妊娠期肝内胆汁淤积症孕妇血清PDCD4，GLUT1 表达水平及其与妊娠结局的相关性研究

目的 检测妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）孕妇血清程序性细胞死亡因子4（programmed cell death factor 4，PDCD4）和葡萄糖转运蛋白1（glucose transporter 1，GLUT1）的表达水平，分析二者与孕妇妊娠结局的相关性。方法 收集巴中市巴州区妇幼保健院产科2018 年7 月～ 2020 年7 月收治的ICP 孕妇126 例作为研究组，其中轻度ICP 组46 例，重度ICP 组80 例，选择同期该院120 例健康产检孕妇作为对照组。采用实时荧光定量PCR（qRT-PCR）法测定ICP 孕妇血清PDCD4 和GLUT1 水平，多因素Logistic 回归分析影响ICP 孕妇妊娠结局的因素，Pearson 相关性分析ICP 孕妇血清PDCD4 和GLUT1 水平的相关性。结果 与对照组比较，研究组PDCD4（1.36±0.23 vs 1.02±0.21），GLUT1（1.40±0.22 vs 0.99±0.18）水平升高，差异具有统计学意义（t=15.935，12.090，均P=0.000）。重度ICP 组PDCD4（1.41±0.25），GLUT1（1.45±0.22）水平显著高于轻度ICP 组（1.27±0.20，1.31±0.21），差异具有统计学意义（t=3.246，3.496，均P ＜ 0.05）。研究组羊水胎粪污染（20.63%）、自发性早产（7.14%）、产后出血（8.73%）、宫内窘迫（11.90%）等不良妊娠结局的发生率均高于对照组（0.00%，0.83%，0.83%，1.67%），差异均具有统计学意义（χ2=1.049 ～ 29.159，均P ＜ 0.05）；妊娠结局良好组和妊娠结局不良组患者的发病程度（OR=1.109，95% CI =1.035 ～ 1.188）、 PDCD4（OR=1.428，95% CI =1.013 ～ 2.012）以及GLUT1（OR=1.453，95%CI =1.066 ～ 1.980）水平差异具有统计学意义（均P ＜ 0.05）；多因素Logistic 回归分析显示，发病程度、PDCD4，GLUT1 为ICP 孕妇妊娠结局不良的影响因素（Waldχ2==8.738，1.428，1.453；P=0.003，0.041，0.018）；Pearson 相关性分析显示，ICP 孕妇血清PDCD4 与GLUT1 水平呈正相关（r=0.460，P ＜ 0.05）。结论 PDCD4，GLUT1 在ICP 孕妇血清中表达均上调，二者呈正相关，是ICP 孕妇妊娠结局不良的影响因素。

Study on the Expression Level of Serum PDCD4 and GLUT1 in Pregnant Women with Intrahepatic Cholestasis During Pregnancy and Its Correlation with Pregnancy Outcome

Objective To measure the expression levels of serum programmed cell death 4 (PDCD4) and glucose transporter 1 (GLUT1) in pregnant women with intrahepatic cholestasis of pregnancy (ICP), and analyze the correlation between the two and the pregnancy outcome of pregnant women. Methods From July 2018 to July 2020, 126 pregnant women with ICP who were admitted to Department of Obstetrics and Gynecology，Bazhong City Bazhou District Maternal and Child Health Hospital were gathered as the study group, including 46 cases in mild ICP group and 80 cases in severe ICP group. A total of 120 healthy pregnant women in the hospital were regarded as the control group. Quantitative real-time PCR (qRT-PCR) was used to measure the serum PDCD4 and GLUT1 levels in pregnant women with ICP, multivariate logistic regression was performed to analyze the factors affecting pregnancy outcomes in pregnant women with ICP, and Pearson correlation was performed to analyze the correlation of serum PDCD4 and GLUT1 levels in pregnant women with ICP. Results The levels of PDCD4(1.36±0.23 vs 1.02±0.21) and GLUT1(1.40±0.22 vs 0.99±0.18) in the study group were obviously higher than those in the control group (t=15.935,12.090，all P=0.000).The levels of PDCD4(1.41±0.25)and GLUT1(1.45±0.22)in the severe ICP group were obviously higher than those in the mild ICP group（1.27±0.20，1.31±0.21）, the differences were statistically significant （t=3.246，3.496，all P ＜ 0.05）. The incidences of adverse pregnancy outcomes such as amniotic fluid meconium pollution(20.63%), spontaneous premature birth(7.14%), postpartum hemorrhage(8.73%), and intrauterine distress(11.90%) in the study group were higher than those in the control group（0.00%，0.83%，0.83%，1.67%）, and the differences were statistically significant（χ2=1.049 ～ 29.159，all P ＜ 0.05）, and there were significant differences in the incidence (OR=1.109, 95% CI =1.035 ～ 1.188), PDCD4 (OR=1.428, 95% CI =1.013 ～ 0.012) and GLUT1 (OR=1.453, 95% CI =1.066 ～ 1.980) levels between the two groups ( all P<0.05). Multivariate Logistic regression analysis showed that the severity of disease,PDCD4 and GLUT1 were the influencing factors of poor pregnancy outcomes in pregnant women with ICP (χ2=8.738,1.428,1.453, P=0.003,0.041,0.018). The results of Pearson correlation analysis showed that the serum PDCD4 and GLUT1 levels of pregnant women with ICP were positively correlated (r=0.460, P<0.05).Conclusion The expressions of PDCD4 and GLUT1 in the serum of pregnant women with ICP were both up-regulated, and the two were positively correlated. They are the influencing factors of poor pregnancy outcomes of pregnant women with ICP.