血清甘胆酸在妊娠期肝内胆汁淤积症诊断中的应用评价

Clinical application of serum cholyglycine in intrahepatic cholestasis of pregnancy

目的探讨血清甘胆酸(CG)在妊娠期肝内胆汁淤积症(ICP)诊断中的应用。方法采用临床对照回顾性研究方法。选取我院2015年5月至2016年11月就诊的80例ICP患者(ICP孕妇组),以60例正常孕妇作为健康对照组。监测治疗后3 d内两组孕妇血清CG与总胆汁酸(TBA)、谷氨酰转移酶(GGT)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)等生物学指标变化,进行相关性及受试者工作特征曲线(ROC)分析,评价血清CG水平在ICP诊断和疗效中的临床应用价值。结果 ICP孕妇组CG、TBA、GGT、ALT、AST水平均明显高于健康对照组CG(mg/L):9.17(5.30~14.96)比0.66(0.37~1.15),TBA(mol/L):16.05(11.42~23.27)比3.00(2.10~4.85),GGT(U/L):75.00(50.20~187.40)比16.70(10.77~25.37),ALT(U/L):42.40(17.60~86.30)比15.20(10.17~22.55),AST(U/L):35.00(22.00~73.00)比19.50(17.00~24.00),均P<0.001。ICP组中CG和TBA水平呈显著正相关(r值=0.892,P<0.01),与GGT、ALT相关性较低(GGT:r值=0.396,P<0.05,ALT:r值=0.260,P<0.05),与AST无相关性(r值=0.892,P>0.05)。血清CG在ICP组中的ROC曲线下面积(AUC)、敏感性和特异性分别为(0.957、93.8%,98.3%)均高于TBA、GGT、ALT、AST(AUC分别为0.934、0.771、0.704、0.608,敏感性分别为91.2%、65.0%、67.5%、71.2%,特异性分别为95.0%、85.0%、85.0%、53.3%,均P<0.05)。动态监测结果显示,治疗后随病情好转1、2、3 d各指标明显降低,治疗后3 d CG、TBA均有统计学意义(均P<0.05)。结论血清CG是ICP患者早期诊断和鉴别诊断的理想生物学指标之一,也是疗效监测的敏感指标。

Objective To investigate the clinical application of cholyglycine （CG） in intrahepatic cholestasis of pregnancy （ICP）. Methods Clinical retrospective controlled research method was utilized. 80 ICP patients hospitalized from May 2015 to November 2016 were enrolled as the experimental group （ICP group）, and another 60 normal gravidas were enrolled as the control group. The changes of serum CG and some biological indicators including total bile acid （TBA）, alanine aminotransferase （ALT）, alanine aminotransferase （AST） of pregnant women in two groups were determined, the correlation and receiver operating characteristic curve （ROC） were analyzed and the clinical value of serum CG levels in diagnosis and efficiency of ICP was evaluated in three-day after treatment. Results Levels of CG, TBA, GGT, ALT, AST in ICP group were apparently higher than Levels of the control group [CG （mg/L） ： 9.17 （5.30-14.96） vs. 0.66 （0.37-1.15）, TBA （mmol/L） ： 16.05 （11.42-23.27） vs. 3.00 （2.10-4.85）, GGT （U/L）： 75.00 （50.20-187.40） vs. 16.70 （10.77- 25.37）, ALT （U/L） ： 42.40 （17.60-86.30） vs. 15.20 （10.17-22.55）, AST （U/L） ： 35.00 （22.00-73.00） vs. 19.50 （17.00-24.00）, all P 〈 0.001] . There were significant correlations between CG and TBA level （r = 0.892, P 〈 0.01）. There were low correlation with GGT and ALT （GGT ： r = 0.396, P 〈 0.05, ALT ： r = 0.260, P 〈 0.05）, there was no correlation with AST （r = 0.892, P 〉 0.05）. In ICP group, the area under ROC curve （AUC）, sensitivity and specificity of the serum CG were 0.957, 93.8% and 98.3% respectively, which were higher than another four indicators （TBA, GGT, ALT, AST） ： AUC were 0.934, 0.771, 0.704, 0.608, sensitivity were 91.2%, 65.0%, 67.5%, 71.2%, specificity were 95.0%, 85.0%, 85.0%, 53.3%, respectively, all P 〈 0.05）. The results of dynamic monitoring showed that the indexes were decreased significantly at 1, 2 and 3 days after treatment and DCG and TBA were statisticaUy significant at third day after treatment （all P 〈 0.05）. Conclusions Serum CG was not only one of the idealist biological indicators for early diagnosis and differential diagnosis of ICP patients but was also a sensitive index of curative effect monitoring.