妊娠期肝内胆汁淤积症孕妇血清和脐静脉血中鸢尾素水平及与临床指标的相关性

Levels of irisin in serum and umbilical vein blood of pregnant women with intrahepatic cholestasis of pregnancy and the relationship with clinical indicators

目的分析妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)孕妇血清及脐带血中鸢尾素水平及与临床指标的相关性。方法选取2017年11月至2019年11月深圳市龙华区人民医院收治的84例ICP患者为研究对象。依据ICP严重程度将患者分为轻症组(50例)和重症组(34例),另选择同时期来本院进行孕期保健的60例正常孕妇为健康组。采集全部孕妇空腹上臂静脉血样本及产后3 min内脐静脉血样本,分别进行血清鸢尾素水平及各临床指标的检测。比较各组间年龄、妊娠周期、体重指数(body mass index,BMI)、血压、胎儿体质量、新生儿Apgar评分、脐动脉阻力指数(resistance index,RI)、脐动脉收缩期最大血流速度/舒张期末期血流速度(S/D)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、总胆固醇(total cholesterol,TC)、脂蛋白、载脂蛋白A-I、载脂蛋白B、载脂蛋白比值、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、碱性磷酸酶(alkaline phosphatase,ALP)、γ-谷氨酰转移酶(gamma glutamyltransferase,GGT)、总胆汁酸、直接胆红素(direct bilirubin,DBil)、总胆红素(total bilirubin,TBil)、胆碱酯酶、肌酐、尿素、胱抑素C、葡萄糖及同型半胱氨酸(homocysteine,Hcy)水平。采用Pearson相关性分析上述临床相关指标与ICP孕妇血清及脐静脉中鸢尾素水平间的相关性。采用多因素Logistic回归分析ICP孕妇胎儿出生体质量低的影响因素。结果轻症组胎儿体质量、HDL-C和TG水平均显著低于健康组,ALT、AST、GGT及总胆汁酸水平均显著高于健康组(P均<0.05)。重症组妊娠周期、胎儿体质量、HDL-C及Hcy水平均显著低于健康组和轻症组,TG、LDL-C、TC、ALT、AST、ALP、GGT、总胆汁酸、DBil、TBil及肌酐水平均显著高于健康组和轻症组(P均<0.05)。3组患者脐静脉血中鸢尾素水平均显著低于血清中鸢尾素水平[健康组:(596.03±160.57)ng/L vs(902.47±153.17)ng/L;轻症组:(650.95±162.78)ng/L vs(1031.02±136.87)ng/L;重症组:(860.28±96.88)ng/L vs(1096.24±152.68)ng/L],健康组和轻症组患者脐静脉血中鸢尾素水平均显著低于重症组(P均<0.05)。ICP孕妇各项临床相关指标与血清中鸢尾素水平均无相关性(P均>0.05);胎儿体质量与脐静脉血中鸢尾素水平呈负相关(r=-0.386,P=0.042),脐动脉S/D值、TG、LDL-C、TC、ALT、AST、GGT、总胆汁酸及DBil与脐静脉血中鸢尾素水平呈正相关(P均<0.05)。Logistic回归分析表明血清中鸢尾素水平(OR=1.874,95%CI:1.361~8.242,P<0.001)及脐静脉血中鸢尾素水平(OR=1.868,95%CI:1.359~8.084,P<0.001)为ICP孕妇胎儿出生体质量低的独立危险因素,孕周为保护因素(OR=0.121,95%CI:0.032~0.951,P=0.113)。结论鸢尾素水平与ICP具有一定的关联。脐静脉血中鸢尾素水平均显著低于血清中鸢尾素水平,轻症ICP患者脐静脉血中鸢尾素水平均显著低于重症患者。ICP孕妇胎儿出生体质量降低可能与鸢尾素在能量及脂肪代谢方面的作用有关。

Objective To analyze the levels of irisin in serum and umbilical vein blood of pregnant women with intrahepatic cholestasis of pregnancy(ICP)and the relationship with clinical indicators.Methods Total of 84 patients with ICP in Longhua District People’s Hospital from November 2017 to November 2019 were selected and divided into mild group(50 cases)and severe group(34 cases)according to the severity of ICP.Another 60 normal pregnant women who came to our hospital at the same time for health care during pregnancy were selected as healthy group.All pregnant women’s fasting upper arm venous blood samples and umbilical venous blood samples within 3 minutes after delivery were collected to detect the irisin level and biochemical indicators.Age,gestational cycle,body mass index(BMI),blood pressure,fetal weight,neonatal Apgar score,umbilical artery resistance index(RI),maximum systolic/end diastolic blood flow velocity of umbilical artery(S/D),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),total cholesterol(TC),lipoprotein,apolipoprotein A-I,apolipoprotein B,apolipoprotein ratio,alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyltransferase(GGT),total bile acid,direct bilirubin(DBil),total bilirubin(TBil),cholinesterase,creatinine,urea,cystatin C,glucose and homocysteine(Hcy)of patients in all groups were compared.Pearson correlation analysis was used to analyze the correlation between the above clinical relevant indicators and irisin levels in serum and umbilical veins in pregnant women with ICP.Multivariate Logistic regression was used to analyze the risk factors of low fetal birth mass of ICP patients.Results The fetal weight,HDL-C level and TG level of patients in mild group were significantly lower than those of healthy group,and the levels of ALT,AST,GGT and total bile acid were significantly higher than those of healthy group(all P<0.05).Gestational cycle,fetal weight,HDL-C and Hcy level of patients in severe group were significantly higher than those of healthy group and mild group,levels of TG,LDL-C,TC,ALT,AST,ALP,GGT,total bile acid,DBil,TBil and creatinine were significantly lower than those of healthy group and mild group(all P<0.05).The umbilical vein blood irisin level of patients in the three groups were significantly lower than those in serum[healthy group:(596.03±160.57)ng/L vs(902.47±153.17)ng/L;mild group:(650.95±162.78)ng/L vs(1031.02±136.87)ng/L;severe group:(860.28±96.88)ng/L vs(1096.24±152.68)ng/L],the umbilical vein blood irisin level of patients in healthy group and mild group were significantly lower than that of severe group(all P<0.05).There were no correlation between the clinical indicators and serum irisin level in pregnant women with ICP(all P>0.05).There was a negative correlation between fetal weight and irisin level in umbilical venous blood(r=-0.386,P=0.042).S/D value,TG,LDL-C,TC,ALT,AST,GGT,total bile acid and DBil were positively correlated with irisin level in umbilical venous blood(all P<0.05).Logistic regression analysis showed that the levels of irisin in serum(OR=1.874,95%CI:1.361~8.242,P<0.001)and umbilical vein blood(OR=1.868,95%CI:1.359~8.084,P<0.001)were independent risk factors for low birth weight,and gestational cycle was a protective factor(OR=0.121,95%CI:0.032~0.951,P=0.113).Conclusions Irisin level was somewhat associated with ICP.The umbilical vein blood irisin level was significantly lower than that in serum,the umbilical vein blood irisin level of patients with mild ICP was significantly lower than that of patients with severe ICP.In addition,the decrease of fetal birth weight of ICP patients may be related to the effect of irisin on energy and fat metabolism.