血清生物标志物水平在妊娠期肝内胆汁淤积症诊断中的临床意义

目的 探讨生物标志物水平在妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)诊断中的临床意义.方法 测定86例ICP产妇(轻度和重度各43例)和86位正常孕妇的血清总胆汁酸(total bile acid,TBA)、雌三醇(estriol,E3)、肿瘤坏死因子-d(tumor necrosis factor-α,TNF-α)、高敏C-反应蛋白(high sensitive C-reactive protein,hs-CRP)和降钙素原(procalcitonin,PCT)水平,并进行对比性分析和围生期结局比较.对血清TBA与E3、TNF-α、hs-CRP和PCT水平进行Pearson相关性分析.结果 86例ICP产妇的血清TBA、E3、TNF-α、hs-CRP和PCT水平较之86位正常孕妇明显增高(P均＜0.01),并随ICP产妇的严重程度而增高.血清TBA水平与E3、TNF-α、hs-CRP、PCT水平呈正相关(r分别为0.846、0.530、0.863和0.781,P均＜0.05).在围生期结局比较中,86例ICP产妇较之正常孕妇早产、羊水胎粪污染、新生儿窒息和胎儿窘迫的发生率明显增高(P＜0.01).结论 血清E3、TNF-α、hs-CRP、PCT与TBA水平呈正相关,并与妊娠期肝内胆汁淤积症严重程度及不良妊娠结局有关,上述血清学标志可作为疾病诊断、严重程度判断的重要指标,并提示上述指标可能参与ICP的发生和发展.

Diagnostic Significance in Diagnosis of Biomarkers Levels for Intrahepatic Cholestasis Pregnancy

Objective To explore the clinical significance in diagnosis of serum biomarkers level for intrahepatic cholestasis of pregnancy (ICP).Methods The serum biomarkers (TBA,E3,TNF-α,hs-CRP and PCT) levels were determined in 86 patients with ICP and 86 normal pregnant women.The results were compared and perinatal analysis was conducted.The relationship analysis was done between TBA level and E3,TNF-α,hs-CRP and PCT by Pearson relationship analysis.Results The serum TBA,E3,TNF-α,hsCRP and PCT levels in 86 patients with ICP were significantly higher than those in 86 normal pregnancy (P ＜ 0.001,＜ 0.001,＜ 0.001,＜ 0.01 and ＜ 0.001,respectively).The differences increased further as severity of ICP got.The positive correlation existed between serum TBA and E3,TNF-α,hs-CRP and PCT levels (coefficient of correlation r were 0.846,0.530,0.863 and 0.781,P ＜ 0.01,＜ 0.01,＜ 0.05 and ＜0.01,respectively).In the perinatal period comparison,the rate (％) of premature delivery,meconium stained patients with ICP were significantly higher than those in 86 normal pregnant.Conclusion The serum TBA,E3,TNF-α,hs-CRP and PCT levels were positively correlated to the development of ICP.