血清载脂蛋白A1和胆碱酯酶在妊娠期肝内胆汁淤积症诊断及程度判定中的价值

The value of apolipoprotein A1 and cholinesterase in the diagnosis and severity of intrahepatic cholestasis of pregnancy

目的:探讨血清载脂蛋白A1(apolipoprotein A1,APOA1)、胆碱酯酶(cholinesterase,CHE)在妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)诊断及程度判定中的应用价值。方法:采用回顾性病例对照研究,选取100例ICP患者和100例正常妊娠女性为研究对象。分析比较两组血清APOA1、CHE水平,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析两者对ICP诊断和疾病程度判定的价值。结果:ICP组APOA1、CHE含量与正常对照组相比显著降低(P<0.05),其与总胆汁酸具有显著负相关性。APOA1与CHE诊断ICP疾病的ROC曲线下面积(area under the curve,AUC)分别为0.871、0.782,APOA1与CHE对ICP疾病程度判定的AUC分别为0.843、0.773。两种标志物联合诊断ICP的AUC为0.909,两种标志物联合检测对ICP疾病程度判定的AUC为0.891。结论:APOA1和CHE联合检测可以作为诊断ICP疾病和程度判定的新型标志物,提高ICP疾病的诊断率。

Objective:To explore the application value of apolipoprotein A1(APOA1)and cholinesterase(CHE)in the diagnosis and severity of intrahepatic cholestasis of pregnancy(ICP). Methods:This retrospective case-control study was conducted with 100 ICP patients and 100 normal pregnant women. Protein molecular markers APOA1 and CHE were compared between two groups.Results:APOA1 and CHE levels in the ICP group were significantly lower than those in the normal group(P<0.05),the levels of two markers were negatively associated with that of total bile acids. The area under the receiver operating characteristic(ROC)curves(AUC)of APOA1 and CHE in diagnosis of ICP were 0.871 and 0.782,respectively,the AUC of APOA1 and CHE in severity of ICP were 0.843 and 0.773,respectively. Multiple logistic regression analysis showed that a combination of the levels of the two markers optimized the AUC to 0.909 and 0.891 in diagnosing ICP or evaluating the severity of ICP. Conclusion:Combined detection of APOA1 and CHE markers can be used as novel noninvasive biomarkers to evaluate the diagnosis and severity of ICP. The findings of this study can improve the diagnosis rate of ICP disease.