| Objectives This study retrospectively analyzed the family addresses of single center ICP patients in Lhasa region to understand whether the prevalence of ICP in Tibet Autonomous Region is the same at different altitudes,and whether there is a linear relationship between altitude and ICP prevalence.According to the ICP patients who have been diagnosed for nearly 10 years,other complications and complications are excluded,and the TBA and liver enzyme ALT and AST levels are grouped.After the grouping,the impact of different levels of TBA,liver enzyme ALT and AST on the perinatal outcome of pregnant and lying-in women who have been diagnosed with ICP is studied.Therefore,the TBA,liver enzyme ALT and AST levels of ICP patients are more strictly managed in clinical practice,hoping to greatly improve the perinatal outcome of ICP.Methods TA retrospective study was conducted on the medical records of 310 pregnant women who were hospitalized in the obstetric ward of the People’s Hospital of the Tibet Autonomous Region and had delivered during the period from January 1,2013 to July 31,2022,and on the medical records of 7652 pregnant women who were hospitalized in the obstetric ward of the People’s Hospital of the Tibet Autonomous Region and had delivered during the same period for nearly 10 years.The medical records were grouped according to their family address and altitude,To investigate whether there are differences in the prevalence of ICP among regions at different altitudes.According to the altitude of 74 districts,counties,and regions in Tibet,a total of 8 groups were divided,and the prevalence of ICP in each group was studied again to see if it was different.Finally,the ICP prevalence rate of each group was analyzed linearly with the average altitude of the corresponding group.At the same time,A retrospective and scientific analysis was conducted on the medical records of166 cases of single pregnancy who were hospitalized in the obstetric ward of the People’s Hospital of the Tibet Autonomous Region from January 1,2013 to July 31,2022 and had delivered,met the ICP diagnostic criteria,and had no other pregnancy complications and complications.They were divided into mild group(TBA ≥ 10umol/L<40 umol/L)and severe group(TBA ≥ 40 umol/L)according to the serum TBA concentration,respectively;Liverenzyme ALT concentration was divided into group A(normal range of ALT: 7U/L-40U/L),group B(40 < ALT < 100U/L),and group C(ALT ≥ 100U/L);Liver enzyme AST concentration was divided into group I(AST normal range: 13-35U/L),group II(35U/L < ALT < 100U/L),and group III(AST ≥ 100U/L).To investigate whether there are differences in the incidence of adverse perinatal outcomes among TBA,ALT,and AST subgroups during ICP.ResultsAccording to the data analysis of the above case data,the following results are obtained:Altitude and ICP prevalence:(1)There was a significant difference in the prevalence of ICP between the 8groups,and the difference was statistically significant(P < 0.001).(2)There is no linear relationship between the prevalence of ICP and the average altitude of each group,and linear correlation analysis is not available.B.The effects of TBA,ALT and AST on perinatal outcomes were analyzed(1)TBA concentration was divided into two groups: mild group(TBA ≥10umol / L < 40 umol / L)and severe group(TBA ≥ 40 umol / L): A.The incidence of premature infants,low birth weight infants and transferred to pediatric NICU in severe group was significantly higher than that in mild group,and there was a significant difference,with statistical significance(P < 0.001).The incidence of fetal distress,cesarean section,neonatal pneumonia and neonatal jaundice in the severe group were higher than those in the mild group,and the differences were statistically significant(P < 0.05).b.There was no significant difference in the incidence of meconium stained amniotic fluid,fetal malformation,stillbirth or stillbirth between mild TBA group and severe TBA group(P > 0.05).(2)The liver enzyme ALT concentration was divided into three groups: group A(ALT normal range: 7U / l-40 u / L),group B(40 < ALT < 100 u / L),group C(ALT≥ 100 u / L): A.The incidence of fetal distress,cesarean section and premature infants were not the same among the three groups,and there were significant differences,with statistical significance(P < 0.001).b.(1)there was a significant difference in the incidence of cesarean section between group C and group A(P <0.001).There was no significant difference in the incidence of cesarean section between group A and group B,and between group B and group C(P > 0.0166).(2)Group C had the highest incidence of fetal distress.There were significant differences in the incidence of fetal distress between group A and group C,and between group B and group C(P < 0.0166).There was no significant difference in the incidence of fetal distress between group A and group B(P > 0.0166)There was a significant difference in the incidence of premature infants between group C and group A(P < 0.001).There was no significant difference in the incidence of premature infants between group A and group B,and between group B and group C(P > 0.0166).c.There was no significant difference in the incidence of meconium stained amniotic fluid,low birth weight infants,fetal malformations,stillbirth or stillbirth,neonatal pneumonia,neonatal jaundice and transfer to pediatric NICU among the three groups(P > 0.05).(3)Group Ⅰ(normal range of AST: 13-35 u / L),group Ⅱ(35u / L < ALT <100u / L)and group Ⅲ(AST ≥ 100 u / L): A.The incidence of cesarean section was not the same among the three groups,and there was statistical significance(P <0.05).b.There was significant difference in the incidence of cesarean section between group Ⅲ and group Ⅰ(P < 0.0166).There was no significant difference in the incidence of cesarean section between group Ⅰ and group Ⅱ,and between groupⅡ and group Ⅲ(P > 0.0166).c.There was no significant difference in the incidence of fetal distress,premature infants,meconium stained amniotic fluid,low birth weight infants,fetal malformations,stillbirth or stillbirth,neonatal pneumonia,neonatal jaundice and transfer to pediatric NICU among the three groups(P > 0.05).Conclusion1.The prevalence of ICP in different altitude areas in the Tibet Autonomous Region is indeed not entirely the same.2.In this study,the prevalence of ICP in a single center in Tibet in the past 10 years from January 1,2013 to July 31,2022 was 4.05%,far higher than the global incidence rate of 0.8%-1.2%.3.There is no linear relationship between the prevalence of ICP in various regions of the Tibet Autonomous Region and their corresponding altitude.4.Among pregnant women with confirmed ICP,the incidence of adverse perinatal outcomes(premature infants,low birth weight infants,transfer to pediatric NICU,fetal distress,cesarean section,neonatal pneumonia,neonatal jaundice)in patients with severe TBA elevation is significantly higher than in patients with mild TBA elevation.5.Among pregnant women with confirmed ICP,the incidence of adverse perinatal outcomes(fetal distress,cesarean section,premature infants)in patients with liver enzyme ALT ≥ 100 U/L is significantly higher than in patients with normal ALT range(7-40 U/L).6.Among pregnant and lying-in women with confirmed ICP,the incidence of adverse perinatal outcomes(cesarean section)in patients with liver enzyme AST ≥100 U/L is significantly higher than in patients with normal AST range(13-35 U/L). |
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