妊娠期肝内胆汁淤积症患者血清ATX、Melatonin与炎症标志物和妊娠结局的关系  

Relationship between Serum ATX,Melatonin and Inflammatory Markers and Pregnancy Outcome in Patients with Intrahepatic Cholestasis of Pregnancy

作　　者：夏美艳[1] 黄亚雄[1] 曹文雅 李侠 张敏[1] 张强[1] XIA Mei-yan;HUANG Ya-xiong;CAO Wen-ya;LI Xia;ZHANG Min;ZHANG Qiang(Department of Gynaecology and Obstetrics,Chinese Medicine Dongfeng General Hospital Affiliated to Hubei Medical College,Shiyan,Hubei,442000,China)

机构地区：[1]湖北医药学院附属国药东风总医院妇产科,湖北十堰442000

出　　处：《现代生物医学进展》2024年第16期3186-3190,3200,共6页Progress in Modern Biomedicine

基　　金：湖北省卫生健康委科研项目(21Y90)。

摘　　要：目的:探讨妊娠期肝内胆汁淤积症(ICP)患者血清自分泌运动因子(ATX)、褪黑素(MT)与炎症标志物和妊娠结局的关系。方法:选取2021年1月至2023年1月湖北医药学院附属国药东风总医院收治的ICP患者120例作为ICP组。根据病情严重程度将ICP患者分为轻度组(78例)和重度组(42例),根据ICP患者妊娠结局分为结局良好组(79例)和结局不良组(41例),另选取同期健康产检孕妇120例作为对照组。检测并比较各组血清中ATX、MT及炎症标志物[白细胞(WBC)、中性粒细胞/淋巴细胞(NLR)、血小板/淋巴细胞(PLR)]的差异。应用Pearson分析SATX、MT与ICP患者血清炎症标志物的相关性,应用多因素Logistic回归分析ICP患者妊娠结局不良的独立危险因素,应用受试者工作特征(ROC)曲线分析血清ATX、MT对ICP患者妊娠结局不良的预测价值。结果:与对照组相比,ICP组血清ATX、WBC、NLR显著升高,MT、PLR显著降低(P<0.05)。与轻度组比较,重度组血清ATX、WBC、NLR显著升高,MT、PLR显著降低(P<0.05)。ICP组患者血清ATX与WBC、NLR均呈显著正相关,与PLR呈负相关(P<0.05);MT与WBC、NLR均呈显著负相关,与PLR呈显著正相关(P<0.05)。与结局良好组相比,结局不良组患者血清ATX、NLR升高,血清MT、PLR显著降低(P<0.05)。多因素Logistic回归分析显示,ATX、总胆汁酸水平升高,MT水平下降,重度ICP是ICP患者妊娠结局不良的危险因素(P<0.05)。ROC曲线分析显示,ATX、MT联合ICP分级预测ICP患者妊娠结局不良的曲线下面积(AUC)为0.808,高于单一指标预测。结论:ICP患者血清ATX水平升高,MT水平下降,是妊娠结局不良的危险因素,二者与炎症标志物显著相关。ATX、MT联合ICP分级对ICP患者妊娠结局不良具有较高的预测价值。Objective:To investigate the relationship between serum autocrine motility factor(ATX),melatonin(MT)and inflammatory markers and pregnancy outcome in patients with intrahepatic cholestasis of pregnancy(ICP).Methods:120 ICP patients admitted to Chinese Medicine Dongfeng General Hospital Affiliated to Hubei Medical College from January 2021 to January 2023 were selected as ICP group.ICP patients were divided into mild group(78 cases)and severe group(42 cases)according to the severity of the patient's condition,and ICP patients were divided into good outcome group(79 cases)and poor outcome group(41 cases)according to the pregnancy outcome,another 120 healthy pregnant women were selected as control group.The differences of ATX,MT and inflammatory markers[white blood cells(WBC),neutrophils/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR)]in serum of each group were detected and compared.The correlation between SATX,MT and serum inflammatory markers in ICP patients was analyzed by Pearson,the independent risk factors for poor pregnancy outcomes in ICP patients were analyzed by multivariate Logistic regression,the predictive value of serum ATX and MT for poor pregnancy outcomes in ICP patients was analyzed by receiver operating characteristic(ROC)curve.Results:Compared with control group,serum ATX,WBC and NLR in ICP group were significantly increased,and MT and PLR were significantly decreased(P<0.05).Compared with mild group,serum ATX,WBC and NLR in severe group were significantly increased,while MT and PLR were significantly decreased(P<0.05).Serum ATX in ICP group was positively correlated with WBC and NLR,and negatively correlated with PLR(P<0.05).MT was negatively correlated with WBC and NLR,and positively correlated with PLR(P<0.05).Compared with good outcome group,the serum ATX and NLR in poor outcome group were increased,and the serum MT and PLR were significantly decreased(P<0.05).Multivariate Logistic regression analysis showed that,ATX and total bile acid levels increased,MT level decreased and severe ICP

关 键 词：妊娠期肝内胆汁淤积症 自分泌运动因子 褪黑素 炎症标志物 妊娠结局 

分 类 号：R714.25[医药卫生—妇产科学]