应用ROC曲线分析肝内胆汁淤积症孕妇血甘胆酸预测胎儿窘迫的最佳临界值

The best critical value of serum cholyglycine in intrahepatic cholestasis of pregnancy(ICP) and its clinical significance in predicting the fetal distress

目的探讨肝内胆汁淤积症孕妇血甘胆酸预测胎儿窘迫的最佳临界值。方法回顾性分析96例ICP孕妇血甘胆酸与胎儿窘迫发生与否的关系,应用ROC曲线寻找和确定用于预测胎儿窘迫的甘胆酸最佳临界值。结果妊娠肝内胆汁淤积症发生胎儿窘迫孕妇血清甘胆酸均值为28.65μg/ml,高于未发生胎儿窘迫血清甘胆酸水平17.78μg/ml,两组差异具有统计学意义(P<0.001)。依据敏感度与特异度之和最大化原则计算预测胎儿窘迫的甘胆酸临界值23.60μg/ml,ROC曲线下面积可达0.875,面积的95%可信区间为(0.794,0.956)。以23.60μg/ml界值预测胎儿窘迫吻合系数为0.592,敏感度81.00%,特异85.30%,阴性预测值0.941,阳性预测值0.607(P<0.001)。结论血清甘胆酸水平是预测妊娠期肝内胆汁淤积症孕妇是否发生胎儿窘迫的一项重要指标,随着甘胆酸水平的升高,胎儿窘迫的发生率逐渐增加,当血清甘胆酸≥23.60μg/ml时应加强胎儿宫内监护,及时终止妊娠,降低围生儿病率。

[ Objective ] To explore the best critical value of serum eholyglyeine predicting fetal distress in intra- hepatic cholestasis of pregnancy pregnant women. [ Methods ] The relationship between serum cholyglycine level and fetal distress in 96 ICP were retrospectively analyzed, and the critical value of serum cholyglycine was confirmed by the ROC （receiver operating characteristic） curve. [ Results ] The average level of serum eholyglyeine in the fetal distress group was 28.65 μg/m], which was much more higher than that of the control group whose average value was 17.78μg/ml, and the difference between the two groups was statistically significant（P 〈0.001）. The best critical value of serum cholyglyeine was 23.60 μg/ml, the area of cholyglycine under the ROC curve was up to 0.875, the sensi- tivity was 81.00%, the specificity was 85.30%, the positive predictive value was 0.607, the negative predictive value was 0.941, and the anastomosis coefficient was 0.592. [Conclusions] This study suggests that the serum cholyg- lycine level is an important indicator predicting fetal distress in ICP, implying that the incidence of fetal distress will gradually increase with the rise of serum cholyglycine level, and we are to strengthen fetal monitoring when the serum cholyglycine level exceeded 23.60 μg/ml, timely terminating pregnancy to reduce the incidence of perinatals.