Eyisoy Ömer Gökhan, Demirci Oya, Taşdemir Ümit, Özdemir Mucize, Öcal Aydın, Kahramanoğlu Özge
Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Zeynep Kamil Women and Children Diseases Education and Research Hospital Istanbul, Istanbul, Turkey.
Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Haseki Training and Research Hospital, Istanbul, Turkey.
Fetal Diagn Ther. 2024;51(6):617-623. doi: 10.1159/000540261. Epub 2024 Jul 16.
The aim of this study was, first, to investigate the difference in fetal atrioventricular conduction in patients with and without intrahepatic cholestasis of pregnancy (ICP) by measuring the fetal PR interval; second, to evaluate the altering effect of ursodeoxycholic acid (UDCA) treatment on the fetal PR interval in ICP patients.
The study consisted of 42 ICP patients and 48 healthy pregnant women. Fetal echocardiography was performed to measure the mechanical PR interval. The fetal PR interval and the clinical characteristics were compared between the two groups. The effect of UDCA treatment on the fetal PR interval in ICP patients was evaluated.
In ICP patients, significantly longer fetal PR intervals were observed than in the control group (123.21 ± 8.54 vs. 115.13 ± 5.95 ms, p < 0.001). In the ICP group, there was a positive correlation between the fetal PR interval and maternal fasting total bile acid (TBA) levels (r = 0.514, p = 0.001). After 1 week of treatment with UDCA in patients with ICP, the PR interval was shorter than before, although the reduction was not statistically significant (120.98 ± 6.70 vs. 123.21 ± 8.54 ms, p = 0.095). In patients with severe ICP (TBA >40 mmol/L, n = 10), a significant reduction in the fetal PR interval was observed after treatment with UDCA (127.5 ms [IQR, 118.0-134.75] before vs. 122 ms [IQR, 109.5-126.5] after, p = 0.037).
Fetal PR interval increased in ICP patients in correlation with maternal serum TBA concentration. Treatment with UDCA may have limited positive effects on the fetal AV conduction system. The beneficial effects of UDCA on the fetal PR interval may be more pronounced in patients with higher bile acid levels.
本研究的目的，首先是通过测量胎儿PR间期，调查妊娠合并肝内胆汁淤积症（ICP）患者与未患该症患者胎儿房室传导的差异；其次，评估熊去氧胆酸（UDCA）治疗对ICP患者胎儿PR间期的改变作用。
该研究纳入了42例ICP患者和48例健康孕妇。进行胎儿超声心动图检查以测量机械性PR间期。比较两组的胎儿PR间期和临床特征。评估UDCA治疗对ICP患者胎儿PR间期的影响。
与对照组相比，ICP患者的胎儿PR间期明显更长（123.21±8.54 vs. 115.13±5.95毫秒，p<0.001）。在ICP组中，胎儿PR间期与母体空腹总胆汁酸（TBA）水平呈正相关（r=0.514，p=0.001）。ICP患者接受UDCA治疗1周后，PR间期虽比之前缩短，但差异无统计学意义（120.98±6.70 vs. 123.21±8.54毫秒，p=0.095）。在重度ICP患者（TBA>40 mmol/L，n=10）中，接受UDCA治疗后胎儿PR间期显著缩短（治疗前为127.5毫秒[四分位间距，118.0 - 134.75]，治疗后为122毫秒[四分位间距，109.5 - 126.5]，p=0.037）。
ICP患者胎儿PR间期增加，与母体血清TBA浓度相关。UDCA治疗对胎儿房室传导系统可能有有限的积极作用。UDCA对胎儿PR间期的有益作用在胆汁酸水平较高的患者中可能更明显。
