母体血清ADAM12-S与总胆汁酸联合检测妊娠期肝内胆汁淤积患者的诊断价值

Diagnostic value of maternal serum ADAM12-S combined with total bile acid levels in patients with intrahepatic cholestasis of pregnancy

目的探讨母体血清解整合素-金属蛋白酶12-S(ADAM12-S)、总胆汁酸(TBA)浓度检测对妊娠期肝内胆汁淤积(ICP)的诊断价值。方法选取2017年1月—2019年1月威海市立第三医院收治的194例ICP患者(观察组)和同期200例正常妊娠孕妇(对照组)。检测两组血清ADAM12-S、TBA、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST),观察组间差异,绘制ROC曲线分析ADAM12-S、TBA、ADAM12-S+TBA联合诊断ICP的价值。结果观察组患者血清ADAM12-S水平低于对照组(P<0.05),TBA、ALT、AST水平高于对照组(P<0.05);重度组患者血清ADAM12-S水平低于轻、中度组患者,血清ADAM12-S水平随着ICP病情程度的加重而降低(P<0.05);重度组患者TBA、ALT、AST水平高于轻、中度组患者,TBA、ALT、AST水平随着ICP病情程度的加重而升高(P<0.05)。ADAM12-S与TBA(r=-0.351,P<0.05)、ALT(r=-0.309,P<0.05)、AST(r=-0.419,P<0.05)均呈负相关。ROC分析结果显示ADAM12-S、TBA及ADAM12-S+TBA联合诊断ICP的曲线下面积(AUC)为0.761、0.830及0.879。结论ICP患者血清ADAM12-S水平降低,TBA水平升高,ADAM12-S和TBA水平与ICP病情密切相关,ADAM12-S+TBA联合检测对ICP具有较高诊断价值。

Objective To investigate the diagnostic value of maternal serum integrin-metalloproteinase 12-S(ADAM12-S)and total bile acid(TBA)levels in intrahepatic cholestasis(ICP)during pregnancy.Methods From January 2017 to January 2019,194 patients with ICP(observation group)and 200 normal pregnant women(control group)treated in our department of obstetrics and gynecology were selected.Detection of serum ADAM12-S,TBA,alanine aminotransferase(ALT),and aspartate aminotransferase(AST)in two groups,observation of differences between groups,and ROC analysis of the value of ADAM12-S and TBA combined with ADAM12-S+TBA in the diagnosis of ICP were performed.Results The serum levels of ADAM12-S in the observation group were lower than those in the control group(P<0.05),and TBA,ALT,and AST were higher than those in the control group(P<0.05).The level of serum ADAM12-S in the severe group was significantly higher than that in the mild-to-moderate group,and the difference was statistically significant(P<0.05).The serum ADAM12-S level decreased with the severity of ICP(P<0.05).The levels of TBA,ALT,and AST of patients in the severe group were significantly higher than those in the mild to moderate group,and the difference was statistically significant(P<0.05).TBA,ALT,and AST increased with the severity of ICP(P<0.05).ADAM12-S level is negatively correlated with TBA level(r=-0.351,P<0.05),ALT level(r=-0.309,P<0.05),AST level(r=-0.419,P<0.05)。ROC analysis results showed that the area under the curve(AUC)of ADAM12-S,TBA,combined ADAM12-S+TBA diagnostic ICP was 0.761,0.830,0.879.Conclusion Serum ADAM12-S levels decrease and TBA levels increase in patients with ICP.ADAM12-S and TBA levels are closely related to ICP disease and have high value for ICP diagnosis.