血清TSH、TPOAb水平变化与妊娠期肝内胆汁淤积疾病严重程度的关联性

Correlation between changes of serum levels of TSH and TPOAb and severity of intrahepatic cholestasis of pregnancy

目的探讨血清促甲状腺激素(thyroid stimulating hormone,TSH)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)水平变化与妊娠期肝内胆汁淤积(intrahepatic cholestasis of pregnancy,ICP)疾病严重程度的关联性.方法选取2014-07/2017-09温州医科大学附属第一医院永嘉分院(永嘉中医院)收治的77例ICP患者设为观察组,其中轻度39例,重度38例,另取同期健康体检孕妇63例设为对照组.采集受检者晨起空腹状态下肘静脉血3 mL,离心分离上层血清,以化学发光微粒子免疫分析法对血清TSH、TPOAb及雌二醇(E_2)水平进行检测,同时观察组77例患者给予熊去氧胆酸联合腺苷蛋氨酸治疗.对比观察组与对照组之间、观察组不同病情严重程度之间血清TSH、TPOAb及E_2水平,对比观察组治疗前后血清TSH、TPOAb水平,分析血清TSH、TPOAb水平与ICP病情严重程度相关性.结果观察组的血清TSH水平(3.89 ng/L±1.11 ng/L)、TPOAb水平(19.43 ng/L±5.37 ng/L)、E_2水平(281.43 pmol/L±57.21 pmol/L)均高于对照组(P<0.05);重度ICP患者血清TSH(4.57 ng/L±1.14 ng/L)、TPOAb(25.23 ng/L±11.45 ng/L)、E_2(303.42 pmol/L±63.48 pmol/L)高于轻度ICP(P<0.05);血清TSH、TPOAb水平与ICP病情严重程度呈明显正相关(r_1=0.351,r_2=0.515,P<0.05);治疗后观察组轻度ICP血清TSH(2.42 ng/L±0.85 ng/L)、TPOAb(10.39 ng/L±2.04 ng/L)、重度ICP血清TSH(2.71 ng/L±0.56 ng/L)、TPOAb水平(11.21 ng/L±3.57 ng/L)均较治疗前显著降低(P<0.05).结论 ICP患者血清T S H、TPOAb水平呈异常表达状态,且TSH、TPOAb水平与ICP病情严重程度呈明显正相关,随疾病转归其水平呈下降趋势,故血清TSH、TPOAb可辅助诊断ICP,其水平变化监测亦可指导临床判断ICP病情严重程度及预后转归情况.

AIM To analyze the correlation between the changes of serum levels of thyroid stimulating hormone （TSH） and thyroid peroxidase antibody （TPOAb） and the severity of intrahepatic cholestasis of pregnancy （ICP）.METHODS A total of 77 ICP patients admitted to Yongjia Branch Hospital of the First Affiliated Hospital of Wenzhou Medical University （Yongjia Hospital of Traditional Chinese Medicine） from July 2014 to September 2017 were included as an observation group, of which 39 cases were mild and 38 were severe. Another 63 cases of pregnant women who underwent healthy physical examination in the same period were included as a control group. Fasting elbow vein blood （3 mL） was collected from all subjects, and sera were separated by centrifugation to detect the levels of TSH, TPOAb, and estradiol （E2） by chemiluminescent immunoassay. Seventy-seven patients in the observation group were treated with ursodeoxycholic acid and adenosine methionine. The levels of serum TSH, TPOAb, and E2 were compared between the observation group and the control group, between patients with different degrees of severity of disease in the observation group, and between patients in the observation group before and after treatment. The correlation between the levels of serum TSH and TPOAb and the severity of ICP was then analyzed.RESULTS The levels of serum TSH （3.89 ng/L ± 1.11 ng/L）, TPOAb （19.43 ng/L ±5.37 ng/L）, and E2 （281.43 pmol/L ± 57.21 pmol/L） in the observation group were significantly higher than those in the control group （P 〈 0.05）. The levels of serum TSH （4.57 ng/L ± 1.14 ng/L）, TPOAb （25.23 ng/L ± 11.45 ng/L）, and E2 （303.42 pmol/L ± 63.48 pmol/L） in patients with severe ICP were higher than those in patients with mild ICP （P 〈 0.05）. The levels of serum TSH and TPOAb were positively correlated with the severity of ICP （rl = 0.351, r2 = 0.515, P 〈 0.05）. After treatment, the levels of serum TSH and TPOAb in both patients with mild ICP （serum TSH： 2.42 ng/L ± 0.85 ng/L; TPOAb： 10.39 ng/L ± 2.04 ng/L） and those with severe ICP （serum TSH： 2.71 ng/L ± 0.56 ng/L; TPOAb： 11.21 ng/L ± 3.57 ng/L） in the observation group were significantly lower than those before treatment （P 〈 0.05）.CONCLUSION The levels of serum TSH and TPOAb in ICP patients show abnormal expression, positively correlate with the severity of ICP, and exhibit a downward trend with the improvement of the disease.