血清甘胆酸、总胆汁酸检测在妊娠期肝内胆汁淤积症中的临床诊断价值

目的探讨血清甘胆酸(CG)、总胆汁酸(TBA)检测在妊娠期肝内胆汁淤积症(ICP)中的应用及其临床价值。方法采用分层抽样方法选取2018年2月—2020年4月我院接诊的60例ICP患者和60例行常规孕检的健康孕妇,其中ICP患者设为观察组,健康孕妇设为对照组。采集两组血清,测定血清TBA、CG。比较不同组别、不同病情程度ICP患者血清TBA、CG水平,分析TBA、CG单项和联合诊断ICP价值。结果观察组血清TBA水平(33.01±11.05)μmol/L高于对照组(3.35±1.08)μmol/L,差异有统计学意义(t=20.693,P<0.001),观察组血清CG水平(13.48±3.47)mg/L高于对照组(1.62±0.44)mg/L,差异有统计学意义(t=26.264,P<0.001);重度ICP患者血清TBA水平(59.62±12.28)μmol/L高于轻度患者(14.01±4.96)μmol/L,差异有统计学意义(t=20.961,P<0.001);重度ICP患者血清CG水平(26.42±9.35)mg/L高于轻度患者(4.24±1.28)mg/L,差异有统计学意义(t=13.899,P<0.001);TBA、CG联合诊断ICP的AUC为0.956,高于TBA单一诊断的0.770和CG单一诊断的0.935,TBA、CG联合诊断灵敏度和特异度为98.54%、92.32%,均高于TBA单一诊断的76.88%、75.42%和CG单一诊断的87.72%、90.82%。结论TBA、CG是诊断ICP的有效指标,能够预测患者病情严重程度,联合检测能够提高诊断准确性,指导临床治疗。

Clinical diagnostic value of serum glycocholic acid and total bile acid detections in intrahepatic cholestasis of pregnancy

Objective To explore the application and clinical value of serum glycocholic acid (CG) and total bile acid (TBA) detections in intrahepatic cholestasis of pregnancy (ICP). Methods A stratified sampling method was used to select 60 ICP patients and 60 healthy pregnant women who underwent the routine pregnancy test in our hospital from February 2018 to April 2020. Among them, ICP patients were set as an observation group and the healthy pregnant women as a control group. Serum TBA and CG were measured. The levels of serum TBA and CG in ICP patients of different groups and different degrees of illness were compared, and the values of single and combined diagnosis of TBA and CG were analyzed in ICP. Results The serum TBA level in the observation group was (33.01±11.05) μmol/L, higher than that in the control group: (3.35±1.08) μmol/L and the difference was statistically significant (t=20.693, P<0.001). The serum CG level in the observation group was (13.48±3.47) mg/L, higher than that in the control group: (1.62±0.44) mg/L, (t=26.264, P<0.001). The serum TBA level in severe ICP patients was (59.62±12.28) μmol/L, higher than that in mild ICP patients: (14.01±4.96) μmol/l and the difference was statistically significant (t=20.961, P<0.001). The serum CG level in severe ICP patients was (26.42±9.35) mg/L, higher than that in mild ICP patients: (4.24±1.28) mg/L and the difference was statistically significant (t=13.899, P<0.001). The AUC of TBA and CG combined diagnosis of ICP was 0.956, which was higher than 0.770 of TBA single diagnosis and 0.935 of CG single diagnosis. The sensitivity and specificity of TBA and CG combined diagnosis were 98.54% and 92.32% respectively, which were higher than 76.88% and 75.42% of TBA single diagnosis, and 87.72% and 90.82% of CG single diagnosis. Conclusion TBA and CG are effective indicators for the diagnosis of ICP, which can predict the severity of patients‘ illness. The combined detection can improve the diagnostic accuracy and guide clinical treatment.