血清γ-谷氨酰转移酶/胆碱酯酶比值对妊娠期肝内胆汁淤积症患者妊娠结局的预测价值  

Predictive Value of Serumγ-Glutamyl Transferase/Cholinesterase Ratio on Pregnancy Outcomes in Patients with Intrahepatic Cholestasis of Pregnancy

作　　者：周晓丽 刘光虹[1] 张丽丽[1] ZHOU Xiaoli;LIU Guanghong;ZHANG Lili(Department of Obstetrics and Gynecology,People’s Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州人民医院产科,河南郑州450000

出　　处：《河南医学研究》2025年第7期1291-1296,共6页Henan Medical Research

摘　　要：目的分析血清γ-谷氨酰转移酶/胆碱酯酶比值(GCR)预测妊娠期肝内胆汁淤积症(ICP)患者妊娠结局的应用价值。方法采用前瞻性队列研究的方法,纳入并分析2021年3月至2023年2月在郑州人民医院诊治的115例ICP患者,入院常规检查患者肝功能、雌激素水平,并根据检查结果计算GCR值。以终止妊娠或完成分娩为研究终点,根据是否发生不良妊娠结局(以胎儿结局记)将115例患者分为不良结局组和良好结局组。采用logistic回归,分析GCR对ICP患者妊娠结局的影响;绘制受试者工作特征(ROC)曲线和决策曲线,分析GCR对ICP患者妊娠结局的预测价值。结果本研究中115例患者GCR检查结果为9.95~35.02,总计发生不良妊娠结局32例,不良妊娠结局发生率为27.83%。根据GCR值四分位数由低到高将115例患者分为Q1~Q4组,Q4组ICP重度占比、不良结局占比高于Q1~Q3组,血清总胆汁酸(TBA)、雌二醇(E_(2))水平高于Q1~Q3组(P<0.05)。不良结局组重度ICP占比高于良好结局组,血清TBA、E_(2)、GCR值高于良好结局组(P<0.05)。采用logistic回归分析,ICP严重程度、血清TBA、E_(2)、GCR值可能是ICP患者妊娠结局的影响因素(P<0.05)。绘制ROC曲线,GCR值预测ICP患者妊娠结局的曲线下面积为0.810(95%CI:0.720~0.900,P<0.05),当GCR值达22.505时,能得到最高的约登指数0.488,预测ICP患者妊娠结局的敏感度为0.813,特异度为0.675。绘制决策曲线,ICP程度、TBA、GCR、E_(2)预测ICP患者妊娠结局均有良好收益率,且联合预测的收益率更高。结论ICP患者发生不良妊娠结局与GCR值升高有关,计算GCR值有助于预测ICP患者胎儿不良结局风险,且联合其他主要的指标能提高预测价值。Objective To analyze the application value of serumγ-glutamyl transferase/cholinesterase ratio(GCR)in predicting pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy(ICP).Methods A prospective cohort study was used to include and analyze 115 ICP patients who were treated at People’s Hospital of Zhengzhou from March 2021 to February 2023.Routine examinations were conducted on their liver function and estrogen levels upon admission,and GCR values were calculated based on the examination results.A total of 115 patients were divided into an adverse outcome group and a good outcome group based on the occurrence of adverse pregnancy outcomes(recorded as fetal outcomes),with termination of pregnancy or completion of delivery as the research endpoint.Logistic regression was used to analyze the impact of GCR on pregnancy outcomes in ICP patients.Receiver operating characteristic(ROC)curves and decision curves were drawn to analyze the predictive value of GCR on pregnancy outcomes in ICP patients.Results In this study,the GCR results of 115 patients ranged from 9.95 to 35.02,with a total of 32 cases experiencing adverse pregnancy outcomes.The incidence of adverse pregnancy outcomes was 27.83%.According to the quartile of GCR values,115 patients were divided into Q1 to Q4 groups,with a higher proportion of severe ICP and adverse outcomes in the Q4 group compared to the Q1 to Q3 group.The serum total bile acid(TBA)and estradiol(E_(2))levels were higher than those in the Q1 to Q3 group(P<0.05).The proportion of severe ICP in the adverse outcome group was higher than that in the good outcome group,and the serum TBA,E_(2),and GCR values were higher than those in the good outcome group(P<0.05).Logistic regression analysis was used,the severity of ICP,serum TBA,E_(2),and GCR values may be influencing factors for pregnancy outcomes in ICP patients(P<0.05).The ROC curve was drawn,and the area under the curve for predicting pregnancy outcomes in ICP patients with GCR values was 0.810(95%CI:0.720-0.900,P<0.05)

关 键 词：妊娠期肝内胆汁淤积症 Γ-谷氨酰转移酶 胆碱酯酶 妊娠结局 预测 

分 类 号：R714.2[医药卫生—妇产科学]