕妇的人口学特征、临床特征、母儿围生结局以及与疾病复发相关的潜在危险因素进行了分析。
最终共有118例孕妇纳入本研究，其中复发性重度妊娠肝内胆汁淤积症组63例，非复发性重度妊娠肝内胆汁淤积症组55例。
既往妊娠期间，复发性重度妊娠肝内胆汁淤积症组孕妇的乙型肝炎病毒（hepatitis B virus, HBV）感染率（HBsAg阳性、HBeAg阳性、HBcAb阳性）以及早发性妊娠肝内胆汁淤积症（发病孕周<28周）占比均高于非复发性组。
在第二次分娩时，复发性重度妊娠肝内胆汁淤积症组的新生儿结局较非复发性组更差。
针对第二次分娩时疾病复发的预测危险因素进行Logistic回归分析结果显示，既往妊娠合并乙型肝炎病毒感染与早发性妊娠肝内胆汁淤积症的联合预测效能最优，其受试者工作特征（receiver–operating characteristic, ROC）曲线下面积为0.720（95%置信区间：0.629~0.812）。
既往确诊为重度妊娠肝内胆汁淤积症的孕妇，其第二次妊娠时的疾病复发率更高。
既往妊娠期间确诊妊娠肝内胆汁淤积症时孕周<28周以及合并乙型肝炎病毒感染，是重度妊娠肝内胆汁淤积症复发的独立预测危险因素。