中性粒细胞-淋巴细胞比率和胆酸水平在妊娠期肝内胆汁淤积症中的诊断价值

The diagnostic value of neutrophil-to-lymphocyte ratio and serum bile acid in pregnant women with intrahepatic cholestasis of pregnancy

目的：通过计算中性粒细胞－淋巴细胞比率（NLR）及禁食后／餐后血清总胆汁酸（TBA）水平，探讨 NLR 的临床诊断价值和 NLR 与禁食后／餐后血清 TBA 水平之间的关系。方法本研究采用回顾性临床研究，研究周期为2010年8月至2015年5月，纳入研究的为确诊妊娠期肝内胆汁淤积症（ICP）患者127例，留取禁食后／餐后血清 TBA、NLR、天门冬氨酸氨基转移酶（AST）／丙氨酸氨基转移酶（ALT）血标本并立即送检。其中，符合轻度 ICP 诊断标准者79例（轻度组），符合重度 ICP 诊断标准者48例（重度组）。对照组采用同期125名正常妊娠无并发症处于第3周期的初产妇。结果孕妇年龄为18～42岁，其中轻症组平均（28．0±3．8）岁，孕周平均为（37．2±2．7）周，重症组平均（27．6±3．2）岁，孕周平均为（37．8±3．2）周。ICP 患者轻、重度组与对照组在年龄、孕周及 BMI 均差异无统计学意义（P ＞0．05），而 ALT、AST、白细胞计数、中性粒细胞计数、淋巴细胞计数、甘胆酸、NLR 以及住院天数和28 d 死亡率在各组之间均差异有统计学意义（P ＜0．05）。ROC 曲线分析表明，NLR 在诊断 ICP ROC 曲线下面积为0．912±0．02（95％ CI：0．879～0．946，P ＜0．01），NLR 在分辨轻重症ICP 患者 ROC 曲线下面积为0．787±0．03（95％ CI：0．728～0．846，P ＜0．01）。无论空腹还是餐后，TBA 水平在轻症组和重症组之间均差异有统计学意义（P ＜0．01）。相关性分析显示，在轻重症 ICP 组，NLR 与禁食后及餐后 TBA 水平之间均存在正相关（r ＝0．350，0．236，0．260，0．240，P ＜0．01）。结论NLR 可用于诊断 ICP 和对 ICP 的严重程度进行分级。

Objective To analyze the diagnostic value of neutrophil-to-lymphocyte ratio （NLR）and relation-ship between serum NLR and fasting and postprandial TBA concentration in pregnant women with intrahepatic cholesta-sis of pregnancy （ICP）.Methods 127 pregnant women were admitted with a history of intrahepatic cholestasis of preg-nancy between Aug 2010 and May 2015.Blood samples for estimation of fasting and postprandial TBA,NLR,and amin-otransferase （AST/ALT）levels were sent immediately to the laboratory.79 pregnant women were accorded with mild ICP and 48 with severe ICP,125 healthy pregnant women without complicated pregnancies in third trimester served as the control group during the same period.Results The age range was 18 -42years.The mean age was（28.0 ±3.8）and the mean gestational week was（37.2 ±2.7）in mild disease group.The mean age was（27.6 ±3.2）and the mean gesta-tional week was（37.8 ±3.2）in severe disease group.There was no statistically significant difference in mean age,gesta-tional week and BMI between the mild and severe ICP group and control groups （P〉0.05）.There was a statistically significant difference in fasting and postprandial TBA,CG,NLR,aminotransferase （AST/ALT）concentrations,length of stay and 28-day mortality rate between the mild and severe ICP group and control groups （P〈0.05）.The area under the curve （ROC）was（0.912 ±0.02）（95% CI 0.879-0.946,P〈0.01）for serurn NLR in diagnosing ICP and dif-ferentiating mild and severe cholestasis was（0.787 ±0.03）（95% CI 0.728-0.846,P〈0.01）.There was a statisti-cally significant difference in TBA between the fasting and postprandial group.The correlation between fasting NLR and fasting and postprandial TBA concentrations group were significant（r =0.350,0.236,0.260,0.240,P〈0.01）resepec-tively.Conclusions Serum NLR can be used as an diagnosis and classification tool for ICP.