血清TPOAb和25-(OH)D3水平联合检测在妊娠期肝内胆汁淤积症中的临床价值

Clinical value of serum TPOAb and 25-(OH)D3 combined detection in patients with intrahepatic cholestasis during pregnancy

目的探讨血清甲状腺过氧化物酶抗体(TPOAb)联合25羟维生素D[25-(OH)D3]水平检测在妊娠期肝内胆汁淤积症(ICP)中的临床价值。方法选取我院妇产科2018年1月—2020年12月在海安市人民医院妇产科参加体检建档和住院分娩的90例ICP孕产妇列入观察组,选择同期在本院体检分娩的健康产妇60名列入对照组;采集空腹静脉血样,测定血清总胆汁酸(TBA)、甘胆酸(CG)、丙氨酸氨基转移酶(ALT)和碱性磷酸酶(ALP)等血生化指标水平,以及血清TPOAb和25-(OH)D3水平。根据TBA、TPOAb和25-(OH)D3水平,将观察组分成高、低亚组,比较观察组各亚组和对照组之间的血生化指标水平;采用Pearson相关性分析评估血清TPOAb和25-(OH)D3水平单独检测与联合检测的诊断效能。结果观察组的重症亚组血清TPOAb水平为(25.87±4.63)ng/L,高于轻症组的(16.38±3.71)ng/L和对照组的(9.75±2.36)ng/L,重症亚组血清25-(OH)D3水平为(22.37±4.09)μg/mL,低于轻症组的(29.85±4.63)μg/mL和对照组的(35.26±5.74)μg/mL,差异有统计学意义(F=17.482,13.287,均P<0.05)。高TPOAb亚组的血清TBA、CG、ALT和ALP分别为(48.65±8.34)μmol/L、(410.98±45.67)μmol/L、(92.23±11.75)U/L和(164.75±18.62)U/L,高于低TPOAb亚组的(22.78±5.03)μmol/L、(249.71±30.54)μmol/L、(67.38±8.34)U/L和(112.65±13.49)U/L,差异有统计学意义(t=14.361,11.578,10.954,9.803,均P<0.05);高25-(OH)D3亚组的血清TBA、CG、ALT和ALP分别为(422.78±5.03)μmol/L、(256.43±31.57)μmol/L、(69.25±8.06)U/L和(109.84±12.36)U/L,低于低25-(OH)D3亚组的(47.29±8.15)μmol/L、(412.59±46.82)μmol/L、(91.72±11.28)U/L和(165.37±19.03)U/L,差异有统计学意义(t=13.297,10.472,9.716,12.569,均P<0.05)。高TPOAb亚组孕妇的贫血、剖宫产、产后出血、胎儿宫内窘迫、早产和新生儿低体重等妊娠结局指标均显著高于低TPOAb亚组;高25-(OH)D3亚组孕妇的妊娠结局指标均显著低于低25-(OH)D3亚组(P<0.05)。Pearson相关性分析显示,血清TPOAb和25-(OH)D3水平联合检测的AUC显著高于单个指标检测(AUC=0.763、0.745、0.869,P<0.01)。结论血清TPOAb和25-(OH)D3水平联合检测对ICP患者的疾病诊断、病情监测和预后评估具有较高的临床应用价值。

Objective To investigate the clinical value of serum thyroid peroxidase antibody(TPOAb)combined with 25 hydroxyvitamin D[25-(OH)D3]in patients with intrahepatic cholestasis of pregnancy(ICP).Methods 90 ICP women who participated in physical examination filing and hospital delivery in the department of obstetrics and gynecology of our hospital from January 2018 to December 2020 were included in the observation group,and 60 healthy pregnant women who delivered in our hospital during the same period were included in the control group.Fasting venous blood samples were collected to determine serum levels of total bile acid(TBA),glycholic acid(CG),alanine aminotransferase(ALT)and alkaline phosphatase(ALP),as well as serum levels of TPOAb and 25-(OH)D3.The observation group was divided into severe and mild subgroups according to the levels of TBA,TPOAb and 25-(OH)D3,and the biochemical indexes between the observation group and the control group were compared.Pearson correlation was used to analyze the diagnostic efficacy of serum TPOAb and 25-(OH)D3 alone and in combination.Results The level of serum TPOAb in severe subgroup was(25.87±4.63)ng/L,which was higher than that in mild subgroup(16.38±3.71)ng/L and control group(9.75±2.36)ng/L.The level of serum 25-(OH)D3 in severe subgroup was(22.37±4.09)μg/mL,which was lower than that in mild group[(29.85±4.63)μg/mL]and control group[(35.26±5.74)μg/mL],the difference was statistically significant(F=17.482,13.287,P<0.05).TBA,CG,ALT and ALP in high TPOAb subgroup were(48.65±8.34)μmol/L,(410.98±45.67)μmol/L,(92.23±11.75)U/L and(164.75±18.62)U/L,higher than those of low TPOAb subgroup[(22.78±5.03)μmol/L,(249.71±30.54)μmol/L,(67.38±8.34)U/L and(112.65±13.49)U/L],the difference was statistically significant(t=14.361,11.578,10.954,9.803,all P<0.05).TBA,CG,ALT and ALP in high 25-(OH)D3 subgroup were(422.78±5.03)μmol/L,(256.43±31.57)μmol/L,(69.25±8.06)U/L and(109.84±12.36)U/L,lower than those in low 25-(OH)D3 subgroup[(47.29±8.15)μmol/L,(412.59±46.82)μmol/L,(91.72±11.28)U/L and(165.37±19.03)U/L].The differences were statistically significant(t=13.297,10.472,9.716,12.569,all P<0.05).The incidence of anemia,cesarean section,postpartum hemorrhage,fetal distress,premature delivery,low neonatal weight and other pregnancy outcomes in the high TPOAb subgroup were significantly higher than those in the low TPOAb subgroup.The incidence of pregnancy outcomes in high 25-(OH)D3 group were significantly lower than low 25-(OH)D3 group(P<0.05).After Pearson correlation analysis,the area under the curve(AUC)of serum TPOAb combined with 25-(OH)D3 level was significantly higher than that of single indicator(AUC=0.763,0.745,0.869,P<0.01).Conclusion The combined detection of serum TPOAb and 25-(OH)D3 has high clinical application value for disease diagnosis,disease monitoring and prognosis evaluation of ICP patients.