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[1]汪晓曼,朱怡恬,赵仕成,等.联合检测血清总胆红素和直接胆红素等指标对妊娠期肝内胆汁淤积症孕妇的早期诊断和预后研究[J].医学研究与战创伤救治(原医学研究生学报),2020,22(5):492-496.[doi:10.3969/j.issn.1672-271X.2020.05.009]
　WANG Xiao-man,ZHU Yi-tian,ZHAO Shi-cheng,et al.Combined detection of serum total bilirubin and direct bilirubin for early diagnosis and prognosis of pregnant women with intrahepatic cholestasis of pregnancy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(5):492-496.[doi:10.3969/j.issn.1672-271X.2020.05.009]
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联合检测血清总胆红素和直接胆红素等指标对妊娠期肝内胆汁淤积症孕妇的早期诊断和预后研究()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第22卷
期数:
2020年5期
页码:
492-496
栏目:
临床研究
出版日期:
2020-09-09

文章信息/Info

Title:
Combined detection of serum total bilirubin and direct bilirubin for early diagnosis and prognosis of pregnant women with intrahepatic cholestasis of pregnancy
作者:
汪晓曼; 朱怡恬; 赵仕成; 孙燕群; 曾玉
作者单位：210001南京，南京医科大学附属妇产医院（南京市妇幼保健院）检验科（汪晓曼、朱怡恬、曾玉）；210003南京，南京市卫生信息中心（赵仕成）；210003南京，南京市疾病预防控制中心（孙燕群）
Author(s):
WANG Xiao-man1;  ZHU Yi-tian1;  ZHAO Shi-cheng2;  SUN Yan-qun3;  ZENG Yu1
(1.Clinical Laboratory of Obstetrics and Gynecology Department, Hospital Affiliated to Nanjing Medical University,Nanjing Maternal and Child Health Hospital, Nanjing 210001, Jiangsu, China; 2.Nanjing Health Information Center, Nanjing 210003, Jiangsu, China;3. Nanjing Municipal Center for Disease Control and Prevention, Nanjing210003, Jiangsu, China)
关键词:
妊娠期肝内胆汁淤积症; 血脂; 肝功能; 早期诊断; 预后
Keywords:
intrahepatic cholestasis of pregnancy;  blood lipids;  liver function;  early diagnosis; progsis
分类号:
R714.255
DOI:
10.3969/j.issn.1672-271X.2020.05.009
文献标志码:
A
摘要:
目的分析妊娠期肝内胆汁淤积症（ICP）患者血脂、肝功能的变化及其对妊娠结局的影响。方法回顾性分析2018年1月-2019年5月在南京市妇幼保健院就诊的出院诊断为ICP孕妇164例（ICP组）的临床资料，选取同期出院诊断为健康的孕妇145例作为对照组。2组孕妇在建卡时（孕24～28周）采用全自动生化分析仪检测血清中总胆汁酸（TBA），血脂即总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL），肝功能即丙氨酸氨基转氨酶（ALT）、门冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、直接胆红素（DBIL）的水平。依据TBA结果将ICP组分为轻度组84例（10≤TBA＜40 μmol/L）和重度组80例（TBA≥40 μmol/L），分析比较各组间检测指标及孕妇的妊娠结局。结果ICP组孕妇血清中TBA、TC、TG、LDL、ALT、AST、TBIL、DBIL的水平明显高于对照组，ICP组孕妇血清中HDL水平明显低于对照组，差异均有统计学意义（P<0.05）；ICP重度组孕妇血清中TBA（58.96±14.54）μmol/L、TC（6.80±1.50）μmol/L、TG（3.70±1.24）μmol/L、ALT（216.44±58.48）μmol/L、AST（165.43±40.63）μmol/L、TBIL（15.32±4.58）μmol/L、DBIL（9.36±3.74）μmol/L水平明显高于ICP轻度组TBA（26.72±6.60）μmol/L、TC（6.52±1.70）μmol/L、TG（3.30±1.00）μmol/L、ALT（173.03±54.58）μmol/L、AST（126.90±41.15）μmol/L、TBIL（9.66±3.82）μmol/L、DBIL（4.89±2.25）μmol/L，差异具有统计学意义（P<0.05）。ICP组妊娠结局剖宫产率（82.32%）和产后出血发生率（12.20%）较对照组（20.69%、4.83%）高，围生儿胎儿宫内窘迫（10.98%）、胎儿生长受限（9.15%）、早产的发生率（15.24%）明显高于对照组（3.45%、3.45%、5.52%），差异具有统计学意义（P<0.05）。孕期血清TBIL、DBIL对ICP诊断的最佳临界值分别为6.05 μmol/L、2.88 μmol/L，ROC曲线下面积分别为0.890（95%CI为0.852~0.929）、0.935（95%CI为0.907~0.963），诊断的敏感性分别为93.3%、90.9%，特异性为72.4%、82.1%。结论ICP孕妇发生肝损害及脂代谢的异常可能会增加不良妊娠结局的发生率，TBIL、DBIL的变化可对ICP的发生发展起到监测预警作用。通过检测血清中血脂和肝功酶学等指标尽早发现，尽早诊断，尽早治疗可以降低胆汁淤积综合征发病率，预防不良妊娠结局的发生。
Abstract:
ObjectiveTo determine the change of blood lipids and liver function in patients with intrahepatic cholestasis of pregnancy (ICP) and their association with pregnancy outcomes.MethodsThe pregnant women in Nanjing Maternal and Child Health Hospital from January 2018 to May 2019 were retrospectively analyzed. 164 pregnant women with intrahepatic cholestasis of pregnancy were recruited as ICP group and 145 healthy pregnant women were enrolled as control group. The biochemical indexes including total bile acid (TBA), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL) in serum were measured in two groups of pregnant women at the time of card establishment (24-28 weeks of gestation). The ICP patients were further divided into mild ICP group (10≤TBA＜40 μmol/L) and severe ICP group (TBA≥40 μmol/L) according to the level of TBA. All data were compared and analyzed for the relationship with pregnancy outcomes.ResultsCompared with control group, the levels of serum TBA, TC, TG, LDL, ALT, AST, TBIL, DBIL in ICP group were significantly higher (P＜0.05). The level of serum HDL was significantly lower than that of control group (P＜0.05). The levels of serum TBA（58.96±14.54）μmol/L, TC（6.80±1.50）μmol/L,TG（3.70±1.24）μmol/L, ALT（216.44±58.48）μmol/L, AST（165.43±40.63）μmol/L, TBIL（15.32±4.58）μmol/L, DBIL（9.36±3.74）μmol/L in severe ICP group were significantly higher than those of mild ICP group: TBA（26.72±6.60）μmol/L, TC（6.52±1.70）μmol/L, TG（3.30±1.00）μmol/L, ALT（173.03±54.58）μmol/L, AST（126.90±41.15）μmol/L, TBIL（9.66±3.82）μmol/L, DBIL（4.89±2.25）μmol/L (P＜0.05). The cesarean section rate (82.32%) and postpartum hemorrhage rate (12.20%) in ICP group were higher than those in control group (20.69%, 4.83%). The incidence of fetal distress (10.98%), fetal growth restriction (9.15%) and preterm delivery (15.24%) in the perinatal group were significantly higher than that in the control group (3.45%, 3.45%, 5.52%) (P<0.05). The ROC analysis showed that the area under the curve (AUC) of TB was 0.890 (95%CI: 0.852-0.929), the sensitivity, specificity in serum and optimal cut-off level were 93.3%, 72.4% and 6.05 μmol/L, respectively. In addition, the AUC of DB was 0.935 (95%CI: 0.907-0.963), the sensitivity, specificity in serum and optimal cut-off level were 90.9%, 82.1% and 2.88 μmol/L, respectively.ConclusionLiver damage and abnormal lipid metabolism in ICP patients may increase the incidence of adverse pregnancy outcomes. TB and DB can effectively monitor ICP and predict pregnancy outcomes. Therefore, timely examination, diagnosis and treatment can reduce the occurrence of ICP and prevent adverse pregnancy outcomes.

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更新日期/Last Update: 2020-09-09