传统炎性标志物对妊娠期肝内胆汁淤积症的诊断及预后预测价值

目的 探讨传统炎性标志物对妊娠期肝内胆汁淤积症(ICP)的诊断及预后预测价值.方法 选择2009年1月至2019年1月,于厦门大学附属中山医院消化内科和妇产科确诊的130例ICP患者为研究对象,并纳入ICP组,其中,初产妇为86例,经产妇为44例.根据ICP严重程度,进一步将其分为重度ICP亚组(n=29)和轻度ICP...

Diagnostic and prognostic value of blood routine inflammatory markers in intrahepatic cholestasis of pregnancy

Objective To investigate the diagnostic and prognostic value of blood routine inflammatory markers in intrahepatic cholestasis of pregnancy(ICP).Methods From January 2009 to January 2019,a total of 130 pregnant women with ICP diagnosed at the Department of Gastroenterology and Department of Obstetrics and Gynecology,Zhongshan Hospital,Affiliated to Xiamen University were selected into this study(ICP group),including 86 primiparae and 44 pluriparae.According to the severity of ICP,they were further divided into severe ICP subgroup(n=29)and mild ICP subgroup(n=101).Meanwhile,another 80 healthy pregnant women who visited the same hospital during same period were included into control group.In addition,those 86 primiparae were further divided into premature subgroup(n=37)and full-term subgroup(n=49).General clinical data(age,gestational age),aspartate transaminase(AST),alanine transaminase(ALT),alkaline phosphatase(ALP),γ-glutamyltranspeptidase(GGT),leukocyte count,neutrophil count,lymphocyte count,platelet count,red blood cell distribution width(RDW),hemoglobin(Hb),mean platelet volume(MPV),hematocrit(HCT),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and serum total bile acid(sTBA)were collected.This study followed the ethical standards formulated by the Ethics Committee of Zhongshan Hospital,Affiliated to Xiamen University,and was approved(Approval No.2019076).Informed concent was obtained from each participate.Results①There were significant differences between ICP group and control group in age,neutrophil count,lymphocyte count,platelet count,MPV,ALP,AST,NLR and sTBA(P<0.05).There were no significant differences between ICP group and control group in gestational age,white blood cell count,HCT,Hb,GGT,ALT and PLR(P>0.05).②The gestational age in mild ICP subgroup was higher than that in severe ICP subgroup,while the sTBA concentration in mild ICP subgroup was lower than that in severe ICP subgroup,and the differences were statistically significant(P<0.05).In addition,there were no significant differences in age,white blood cell count,neutrophil count,lymphocyte count,MPV,HCT,platelet count,Hb,GGT,ALP,ALT,AST,NLR and PLR between two groups(P>0.05).③Receiver operating characteristic curve(ROC)analysis showed that area under curve(AUC)of NLR,platelet count,MPV for diagnosing ICP were 0.802(95%CI:0.737-0.867,P<0.001),0.642(95%CI:0.560-0.724,P<0.001)and 0.947(95%CI:0.920-0.974,P<0.001).According to the principle of maximum Youden index,the optimal cut-off value for NLR,platelet count,MPV to diagnose ICP were 2.831,254×109/L and 9.662 fL,the sensitivity were 71.4%,64.7%and 72.2%,respectively,and the specificity were 81.3%,71.2%and 82.5%,respectively.④There were significant differences in ALT,AST and sTBA levels between preterm subgroup and full-term subgroup(P<0.05),but there were no significant differences in age,white blood cell count,neutrophil count,lymphocyte count,platelet count,MPV,PDW,NLR and PLR between two groups(P>0.05).⑤ROC analysis showed that AUC of sTBA,ALT and AST for predicting premature birth caused by ICP were 0.634(95%CI:0.513-0.751,P<0.05),0.672(95%CI:0.563-0.784,P<0.001)and 0.692(95%CI:0.544-0.793,P<0.001).According to the principle of maximum Youden index,the optimal cut-off value for sTBA,ALT and AST to predicting premature birth caused by ICP were 48μmol/L,56 U/L and 37 U/L,the sensitivity were 67.2%,62.2%and 63.2%,respectively;and the specificity were 59.6%,41.3%and 49.6%,respectively.Conclusions NLR,platelet count and MPV have good accuracy in diagnosis of ICP,but the blood routine inflammatory markers have no value in the evaluation of the severity of ICP,and ALT,AST and sTBA may have certain predictive value in predicting the preterm birth caused by ICP.