HBV感染孕妇早期胆汁酸谱检测在妊娠期肝内胆汁淤积症诊断中的应用  

Early detection of bile acid profiles for diagnosing intrahepatic cholestasis in HBV-infected pregnant women

作　　者：许宏辉[1] 付旭峰 印永祥[3] 赵军[4] 贾笑天[2] 孙敏雅[1] 张岩[5] XU Hong-hui;FU Xu-feng;YIN Yong-xiang;ZHAO Jun;JIA Xiao-tian;SUN Min-ya;ZHANG Yan(Department of Obstetrics,Wuxi Maternal and Child Health Hospital,Jiangsu 214000,China;Department of Emergency,Wuxi Maternal and Child Health Hospital,Jiangsu 214000,China;Department of Pathology,Wuxi Maternal and Child Health Hospital,Jiangsu 214000,China;Department of Clinical Laboratory,Wuxi Maternal and Child Health Hospital,Jiangsu 214000,China;Department of Science and Education,Wuxi Maternal and Child Health Hospital,Jiangsu 214000,China)

机构地区：[1]无锡市妇幼保健院产科,江苏214000 [2]无锡市妇幼保健院急诊科,江苏214000 [3]无锡市妇幼保健院病理科,江苏214000 [4]无锡市妇幼保健院检验科,江苏214000 [5]无锡市妇幼保健院科教处,江苏214000

出　　处：《肝脏》2024年第3期327-331,369,共6页Chinese Hepatology

基　　金：无锡市科技局重大项目(N20201006)。

摘　　要：目的探讨HBV感染孕妇早期胆汁酸谱检测在妊娠期肝内胆汁淤积症(ICP)诊断中的应用价值。方法回顾性分析2020年1月—2022年12月无锡市妇幼保健院收治的186例HBV感染孕妇,根据ICP诊断标准将其分为单纯HBV组(124例)和HBV并发ICP组(62例),收集两组孕妇一般资料及妊娠早期围保肝生化指标和胆汁酸谱检测结果,采用单因素分析、多因素logistic回归分析HBV感染孕妇并发ICP的主要影响因素,ROC曲线分析预测诊断效能。结果与HBV组比,HBV并发ICP组AST[(46.60±38.98)U/L比(30.97±31.49)U/L,P=0.004]、ALT[(50.80±36.81)U/L比(40.32±29.45)U/L,P=0.037]、DBil[(6.07±2.34)μmol/L比(4.73±1.83)μmol/L,P<0.001]、TBA[(16.98±2.48)μmol/L比(6.01±2.34)μmol/L,P=0.010]明显升高,CA[(0.59±0.49)μmol/L比(0.40±0.34)μmol/L,P=0.007]、GCA[(2.41±1.04)μmol/L比(1.52±0.70)μmol/L,P<0.001]、GDCA[(0.92±0.35)μmol/L比(0.67±0.37)μmol/L,P<0.001]、GCDCA[(2.14±0.89)μmol/L比(1.67±0.56)μmol/L,P<0.001]也升高,且AST、DBil、GCA、GDCA、GCDCA为HBV并发ICP的主要危险因素(P<0.05);AST、DBil、GCA对HBV并发ICP诊断价值较高(分别AUC 0.747、0.725、0.761);GCDCA、GDCA的诊断价值一般(AUC 0.667、0.688)。结论胆汁酸谱GCA、GCDCA、GDCA亚型升高及AST、DBil升高均是HBV感染孕妇并发ICP发生的主要危险因素,且GCA的预测诊断价值最高,临床应结合肝功能指标综合诊断。Objective To evaluate the diagnostic value of early preggnancy bile acid profiling in detecting intrahepatic cholestasis of pregnancy(ICP)among pregnant women infected with the hepatitis B virus(HBV).Methods Between January 2020 and December 2022,a retrospective analysis was conducted on 186 pregnant women with HBV infection admitted to our hospital.Based on the diagnostic criteria for ICP,participants were categorized into two groups:those with HBV infection alone(124 cases)and those with HBV infection complicated by ICP group(62 cases).We collected and compared the general demographic information,peri-protective liver function indices,and early pregnancy bile acid profiles between the two groups.Through univariate and multivariate logistic regression analyses,we identified the primary factors influencing the occurrence of ICP in HBV-infected pregnant women.Additionally,the fiagnostic efficacy for ICP was evaluated using ROC curve analysis.Results In the comparative analysis between the HBV-alone group and the HBV plus ICP group,significant differences were observed in several biochemical parameters.AST levels were notably higher in the HBV plus ICP group[(46.60±38.98)U/L]compared to the HBV-alone group[(30.97±31.49)U/L,P=0.004].Similarly,ALT[(50.80±36.81)U/L vs(40.32±29.45)U/L,P=0.0037],DBil[(6.07±2.34)μmol/L vs(4.73±1.83)μmol/L,P<0.001],and TBA[(16.98±2.48)μmol/L vs(6.01±2.34)μmol/L,P=0.010]were significantly elevated in the HBV plus ICP group.Concentrations of cholic acid(CA),(glycocholic acid)GCA,glycodeoxrycholic acid(GDCA),glycochenodeoxycholic acid(GCDCA)also showed significant increases,with P-values of 0.007,<0.001,<0.001,and<0.001,respectively.Multivariate analysis identified AST,DBil,GCA,GDCA,and GCDCA as major risk factors for the development of ICP in HBV-infected pregnant women(P<0.05).Among these,AST,DBil and GCA demonstrated higher diagnostic values for HBV-complicated ICP with AUCs of 0.747,0.725 and 0.761,respectively.The diagnostic efficiency of GCDCA and GDCA was moderate,with AUC

关 键 词：乙型肝炎病毒 胆汁酸谱检测 胆汁酸 妊娠期肝内胆汁淤积症 诊断 

分 类 号：R714.255[医药卫生—妇产科学]