血清总胆汁酸联合胎儿大脑中动脉血流监测对ICP患者围产儿预后的预测价值

Predictive value of serum total bile acid combined with fetal middle cerebral artery blood flow monitoring for perinatal prognosis of patients with intrahepatic cholestasis

目的探讨血清总胆汁酸(TBA)联合胎儿大脑中动脉(MCA)血流监测在妊娠期肝内胆汁淤积症(ICP)患者围产儿预后中的预测价值,为临床诊疗提供指导。方法选择2017年2月至2019年8月在东莞市第八人民医院产检和分娩的130例ICP患者为研究对象。检测患者血清TBA水平,以TBA>10μmol/L为TBA水平异常,将血清TBA水平正常的47例患者纳入对照组,将血清TBA水平异常的83例患者纳入研究组;并根据两组患者的胎儿MCA血流指标结果,将对照组分为对照A组22例(正常)和对照B组25例(异常),研究组分为研究A组28例(正常)和研究B组55例(异常)。比较对照组和研究组患者收缩期峰值流速/舒张末期流速(S/D)、搏动指数(PI)、阻力指数(RI)等胎儿MCA血流指标;分析血清TBA联合胎儿MCA血流监测结果与围产儿预后不良的关系,并分析两者联合检测对ICP患者围产儿预后的预测价值。结果研究组患者的血清TBA水平为(30.65±7.33)μmol/L,明显高于对照组的(11.54±1.78)μmol/L,差异有统计学意义(P<0.05);研究组患者的胎儿S/D、PI、RI指标分别为3.14±0.31、1.03±0.14、0.32±0.05,明显低于对照组的3.51±0.30、1.32±0.13、0.54±0.05,差异均有统计学意义(P<0.05);研究B组患者的围产儿预后不良率为43.64%,明显高于研究A组的21.43%、对照A组的13.64%及对照B组的20.00%,差异均有统计学意义(P<0.05);TBA联合MCA检测的曲线下面积(AUC)为0.952,明显高于TBA的0.747、胎儿MCA的0.836,差异均有统计学意义(P<0.05);TBA联合MCA检测预测围产儿预后不良的灵敏度和特异度分别为94.85%、96.43%,明显高于TBA (77.91%、81.51%)和胎儿MCA (88.32%、83.17%),差异均有统计学意义(P<0.05)。结论血清TBA联合胎儿MCA血流监测在预测ICP患者围产儿预后中的价值较高,血清TBA水平异常且胎儿MCA血流指标异常患者的围产儿不良预后率最高,两者联合检测可以有效提高预测的灵敏度和特异度,有利于及时采取有效措施预防和减少围产儿不良结局。

Objective To investigate the predictive value of serum total bile acid(TBA)combined with fetal middle cerebral artery(MCA)blood flow monitoring in perinatal prognosis of patients with intrahepatic cholestasis(ICP)during pregnancy,and to provide guidance for clinical diagnosis and treatment.Methods A total of 130 ICP patients who underwent obstetric examination and childbirth in the Eighth People's Hospital of Dongguan from February 2017 to August 2019 were selected as the research subjects.According to the TBA levels(TBA>12μmol/L was regarded as abnormal),47 patients with normal serum TBA levels were divided into the control group,and 83 patients with abnormal serum TBA levels were divided into the study group.According to the fetal MCA blood flow index results,the control group was divided into the control group A(normal,22 cases)and the control group B(abnormal,25 cases),and the study group were divided into the study group A(normal,28 cases)and the study group B(abnormal,55 cases).Fetal MCA blood flow indicators such as systolic peak flow rate/end-diastolic flow rate(S/D),pulse index(PI),resistance index(RI)were compared between the control group and the study group.The relationship between serum TBA combined with fetal MCA blood flow monitoring results and poor perinatal prognosis was analyzed,and the predictive value of the combined detection on perinatal prognosis of ICP patients was analyzed.Results The serum TBA level in the study group was(30.65±7.33)μmol/L,which was significantly higher than(11.54±1.78)μmol/L in the control group(P<0.05).The fetal S/D,PI,and RI indexes in the study group were 3.14±0.31,1.03±0.14,and 0.32±0.05,which were significantly lower than 3.51±0.30,1.32±0.13,and 0.54±0.05 in the control group(P<0.05).The perinatal prognosis rate of patients in study group B was 43.64%,which was significantly higher than 21.43%of study group A,20.00%of the control group A and 13.64%of the control group B(P<0.05).The area under the curve(AUC)of the combined detection was 0.952,which was significantly higher than that of TBA and fetal MCA blood flow indicators alone(0.747,0.836),with statistically significant differences(P<0.05).The sensitivity and specificity of the combined detection to predict the poor prognosis of perinatal infants were 94.85%and 96.43%,which were significantly higher than 77.91%and 81.51%detected by TBA and 88.32%and 83.17%by fetal MCA blood flow indicators alone(P<0.05).Conclusion Serum TBA combined with fetal MCA blood flow monitoring is of high value in predicting perinatal prognosis of ICP patients,and patients with abnormal serum TBA levels and abnormal fetal MCA blood flow indicators have the highest perinatal adverse prognosis rate.The combined detection of the two can effectively improve the sensitivity and specificity of the prediction,which is conducive to timely taking effective measures to prevent and reduce the adverse outcome of perinatal and promote its prognosis.