Paternoster Delia M, Fabris Franco, Palù Giorgio, Santarossa Cinzia, Bracciante Roberto, Snijders Deborah, Floreani Annarosa
Department of Obstetrics, University of Padua, Italy.
Acta Obstet Gynecol Scand. 2002 Feb;81(2):99-103.
Aims of this study were to investigate whether hepatitis C virus infection influences the incidence and natural history of intrahepatic cholestasis of pregnancy (ICP) and whether ICP has different characteristics in hepatitis C virus (HCV) positive women from ICP in HCV negative women.
A prospective study for the prevalence of the HCV infection and for the incidence of ICP was carried out in the 5840 patients admitted to the Prenatal Department of Padua University, Italy, between January 1996 and January 1999. Testing was done for HCV by the enzyme linked immunosorbent assay (ELISA 3), recombinant immuno blot assay (RIBA 3) and polymerase chain reaction (PCR). The diagnosis of ICP was made on clinical grounds based on the occurence of pruritus with onset during pregnancy, persisting up to the time of delivery and disappearing after delivery, supported by demonstrating an elevation of both serum ALT and total serum bile acids. The Student's t-test, one way anova and chi-square tests were used for statistical analysis.
During the study period, 56 of 5840 patients developed ICP (0.96%). Of these, 12 were also HCV-RNA positive. The rate of ICP was observed more commonly in HCV-RNA positive women than in HCV-RNA negative women (20.33% or 12/59 versus 0.78% or 44/5767, P = 0.001
Occurrence of ICP during the third trimester should be an indication to investigate the HCV status of the patient. Although the diagnosis of ICP is not confirmed by specific tests, we confirmed a higher risk of HCV infection in this condition. Therefore, occurence of ICP during the third trimester should be an indication to investigate the HCV status of the patient. Broader studies are necessary to assess the impact of infection on the perinatal outcome of ICP.
本研究旨在调查丙型肝炎病毒感染是否会影响妊娠肝内胆汁淤积症（ICP）的发病率和自然病程，以及HCV阳性女性的ICP与HCV阴性女性的ICP是否具有不同特征。
1996年1月至1999年1月期间，对意大利帕多瓦大学产前科收治的5840例患者进行了HCV感染患病率和ICP发病率的前瞻性研究。通过酶联免疫吸附测定（ELISA 3）、重组免疫印迹测定（RIBA 3）和聚合酶链反应（PCR）检测HCV。ICP的诊断基于临床依据，即孕期出现瘙痒，持续至分娩时并在产后消失，同时伴有血清ALT和总血清胆汁酸升高。采用Student's t检验、单因素方差分析和卡方检验进行统计分析。
在研究期间，5840例患者中有56例发生了ICP（0.96%）。其中，12例HCV-RNA也呈阳性。HCV-RNA阳性女性的ICP发生率高于HCV-RNA阴性女性（20.33%或12/59 vs 0.78%或44/5767，P = 0.001）。
妊娠晚期出现ICP应提示对患者的HCV状况进行调查。虽然ICP的诊断尚无特异性检测方法证实，但我们证实了在此情况下HCV感染风险较高。因此，妊娠晚期出现ICP应提示对患者的HCV状况进行调查。需要进行更广泛的研究来评估感染对ICP围产期结局的影响。
