IL-17和TNF-α在妊娠期肝内胆汁淤积症患者外周血中的表达及意义

Expression and significance of interleukin-17 and tumor necrosis factor-α in peripheral blood of patients with intrahepatic cholestasis of pregnancy

目的:探讨白细胞介素-17(IL-17)和肿瘤坏死因子-α(TNF-α)在妊娠期肝内胆汁淤积症(ICP)患者外周血中的表达及意义。方法:选取2014年1月-2017年1月我院妇产科收治的ICP患者60例作为观察组,根据病情严重程度分为ICP轻度组(血清总胆汁酸<40μmol/L)和ICP重度组(血清总胆汁酸≥40μmol/L)各30例,另取30例同期参加体检的健康孕妇作为对照组。抽取晨起空腹静脉血,比较3组血清IL-17、TNF-α、门冬氨酸转移酶(AST)和丙氨酸转移酶(ALT)水平,采用Pearson法分析炎症细胞因子与肝功能指标的相关性。随访至妊娠结束,比较ICP患者与正常孕妇妊娠结局的差异。结果:3组血清IL-17、TNF-α、AST和ALT水平差异有统计学意义(P均<0.05),由高到低依次为ICP重度组、ICP轻度组和对照组。经Pearson相关分析,IL-17、TNF-α分别与AST和ALT呈正相关(P均<0.05)。观察组新生儿出生体重低于对照组,剖宫产、宫内窘迫、新生儿窒息、羊水粪染和早产的比例均高于对照组(P均<0.05)。结论:ICP对孕妇妊娠结局影响较大,检测外周血IL-17和TNF-α水平对ICP的诊断及预后评估具有重要意义。

To explore the expression and significance of interleukin-17(IL-17)and tumor necrosis factor-α(TNF-α)in peripheral blood of patients with intrahepatic cholestasis of pregnancy(ICP).Methods:Sixty ICP patients admitted in the Obstetrics and Gynecology Department of our hospital from Jan 2014 to Jan 2017 were selected as the observation group,and divided into mild ICP group(serum total bile acid<40μmol/L)and severe ICP group(serum total bile acid≥40μmol/L)according to the severity of the disease(30 each).Another 30 healthy pregnant women contemporaneously participating in physical examination were recruited as control group.The venous blood was extracted in early morning,and the levels of serum IL-17,TNF-α,aspartate aminotransferase(AST)and alanine aminotransferase(ALT)were detected and compared among the 3 groups.Pearson analysis was performed to analyze the relativity of inflammatory cytokines and liver function.Follow-up was continued to the end of pregnancy,and the difference of pregnancy outcome was compared between the ICP and normal pregnant women.Results:The levels of serum IL-17,TNF-α,AST,and ALT in the 3 groups were statistically significant difference(P<0.05),sorting from high to low as severe ICP group,mild ICP group,and control group.Pearson analysis revealed that IL-17 and TNF-αwere positively correlated with AST and ALT(P<0.05).The neonate weight at birth was lower,and the proportions of cesarean section,Miyamauchi Sako,neonatal asphyxia,meconium stained amniotic fluid and premature delivery were all higher in the two observation groups than in control group(P<0.05).Conclusions:ICP may throw a great influence on pregnant women's pregnancy outcome.The detection of IL-17 and TNF-αin peripheral blood is of great significance for the diagnosis and evaluation of the prognosis of ICP.