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  

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

作　　者：田丽莉[1] 刘婕 万曼 谢韵 吴碧芳 苏瑞章 田钊旭 黄秀敏[1] 胡益群[2] Tian Lili;Liu Jie;Wan Man;Xie Yun;Wu Bifang;Su Ruizhang;Tian Zhaoxu;Haung Xiumin;Hu Yiqun(Department of Obstetrics and Gynecology,Zhongshan Hospital,Affiliated to Xiamen University,Xiamen 361004,Fujian Province,China;Department of Gastroenterology,Zhongshan Hospital,Affiliated to Xiamen University,Xiamen 361004,Fujian Province,China;Department of Gastroenterology,Longgang District People′s Hospital,Shenzhen 518172,Guangdong Province,China)

机构地区：[1]厦门大学附属中山医院妇产科,361004 [2]厦门大学附属中山医院消化内科,361004 [3]深圳市龙岗区人民医院消化内科,518172

出　　处：《中华妇幼临床医学杂志（电子版）》2021年第1期37-45,共9页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：福建省医学创新项目(2019-CXB-31)。

摘　　要：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亚组(n=101)。选择同期在本院就诊的80例健康孕妇纳入对照组。按照86例初产妇的分娩孕龄,进一步分为ICP早产亚组(n=37)和ICP足月亚组(n=49)。采集受试者一般临床资料(年龄、孕龄等),天冬氨酸氨基转氨酶(AST)、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、白细胞计数、中性粒细胞计数、淋巴细胞计数、血小板计数、红细胞分布宽度(RDW)、血红蛋白(Hb)、平均血小板体积(MPV)、血细胞比容(HCT)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)和血清总胆汁酸(sTBA)等。本研究经过厦门大学附属中山医院伦理委员会批准(审批文号:2019076),与所有患者签署临床研究知情同意书。结果①ICP组和对照组孕妇年龄、中性粒细胞计数、淋巴细胞计数、血小板计数、MPV、ALP、AST、NLR和sTBA比较,差异均有统计学意义(P<0.05)。2组孕妇孕龄、白细胞计数、HCT、Hb、GGT、ALT和PLR比较,差异无统计学意义(P>0.05)。②轻度ICP亚组患者的孕龄大于重度ICP亚组,而轻度ICP亚组患者sTBA浓度低于重度ICP亚组,2组比较,差异均有统计学意义(P<0.05)。此外,2组患者年龄、白细胞计数、中性粒细胞计数、淋巴细胞计数、MPV、HCT、血小板计数、Hb、GGT、ALP、ALT、AST、NLR和PLR比较,差异均无统计学意义(P>0.05)。③NLR、血小板计数和MPV诊断ICP的受试者工作特征曲线(ROC)分析结果:NLR、血小板计数和MPV诊断ICP的曲线下面积(AUC)分别为0.802(95%CI:0.737~0.867,P<0.001),0.642(95%CI:0.560~0.724,P<0.001)和0.947(95%CI:0.920~0.974,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 signifi

关 键 词：胆汁淤积 肝内 早产 足月分娩 总胆汁酸 ROC曲线 预测 孕妇 

分 类 号：R714.255[医药卫生—妇产科学]