妊娠合并肝内胆汁淤积症患者胎盘巨噬细胞数量及其亚群变化的临床意义  

Clinical significance of changes in the number and subpopulations of placental macrophages in patients with intrahepatic cholestasis of pregnancy

作　　者：代逃芳 吴晓容[1] 曾莉 DAI Tao-fang;WU Xiao-rong;ZENG Li(Department of Obstetrics and Gynecology,Rongxian People’s Hospital,Sichuan 643100,China;Department of Obstetrics and Gynecology the First People’s Hospital of Zigong City,Sichuan 643000,China)

机构地区：[1]荣县人民医院妇产科,四川643100 [2]自贡市第一人民医院妇产科,643000

出　　处：《肝脏》2025年第1期112-116,共5页Chinese Hepatology

基　　金：四川省科技厅科研计划项目(2022ZHY20015)。

摘　　要：目的分析妊娠合并肝内胆汁淤积症(ICP)患者胎盘巨噬细胞数量及其亚群变化的临床意义。方法选择2022年5月—2024年7月于我院住院治疗并分娩的ICP患者105例,分为轻型ICP组(n=51)和重型ICP组(n=54);同期选择住院正常妊娠健康产妇30名为对照组。比较3组胎盘总巨噬细胞数和M1、M2型巨噬细胞亚群数、IL-10、IL-4、IL-12、INF-γ、TNF-α、TBA、ALT、AST、TBil水平。结果重型ICP组总巨噬细胞、M1型亚群、M2型亚群为(3.04±0.87)%、(19.75±5.73)%、(81.84±10.98)%,轻型ICP组(2.07±0.54)%、(28.42±7.65)%、(72.11±9.86)%,对照组为(0.32±0.10)%、(46.55±12.44)%、(50.76±8.57)%,3组间比较差异有统计学意义(F=171.265、100.055、92.183,均P<0.05)。3组IL-10水平比较无显著差异(P>0.05)。重型ICP组IL-4、IL-12、INF-γ、TNF-α为(37.01±10.35)、(51.44±8.51)、(181.76±15.64)、(108.35±12.73)pg/mL,轻型ICP组(76.33±19.32)、(38.94±7.63)、(153.54±12.65)、(84.53±11.71)pg/mL,对照组为(128.17±22.54)、(23.95±6.42)、(136.22±11.73)、(62.34±10.08)pg/mL,3组间比较差异有统计学意义(F=273.158、122.976、117.775、152.725,均P<0.05)。重型ICP组TBA、AST、ALT、TBil为(83.54±11.35)μmol/L、(198.76±51.85)U/L、(347.95±103.74)U/L、(23.54±3.11)μmol/L,轻型ICP组(30.07±5.23)μmol/L、(50.21±11.38)U/L、(64.35±18.26)U/L、(11.72±2.89)μmol/L,对照组为(14.15±4.57)μmol/L、(28.93±8.76)U/L、(30.17±9.78)U/L、(7.29±1.32)μmol/L,3组间比较差异有统计学意义(F=892.232、349.851、320.673、420.008,均P<0.05)。总巨噬细胞、M2型亚群、IL-4、IL-12、INF-γ、TNF-α水平与ICP患者肝功能均呈正相关(P<0.05);M1型亚群、IL-4水平与ICP患者肝功能均呈负相关(P<0.05);IL-10水平与ICP患者肝功能无显著相关性(P>0.05)。结论ICP患者胎盘巨噬细胞数量及其亚群分化存在异常,M1/M2型巨噬细胞亚群失衡可能会造成母胎界面免疫微环境损伤,引起发病和病情进展。Objective To analyze the clinical significance of changes in the number and subpopulations of placental macrophages in patients with intrahepatic cholestasis of pregnancy(ICP).Methods 105 ICP patients who were hospitalized and delivered in our hospital from May 2022 to July 2024 were selected and divided into a mild ICP group(n=51)and a severe ICP group(n=54);during the same period,30 hospitalized healthy pregnant women were selected as the control group.Compare the total number of placental macrophages and subgroups of M1 and M2 macrophages,as well as the levels of IL-10,IL-4,IL-12,INF-γ,TNF-α,TBA,ALT,AST,and TBil in three groups.Results The total macrophages,M1 subtype,and M2 subtype in the severe ICP group were(3.04±0.87)%,(19.75±5.73)%,and(81.84±10.98)%,while in the mild ICP group they were(2.07±0.54)%,(28.42±7.65)%,and(72.11±9.86)%.The control group had(0.32±0.10)%,(46.55±12.44)%,and(50.76±8.57)%,respectively.There were statistically significant differences among the three groups(F=171.265,100.055,92.183,all P<0.05)There was no significant difference in IL-10 levels among the three groups(P>0.05);The levels of IL-4,IL-12,INF-γ,and TNF-αin the severe ICP group were(37.01±10.35)pg/mL,(51.44±8.51)pg/mL,(181.76±15.64)pg/mL,and(108.35±12.73)pg/mL,while those in the mild ICP group were(76.33±19.32)pg/mL,(38.94±7.63)pg/mL,(153.54±12.65)pg/mL,and(84.53±11.71)pg/mL.The control group had levels of(128.17±22.54)pg/mL,(23.95±6.42)pg/mL,(136.22±11.73)pg/mL,and(62.34±10.08)pg/mL.The differences were statistically significant(F=273.158,122.976,117.775,152.725,all P<0.05).The TBA,AST,ALT,and TBil levels in the heavy ICP group were(83.54±11.35)μmol/L,(198.76±51.85)U/L,(347.95±103.74)U/L,and(23.54±3.11)μmol/L,while those in the light ICP group were(30.07±5.23)μmol/L,(50.21±11.38)U/L,(64.35±18.26)U/L,and(11.72±2.89)μmol/L.The control group had(14.15±4.57)μmol/L,(28.93±8.76)U/L,(30.17±9.78)U/L,and(7.29±1.32)μmol/L.The differences between the three groups were statistically significant(

关 键 词：妊娠合并肝内胆汁淤积症 胎盘 M1型巨噬细胞 M2型巨噬细胞 白细胞介素 肿瘤坏死因子-α 肝功能 

分 类 号：R714.255[医药卫生—妇产科学]